Highlights
- •Hypertriglyceridemia is associated with increased ASCVD risk.
- •Long-chain omega-3 fatty acids lower circulating TG.
- •Benefits of low-dose omega-3 have been controversial.
- •In REDUCE-IT, icosapent ethyl demonstrated 25% net ASCVD risk reduction.
- •NLA: use icosapent ethyl in selected high TG ASCVD and/or diabetic patients on statin.
Abstract
Representatives from the National Lipid Association (NLA) participated in the development
of the 2018 American Heart Association/American College of Cardiology/Multisociety
Guideline on the Management of Blood Cholesterol, which reaffirmed that lifestyle
changes and statin treatment are therapeutic cornerstones for atherosclerotic cardiovascular
disease (ASCVD) risk reduction. It also updated prior recommendations to incorporate
newer data demonstrating ASCVD risk reduction with ezetimibe and proprotein convertase
subtilisin kexin type 9 inhibitors as adjuncts to statin therapy for patients at high
and very-high ASCVD risk. The 2018 Guideline was finalized shortly before full results
were available from a randomized, placebo-controlled cardiovascular outcomes trial
[Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT)]
that examined the effects of icosapent ethyl (IPE) 4 g/d on major adverse cardiovascular
events in selected high- or very high-risk, statin-treated patients with elevated
triglycerides. The primary outcome variable of first major adverse cardiovascular
event (cardiovascular death, myocardial infarction, stroke, coronary revascularization
and hospitalization for unstable angina) was reduced by 25% (95% confidence interval
17%–32%, P < .001). REDUCE-IT served as the primary basis for the NLA's review of evidence for
the use of IPE for ASCVD risk reduction. Based on this review, the NLA position is
that for patients aged ≥45 years with clinical ASCVD, or aged ≥50 years with diabetes
mellitus requiring medication plus ≥1 additional risk factor, with fasting triglycerides
135 to 499 mg/dL on high-intensity or maximally tolerated statin therapy (±ezetimibe),
treatment with IPE is recommended for ASCVD risk reduction (evidence rating: class
I; evidence level: B-R).
Keywords
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Article info
Publication history
Published online: November 02, 2019
Accepted:
October 25,
2019
Received:
October 21,
2019
Identification
Copyright
© 2019 National Lipid Association. All rights reserved.
