Icosapent ethyl: safely reducing cardiovascular risk in adults with elevated triglycerides

Introduction In patients at high cardiovascular risk, the rate of events remains elevated despite traditional, evidence-based lipid-lowering therapy. Residual hypertriglyceridemia is an important contributor to this risk. However, prior medications with triglyceride-lowering effects have not reduced adverse clinical outcomes in the statin era. Areas covered The present review summarizes evidence and recommendations related to triglyceride-lowering therapy in the primary and secondary preventive settings. We provide an overview of findings from recent meta-analyses, important observational studies, and a detailed description of landmark trials, including the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT). We further review recommendations from current guidelines. Expert opinion Icosapent ethyl is a stable, highly purified ethyl ester of eicosapentaenoic acid that safely and effectively reduces cardiovascular events in the contemporary setting. It is prescribed at a dose of 2 grams twice daily and is indicated in patients at high cardiovascular risk who have fasting or non-fasting triglyceride levels >= 150 mg/dl despite maximally tolerated statin treatment, or in individuals with triglyceride levels >= 500 mg/dl. Conversely, omega-3 fatty acid preparations containing a combination of eicosapentaenoic acid and docosahexaenoic acid are not indicated for reduction of cardiovascular risk and should be actively deprescribed.

Automated summary

In high cardiovascular risk patients, residual hypertriglyceridemia remains a significant contributor to elevated event rates despite traditional lipid-lowering therapy. Icosapent ethyl, a highly purified ethyl ester of eicosapentaenoic acid, has been shown to effectively reduce cardiovascular events in these patients, especially when triglyceride levels remain high despite statin treatment. Omega-3 fatty acid preparations containing a mix of eicosapentaenoic acid and docosahexaenoic acid are not recommended for reducing cardiovascular risk.