Physicians' Academy for Cardiovascular Education

Icosapent ethyl decreases CVD risk after MI

Prevention of Cardiovascular Events and Mortality With Icosapent Ethyl in Patients With Prior Myocardial Infarction

Literature - Gaba P, Bhatt, DL, Steg PG, et al. - J Am Coll Cardiol. 2022 May 3;79(17):1660-1671. doi: 10.1016/j.jacc.2022.02.035

Introduction and methods


Despite the variety of treatment options to lower LDL-c and triglyceride levels, it has proven difficult to fully eliminate CVD risk. However, this is of great importance in patients with prior MI, who have an increased risk of recurrent ischemic events [1]. Recently, icosapent ethyl (IPE) has emerged as an additive agent to further reduce CVD risk. This ethyl ester of eicosapentaenoic acid (an omega-3 fatty acid) reduces plaque volume and mitigates inflammation, among others [2-8].

Aim of the study

The authors assessed the effect of IPE on ischemic events in statin-treated patients with prior MI and hypertriglyceridemia.



This was a post-hoc analysis of REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl – Intervention Trial), a multinational, double-blind, phase 3b RCT in which 8179 statin-treated patients with established CVD or diabetes mellitus plus other risk factors were randomized to IPE (2 g twice daily) or placebo [9]. Patients had to have controlled LDL-c levels and moderately elevated triglyceride levels at baseline. Of the 8179 patients in REDUCE-IT, 3693 (45%) had a history of MI, of whom 1870 had received IPE and 1823 placebo. Their median follow-up time was 4.8 years (IQR: 3.2–5.3).


The primary endpoint was defined as a composite outcome of CV death, nonfatal MI, nonfatal stroke, coronary revascularization, and unstable angina requiring hospitalization. The key secondary endpoint was the composite of CV death, nonfatal MI, and nonfatal stroke. Additional prespecified, blindly adjudicated endpoints included some of the individual component of the primary endpoint, as well as sudden cardiac death and cardiac arrest.

Main results

Primary endpoint

Key secondary endpoint

Additional endpoints



In statin-treated patients with prior MI and hypertriglyceridemia, IPE treatment resulted in substantial relative and absolute risk reductions in ischemic events, including CV death. There were small increased risks of atrial fibrillation and minor bleeding.


Show references

Find this article online at J Am Coll Cardiol.

Share this page with your colleagues and friends: