Prevention of cardiovascular events and mortality following myocardial infarction using icosapent ethyl

Abstract

REDUCE-IT is a double-blind trial in which 8,179 patients treated by statins, whose LDL cholesterol level was controlled and triglyceride level slightly raised, were randomized to icosapent ethyl (IPE) therapy or to placebo. The aim of the trial was to assess the effect of IPE therapy on ischemic events in patients with a history of myocardial infarction.

The authors have performed post hoc analyses of patients with such a history. The primary endpoint comprised cardiovascular death, myocardial infarction, stroke, coronary revascularization, and hospitalization for unstable angina.

Data from 3,693 patients with a history of myocardial infarction were used. Primary endpoint was reduced from 26.1% to 20.2%, comparing IPE use to placebo (RR 0.74; 95% CI 0.65-0.85; p = 0.00001).

Significant relative risk reductions (RRR) were achieved, namely RRR of 35% for all ischemic events (p = 0.0000001), RRR of 34% for myocardial infarction (p = 0.00009), RRR of 30% for cardiovascular death (p = 0.01), and RRR of 20% for all-cause death (p = 0.054) while atrial fibrillation became slightly more frequent. The rates of sudden cardiac death and cardiac arrest were also reduced to a significant extent, by 40% and 56%, respectively.

In patients with a history of myocardial infarction, IPE treatment in the REDUCE-IT trial was associated with a large and significant reductions in both relative and absolute risk of ischemic events including cardiovascular death.