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ACC.20/WCC virtual meeting: Benefit in REDUCE-IT linked to eicosapentaenoic acid levels

New insights from the Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial (REDUCE-IT) show that the benefit observed in the trial may be mediated by eicosapentaenoic acid (EPA) levels. REDUCE-IT stunned the clinical community in late 2018 when it reported that treatment with 4 g icosapent ethyl was associated with a 25% reduction in the primary endpoint, a composite of cardiovascular death, myocardial infarction (MI), stroke, coronary revascularization and unstable angina compared to placebo (p<0.00000001), as well as a 26% reduction in the key secondary ‘hard endpoint’ of cardiovascular death, MI and stroke. There was, however, much debate as to what drove this benefit, as the relative reduction in risk was similar in patients with baseline triglycerides ≥ or <150 mg/dL. Moreover, adjusting for triglycerides over time showed that reduction in triglyceride levels only accounted for a small fraction of the benefit. In this new analysis, the REDUCE-IT Investigators showed that higher on-treatment EPA levels were associated with a lower risk of the primary and key secondary endpoint (p<0.001), as well as a lower risk of outcomes of any MI, stroke, coronary revascularization or unstable angina.
EPA Levels and Cardiovascular Outcomes in the Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial.

Bhatt DL et al