Deepak L. Bhatt
A prespecified analysis of the REDUCE-IT trial highlighted a reduction in first and total revascularization events with icosapent ethyl in patients with elevated triglycerides at high CV risk despite statin therapy.
Treatment with icosapent ethyl (Vascepa, Amarin) 4 g per day, compared with matching placebo, significantly reduced first revascularization events by 34% (HR = 0.66; 95% CI, 0.58-0.76) and total revascularization events by 36% (RR = 0.64; 95% CI, 0.56-0.74) during a mean follow-up of 5.7 years, according to data from REDUCE-IT REVASC reported at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions.
“This reduction was consistent across urgent, emergent and elective revascularization categories, as well as for PCI and CABG individually,” Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital, professor of medicine at Harvard Medical School and Cardiology Today intervention section editor, said during a press conference.
The new data demonstrate:
- a 32% reduction in time to elective coronary revascularization with icosapent ethyl vs. placebo (HR = 0.68; 95% CI, 0.57-0.82);
- a 38% reduction in time to emergent coronary revascularization with icosapent ethyl vs placebo (HR = 0.62; 95% CI, 0.42-0.92); and
- a 34% reduction in time to urgent coronary revascularization with icosapent ethyl vs. placebo (HR = 0.66; 95% CI, 0.54-0.79).
There were 258 fewer cases of coronary revascularization overall in the icosapent ethyl group, according to Bhatt.
Need for PCI was reduced by 32% (HR = 0.68; 95% CI, 0.59-0.79) and need for CABG was reduced by 39% (HR = 0.61; 95% CI, 0.45-0.81) during follow-up among patients assigned icosapent ethyl compared with placebo.
“To the best of our knowledge, this is the first non-LDL cholesterol intervention in a major randomized trial in which statin-treated patients underwent fewer CABG surgeries,” Bhatt said during the press conference.
The multicenter, double-blind, placebo-controlled REDUCE-IT trial enrolled 8,179 patients (median age at baseline, 64 years; 71% men) who had fasting triglycerides of 135 mg/dL to 499 mg/dL and LDL levels ranging from 41 mg/dL to 100 mg/dL despite statin therapy and who had established CVD (70%) or diabetes plus other high-risk factors (30%). The primary results, published in The New England Journal of Medicine and first reported at the 2018 American Heart Association Scientific Sessions, demonstrated a 25% reduction in the primary endpoint of CV death, nonfatal MI, nonfatal stroke, coronary revascularization or unstable angina with icosapent ethyl vs. placebo (P = .00000001).
The new REDUCE-IT REVASC data were presented by Benjamin E. Peterson, MD, interventional cardiology fellow at Brigham and Women’s Hospital Heart and Vascular Center and Harvard Medical Center, during the virtual meeting.
“These data highlight the substantial impact of icosapent ethyl on the underlying atherothrombotic burden in the at-risk REDUCE-IT population,” Bhatt said during the press conference. – by Katie Kalvaitis
Peterson BE, et al. Featured Clinical Research. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).
Disclosures: Bhatt reports he has financial ties with numerous drug and device companies, including receiving research funding from Amarin. Peterson reports no relevant financial disclosures.