Optimizing Dyslipidemic Cardiovascular Residual Risk Reduction with Icosapent Ethyl in Post-MI Patients: Key Takeaways

Dr. Boden:
This is ReachMD, and my name is Dr. Bill Boden. I’m Professor of Medicine at Boston University School of Medicine, and we’re going to be discussing an important paper that recently was published in Journal of the American College of Cardiology in terms of optimizing dyslipidemic cardiovascular residual risk reduction in post-MI patients who received icosapent ethyl, plus statins versus statins alone. The REDUCE-IT trial is a landmark trial that looked at the coadministration of icosapent ethyl with statins in patients both with secondary prevention and primary prevention and showed that there was a significant reduction in the primary endpoint as well as in key secondary endpoints as well as recurrent endpoints.

The discussion in question today relates to a post hoc analysis of an important subset of almost 3,600 patients who had prior myocardial infarction as part of the REDUCE-IT study, and this comprised about 45% of the patients with established atherosclerotic coronary disease. And they were randomized, of course, to a combination of a statin plus icosapent ethyl, 2 grams twice daily, versus statin alone, and followed for close to 5 years – 4.9-year follow-up. What was observed in this important subset analysis is that in the patients who received icosapent ethyl plus a statin, there was an overall primary endpoint event rate of 20.2%, and in the statin-only treated patients, it was 26.1%. So, there was nearly a 6% absolute risk reduction among the patients who took the combination of icosapent ethyl plus a statin versus a statin alone. And this 6% absolute risk reduction computes also to a 26% relative risk reduction.

For the secondary endpoint of cardiovascular death, MI, or stroke, a much harder triple endpoint, the event rate in the icosapent ethyl group was 13.3% versus 18% in the statin-only group, an overall, 35% relative risk reduction, and there were similar important reductions in the incidence of myocardial infarction of 34% relative risk reduction, 30% reduction in cardiovascular death, as well as a 20% reduction in all-cause mortality. And all of these, I might add, were statistically significant. It shows the incremental benefit of administering icosapent ethyl plus a statin in patients who have elevated triglycerides, in this case between 150 and 400 mg/dL.

So, the critical takeaway messages from this trial is that treating residual risk in high-risk subsets poses an important challenge in terms of trying to optimize outcomes in patients with cardiovascular disease, and we know that patients who’ve had a prior myocardial infarction are at particular risk for having a recurrent event.

In addition, reducing residual risk in high-risk subgroups of patients with ASCVD is a critically important determinant in making sure that our patients have lower event rates subsequently. And historically, we have focused solely on LDL cholesterol, and I think the REDUCE-IT trial has brought into clear focus that treating hypertriglyceridemia is a critical variable in terms of reducing dyslipidemic risk and overall risk. So, from my perspective, the results of this post-MI analysis clearly indicate that the use of icosapent ethyl combined with a statin in patients who have both elevated LDL and elevated triglycerides affords significant improved cardio-protection in terms of reducing recurrent events and, again, specifically the endpoints of cardiovascular death, MI, and stroke.

So, in conclusion, this important subset analysis in post-MI patients from the REDUCE-IT trial shows the critical importance of treating elevated triglycerides aggressively, as well as low-density lipoprotein cholesterol, in terms of reducing residual risk, and I’m hopeful that people will understand that this is a very important determinant in terms of reducing residual risk for our cardiovascular patients.

For more information on the REDUCE-IT trial and the role of icosapent ethyl in ASCVD residual risk reduction, we invite the audience to go to the Related Resources section on the webpage of this activity. Thank you very much for your attention.

So, this is Dr. Bill Boden, and again, I want to thank you for listening today and hope you found the results of this important trial helpful to you.