REDUCE-IT trial results should alter the approach to managing a growing population of patients with hypertriglyceridemia whose lipid phenotype requires more intensive treatment beyond LDL-C lowering alone, according to a clinical review published in the European Heart Journal.

William E. Boden, MD, FACC, et al., describe the findings and clinical implications of the REDUCE-IT trial in which ethyl eicosapentaenoic acid significantly improved atherosclerotic cardiovascular disease (ASCVD) outcomes. They (William)also highlight the importance of elevated baseline triglycerides in the setting of well-controlled LDL-C on statins as a major contributor to residual ASCVD risk.

The authors explain that prior placebo-controlled trials using niacin, fibrates, omega-3 fatty acids and dietary supplement fish oil preparations have failed to demonstrate significant cardiovascular event reduction when added to statin therapy. However, REDUCE-IT convincingly demonstrated that the administration of high-dose prescription icosapent ethyl 4 g daily (2 g twice daily with meals) in 8,179 patients at high risk for ASCVD with increased baseline triglycerides but well-controlled LDL-C levels had a highly significant clinical benefit and reduced incident events across both the trial primary endpoint and multiple prespecified secondary endpoints, including cardiovascular death, as well as both subsequent and total primary endpoint and key secondary endpoint events.

In addition, REDUCE-IT trial results showed that icosapent ethyl clearly contributed to ASCVD event reduction over and above statin therapy.

The authors point out that both the updated 2019 Lipid Guidelines of the European Society of Cardiology and the U.S. National Lipid Association have explicitly referenced and endorsed icosapent ethyl as a Class IIa and Class IB dyslipidemic therapy, respectively, for patients with hypertriglyceridemia. "We believe these recommendations underscore that icosapent ethyl and the profoundly positive findings of REDUCE-IT herald a new era in dyslipidemia therapeutics, and one in which the previously unfulfilled promise of residual cardiovascular risk reduction in these high-risk patients can now be achieved," the authors conclude.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Diet

Keywords: Fibric Acids, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Niacin, Cholesterol, LDL, Eicosapentaenoic Acid, Hypertriglyceridemia, Dyslipidemias, Atherosclerosis, Dietary Supplements

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