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Author Notes:

Deepak L. Bhatt, MD, MPH, FAHA, Executive Director of Interventional Cardiovascular Programs.

Brigham and Women’s Hospital Heart & Vascular Center, Professor of Medicine, Harvard Medical School, 75 Francis St, Boston, MA 02115.

DLBhattMD@post.harvard.edu

The authors thank the Amarin team members who are not authors of this article but who contributed to the success of the trial and of these analyses, including K. Diffin, A. Granger, and G. Chester, for operational support; R. Bhavanthula, R. H. Iroudayassamy, Dr Jin, D. Klevak, Dr Liu, H. Panchal, J. Shi, Dr Wang, and S.-R. Wang, for data management and statistical support; and J. Bronson for editorial assistance (limited to formatting and collation of coauthor comments); and the investigators, the study coordinators, and especially the patients who participated in REDUCE-IT (The Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial).

See publication for full list of disclosures.

Subject:

Research Funding:

The main REDUCE-IT trial and this analysis have been funded by Amarin.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Peripheral Vascular Disease
  • Cardiovascular System & Cardiology
  • eicosapentaenoic acid
  • icosapent ethyl
  • myocardial revascularization
  • prevention & control
  • ATHEROSCLEROTIC CARDIOVASCULAR-DISEASE
  • HYPERCHOLESTEROLEMIC PATIENTS
  • CORONARY INTERVENTION
  • EICOSAPENTAENOIC ACID
  • FATTY-ACIDS
  • RISK
  • EVENTS
  • TRIGLYCERIDES
  • THERAPY
  • LIPOPROTEINS

Reduction in Revascularization With Icosapent Ethyl Insights From REDUCE-IT Revascularization Analyses

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Journal Title:

CIRCULATION

Volume:

Volume 143, Number 1

Publisher:

, Pages 33-44

Type of Work:

Article | Final Publisher PDF

Abstract:

BACKGROUND: Patients with elevated triglycerides despite statin therapy have increased risk for ischemic events, including coronary revascularizations. METHODS: REDUCE-IT (The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), a multicenter, double-blind, placebo-controlled trial, randomly assigned statin-treated patients with elevated triglycerides (135-499 mg/dL), controlled low-density lipoprotein (41-100 mg/dL), and either established cardiovascular disease or diabetes plus other risk factors to receive icosapent ethyl 4 g/d or placebo. The primary and key secondary composite end points were significantly reduced. Prespecified analyses examined all coronary revascularizations, recurrent revascularizations, and revascularization subtypes. RESULTS: A total of 8179 randomly assigned patients were followed for 4.9 years (median). First revascularizations were reduced to 9.2% (22.5/1000 patient-years) with icosapent ethyl versus 13.3% (33.7/1000 patient-years) with placebo (hazard ratio, 0.66 [95% CI, 0.58-0.76]; P<0.0001; number needed to treat for 4.9 years=24); similar reductions were observed in total (first and subsequent) revascularizations (negative binomial rate ratio, 0.64 [95% CI, 0.56-0.74]; P<0.0001), and across elective, urgent, and emergent revascularizations. Icosapent ethyl significantly reduced percutaneous coronary intervention (hazard ratio, 0.68 [95% CI, 0.59-0.79]; P<0.0001) and coronary artery bypass grafting (hazard ratio, 0.61 [95% CI, 0.45-0.81]; P=0.0005). CONCLUSIONS: Icosapent ethyl reduced the need for first and subsequent coronary revascularizations in statin-treated patients with elevated triglycerides and increased cardiovascular risk. To our knowledge, icosapent ethyl is the first non-low-density lipoprotein-lowering treatment that has been shown to reduce coronary artery bypass grafting in a blinded, randomized trial.

Copyright information:

© 2020 The Authors.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/rdf).
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