Highlights from

ACC 2020

Together with World Congress of Cardiology

Virtual 28 - 30 March 2020

Higher serum levels of eicosapentaenoic acid correlate with reduced CV events

Compared with placebo, icosapent ethyl 4g/day has shown to significantly reduce first and total cardiovascular (CV) events, which is beyond what can be explained by the degree of triglyceride or other biomarker changes. It seems that serum levels of eicosapentaenoic acid (EPA) play an important role here [1].

Dr Deepak Bhatt (Brigham and Women's Hospital, USA) presented the results of the REDUCE-IT EPA analysis, which was based on the initial study including 8,179 patients at 473 sites in 11 countries who had elevated CV risk and were using statins. They were randomised to icosapent ethyl 4g/day (n=4089) or placebo (n=4090) with a mean duration of 4.9 years of follow-up. Results showed that icosapent ethyl 4 grams daily compared with placebo resulted in a reduced combined rate of first and subsequent nonfatal myocardial infarction, stroke, CV death, coronary revascularisation, or hospitalisations for unstable angina by 25% and 30%, respectively. Subsequently, EPA levels were measured and compared with the placebo group. Patients were grouped by tertiles ranging from the lowest to highest levels of EPA and averaged across visits.

Results suggest that achieved EPA within the icosapent ethyl group was strongly associated with CV events. Also, each group of patients showed a significant relative risk reduction in CV events. Significant associations were found with all measured CV outcomes. It emerged that the higher the serum EPA level was, the lower the rate of the various CV events, CV deaths, and even total mortality. Overall, the drug significantly increased serum EPA levels by 386% from baseline to 1-year when compared with placebo. Docosahexaenoic acid (DHA) was also measured and its level decreased (-2.9%), suggesting that it plays no role in the observed CV benefits, which are considered to be the result of EPA. Also, patients who had highest on-treatment EPA levels had a significant reduction in hospitalisations for new onset heart failure with the drug compared with placebo. Furthermore, significant associations were observed between on-treatment EPA levels and a lower risk of sudden cardiac death and cardiac arrest. Dr Bhatt concluded that these are exiting findings that may open a new field of study and hopefully treatment options.

  1. Bhatt DL, et al. Eicosapentaenoic Acid Levels in REDUCE-IT and Cardiovascular Outcomes. Abstract 411-14. ACC/WCC 28-30 March 2020.

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