Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia

Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, Doyle RT, Juliano RA, Jiao L, Granowitz C, REDUCE-IT Investigators · 2019 · New England Journal of Medicine

DOI: 10.1056/NEJMoa1812792View source ↗

“Among patients with elevated triglyceride levels despite the use of statins, the risk of major adverse cardiovascular events was significantly lower with icosapent ethyl than with placebo.”

Summary

The REDUCE-IT trial randomized 8,179 statin-treated adults with elevated triglycerides and either established cardiovascular disease or diabetes plus risk factors to receive 2 grams of icosapent ethyl twice daily (a purified prescription-grade EPA preparation, total daily dose 4 grams) or matching placebo. After a median follow-up of 4.9 years, the icosapent ethyl arm experienced a 25% relative reduction in the primary composite endpoint of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina) compared with placebo. Reductions were observed across multiple individual endpoint components, including cardiovascular death. The trial reignited debate over high-dose omega-3 cardiovascular prevention after several earlier mixed-result trials and stands as the largest, longest, and methodologically strongest RCT supporting a cardiovascular benefit from a specific EPA preparation.

Talking it through with practitioners

The free Skool community is where we discuss what new evidence means for actual cycles.

Join the free community →

Citation graph

How this entry connects to the rest of the library

References cited by this entry

ExtendsFish intake, contaminants, and human health: evaluating the risks and the benefitsMozaffarian D & Rimm EB · 2006
Mozaffarian & Rimm 2006 summarized the population-level fish-omega-3 cardiovascular literature; REDUCE-IT 2019 provides the cleanest randomized confirmation of EPA-driven cardiovascular benefit at pharmacologic dose.
ExtendsThe Omega-3 Index: a new risk factor for death from coronary heart disease?Harris WS & von Schacky C · 2004
Harris & von Schacky framed the membrane-incorporation rationale for cardiovascular benefit; REDUCE-IT operationalized this with a high-dose, EPA-pure intervention.

Entries that reference this one

PrecedesDietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trialGISSI-Prevenzione Investigators · 1999
GISSI was the first major omega-3 cardiovascular benefit signal in a large RCT; REDUCE-IT 2019 represents the modern, higher-dose, EPA-pure successor.