Reduction of Revascularizations in Patients with Hypertriglyceridemia With Icosapent Ethyl: Insights From REDUCE-IT REVASC
Presenter
Benjamin E Peterson, M.D., Brigham and Women's Hospital, Boston, MA
Benjamin E Peterson, M.D.1, Deepak L. Bhatt, M.D., M.P.H., MSCAI1, Philippe Gabriel Steg, M.D.2, Michael Miller, M.D.3, Eliot A. Brinton, M.D.4, Terry A Jacobson, M.D.5, Steven B Ketchum, Ph.D.6, Rebecca A Juliano, Ph.D.6, Lixia Jiao, Ph.D.6, Ralph T Doyle, B.A.7, Craig Granowitz, M.D., Ph.D.7, C. Michael Gibson, M.D., MSCAI8, Duane S. Pinto, M.D., M.P.H.9, Robert P. Giugliano, M.D.1, Matthew J. Budoff, M.D.10, Jean-Claude Tardif, M.D.11, Subodh Verma, M.D., Ph.D.12 and Christie Ballantyne13, (1)Brigham and Women's Hospital, Boston, MA, (2)Université Paris Cité, Paris, France, (3)University of Maryland School of Medicine, Baltimore, MD, (4)University of Utah School of Medicine, Salt Lake City, UT, (5)Emory University, Atlanta, GA, (6)-, Bedminster, NJ, (7)Amarin Pharma Inc., Bedminster, NJ, (8)Beth Israel Deaconess Medical Center, Natick, MA, (9)Beth Israel Deaconess Medical Center, Boston, MA, (10)Harbor–UCLA Medical Center, Los Angeles, CA, (11)Montreal Heart Institude, Montreal, QC, Canada, (12)St. Michael's Hospital, Toronto, ON, Canada, (13)Baylor College of Medicine, Houston, TX
Keywords: Coronary and Pharmacotherapy
Background:
Patients with elevated triglycerides despite statin therapy have increased risk for ischemic events, including coronary revascularizations.
Methods:
REDUCE-IT, a multicenter, double-blind, placebo-controlled trial, randomized statin-treated patients with elevated triglycerides (135-499 mg/dL), controlled LDL (41-100 mg/dL), and established cardiovascular disease or diabetes plus risk factors to icosapent ethyl 4g daily or placebo. The primary composite and other cardiovascular endpoints were substantially reduced. Prespecified analyses examined all coronary revascularizations, recurrent revascularizations, and revascularization subtypes.
Results:
8,179 randomized patients were followed 4.9 years (median). All first revascularizations were 9.2% (22.5/1000 person-years) with icosapent ethyl vs 13.3% (33.7/1000 person-years) with placebo (HR=0.66; 95% CI, 0.58-0.76; p<0.0001; NNT=25); similar reductions were observed in total (first and subsequent) revascularizations (negative binomial RR 0.64; 95% CI, 0.56-0.74; p<0.0001) and across urgent, emergent, and elective revascularizations. Icosapent ethyl significantly reduced PCI (HR=0.68; 95% CI, 0.59-0.79; p<0.0001) and CABG (HR=0.61; 95% CI, 0.45-0.81; p=0.0005) (Figure).
Conclusions:
For statin-treated patients with elevated triglycerides and increased cardiovascular risk, icosapent ethyl significantly reduced first and subsequent revascularizations compared with placebo. We are aware of no other non-LDL based therapy in the statin era that has been shown to reduce CABG in a blinded, randomized trial. 