Generalizability of the REDUCE-IT trial and cardiovascular outcomes associated with hypertriglyceridemia among patients potentially eligible for icosapent ethyl therapy: An analysis of the REduction of Atherothrombosis for Continued Health (REACH) registry. (1st October 2021)

• Record Type: Journal Article
• Authors: Picard, Fabien; Bhatt, Deepak L.; Ducrocq, Grégory; Ohman, E. Magnus; Goto, Shinya; Eagle, Kim A.; Wilson, Peter W.F.; Smith, Sidney C.; Elbez, Yedid; Steg, Philippe Gabriel
• Is Part Of: International journal of cardiology. Volume 340(2021)
• Page Start: 96
• Page End: 104
• Publication Date: 2021-10-01
• Subjects: Hypertriglyceridemia -- Dyslipidemia -- Cardiovascular events -- Icosapent ethyl -- Triglyceride -- Atherosclerosis; ASCVD atherosclerotic cardiovascular disease -- CABG coronary artery bypass graft -- CAD coronary artery disease -- CI confidence interval -- CV cardiovascular -- CVD cerebrovascular disease -- HR hazard ratio -- LDL-C low density lipoprotein cholesterol -- MI myocardial infarction -- PAD peripheral artery disease -- PCI percutaneous coronary intervention -- REACH Reduction of Atherothrombosis for Continued Health -- REDUCE-IT Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention -- TIA transient ischemic attack -- TG triglycerides; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.08.031
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial) trial demonstrated that high-dose icosapent-ethyl reduced the risk of ischemic events in statin-treated patients with elevated triglycerides (TG) and either atherosclerotic cardiovascular disease (ASCVD) or diabetes plus at least one risk factor. Methods and results: Using data from REACH (Reduction of Atherothrombosis for Continued Health), a large international registry of outpatients with or at risk of ASCVD, we evaluated the proportion of patients potentially eligible for enrolment in REDUCE-IT and compared their outcomes to those excluded because of low TG. Among 62, 464 patients with either ASCVD or diabetes enrolled in the REACH Registry, 1036/8418 (12.3%) patients in primary prevention and 6049/54046 (11.2%) patients in secondary prevention (11.3% overall) would have been eligible for inclusion in REDUCE-IT. Compared with patients excluded for low TG level, adjusted risk of the primary composite outcome of cardiovascular death, non-fatal myocardial infarction (MI), non-fatal stroke, unstable angina, or coronary revascularization was higher in the REDUCE-IT eligible group (HR:1.06, 95%CI:1.00–1.13, p = 0.04). In addition, unstable angina, non-fatal MI, percutaneous coronary intervention and coronary artery bypass grafting were also more frequent in the REDUCE-IT eligible group (HR:1.17, 95%CI:1.07–1.27, p < 0.001; HR:1.25, 95%CI:1.07–1.45, p < 0.001; HR:1.42, 95%CI:1.27–1.57, p < 0.001; HR:1.43, 95%CI:1.19–1.71, p < 0.001, respectively), whereas the adjusted risk of non-fatal stroke was lower (HR:0.64, 95%CI:0.54–0.75, p < 0.001). Conclusion: In this large international registry of patients with or at high-risk of ASCVD, 11.3% met the REDUCE-IT trial selection criteria. REDUCE-IT eligible patients were found to be at higher risk of cardiac atherothrombotic events, but at lower risk of stroke than trial-ineligible patients with lower TG. Graphical abstract: Unlabelled Image Highlights: High dose reduced the risk of ischemic events in the REDUCE-IT trial. In the REACH registry, 11.3% of patients would have been eligible for inclusion in REDUCE-IT. REDUCE-IT eligible patients were at higher risk of cardiac atherothrombotic events than trial-ineligible patients with low TG. REDUCE-IT eligible patients were at lower risk of stroke than trial-ineligible patients with low TG.