Abstract
BackgroundThe reduction of cardiovascular events with icosapent ethyl‐intervention trial (REDUCE‐IT) trial revealed robust atherosclerotic cardiovascular risk reduction with a strategy comprising high‐dose omega‐3 icosapent ethyl vs placebo in statin‐treated patients with elevated triglycerides and controlled low‐density lipoprotein cholesterol (LDL‐C).HypothesisAre the results of the REDUCE‐IT trial applicable to the French registry on acute ST‐elevation and non‐ST‐elevation myocardial infarction (FAST‐MI) population?MethodsData were extracted from the FAST‐MI 2010 and 2015 registries. We applied the REDUCE‐IT enrolment criteria (triglycerides 150‐500 mg/dL and LDL‐C 40‐100 mg/dL on statins) to the FAST‐MI population in patients aged ≥45 years who had detailed lipid values postacute hospitalization, focusing on their clinical profile and cardiovascular prognosis.ResultsOf the 3789 FAST‐MI patients with a full lipid profile (median 11.1 [IQR 7.6‐17.4] months after hospitalization for myocardial infarction), 472 (12.5%; 95% CI 11.4‐13.5) met the eligibility criteria for REDUCE‐IT (REDUCE‐IT‐like group). The cardiovascular event rate (all‐cause death, nonfatal myocardial infarction, nonfatal stroke) was 36.7 (95% CI 27.8‐48.6) per 1000 person‐years for the REDUCE‐IT‐like group, which compares with the 36.9 (95% CI 26.1‐51.5) per 1000 person‐years (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke) reported in the REDUCE‐IT trial. The residual cardiovascular risk related to elevated triglycerides in the REDUCE‐IT‐like group was similar to the risk in the REDUCE‐IT trial.ConclusionsIf the results of REDUCE‐IT are applied to patients hospitalized for a myocardial infarction in France, 12.5% of these patients could benefit from a strategy of high‐dose omega‐3 icosapent ethyl on top of contemporary therapy including statins to improve their clinical outcomes.
Highlights
Cardiovascular disease (CVD), remains the most common cause of death worldwide.[1]
High-intensity statin treatment reduces the risk of Atheroclerotic Cardiovascular Disease (ASCVD) events in both primary and secondary prevention,[2] but substantial residual risk remains even after significant reductions in low-density lipoprotein cholesterol (LDL-C) with the use of intensive lipid-lowering therapies (LLT).[3,4,5,6]
Icosapent ethyl reduced the risk of the primary endpoint by 25% and the key secondary endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke by 26% (HR 0.74; 95% confidence interval (CI) 0.65-0.83; P < .001)
Summary
Cardiovascular disease (CVD), remains the most common cause of death worldwide.[1]. High-intensity statin treatment reduces the risk of Atheroclerotic Cardiovascular Disease (ASCVD) events in both primary and secondary prevention,[2] but substantial residual risk remains even after significant reductions in low-density lipoprotein cholesterol (LDL-C) with the use of intensive lipid-lowering therapies (LLT).[3,4,5,6] In such patients, elevated triglycerides are regarded as an additional independent risk factor for ischemic events,[7,8,9,10] and represent a target for investigation with triglyceride-lowering medications. The REDUCE-IT trial confirmed that raised baseline triglycerides in patients with well-controlled LDL-C on statins is a major contributor to ASCVD risk.[16] One of the limitations of randomized trials is that their populations may not be representative of those treated in routine clinical practice.[17] We sought to evaluate the applicability of the REDUCE-IT results to an unselected French population with a previous myocardial infarction, by applying the eligibility criteria for REDUCE-IT to the French registry on acute ST-elevation and non-ST-elevation myocardial infarction (FAST-MI) 2010 and 2015 registries. The reduction of cardiovascular events with icosapent ethyl-intervention trial (REDUCE-IT) trial revealed robust atherosclerotic cardiovascular risk reduction with a strategy comprising high-dose omega-3 icosapent ethyl vs placebo in statin-treated patients with elevated triglycerides and controlled low-density lipoprotein cholesterol (LDL-C). Conclusions: If the results of REDUCE-IT are applied to patients hospitalized for a myocardial infarction in France, 12.5% of these patients could benefit from a strategy of high-dose omega-3 icosapent ethyl on top of contemporary therapy including statins to improve their clinical outcomes
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