Icosapent ethyl: From the REDUCE-IT trial to clinical practice

In addition to low-density lipoproteins (LDL), those containing apolipoprotein (Apo) B and with a diameter less than 70 nm, including the smaller triglyceride-rich lipoproteins, remnant particles, and lipoprotein(a), may independently contribute to atherosclerosis because they also cross the endothelium and penetrate the arterial intima. Although mild/moderate hypertriglyceridemia is a recognized vascular risk factor, only two studies, the Japan EPA Lipid Intervention (JELIS) and the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT), using pure eicosapentaenoic acid (EPA) or icosapent ethyl (IPE), the stable ethyl ester of EPA, respectively, rather than a combination of docosahexaenoic acid (DHA) and EPA, have demonstrated a reduction in the rate of cardiovascular events. For this reason, it was deemed appropriate to examine the implications and applicability of the REDUCE-IT study in real-life settings. This analysis suggests a transversal therapeutic approach, based on both LDL cholesterol and triglycerides, for patients at very high cardiovascular risk to achieve an effective prevention. Furthermore, among patients in secondary prevention, treatment with IPE should focus on those with the highest vascular risk (recent acute coronary syndrome, post-infarction, angioplasty, and coronary bypass grafting).