Expert opinion on drug safety | 2021
Icosapent ethyl: safely reducing cardiovascular risk in adults with elevated triglycerides.
Abstract
INTRODUCTION\nIn patients at high cardiovascular risk, the rate of events remains elevated despite traditional, evidence-based lipid-lowering therapy. Residual hypertriglyceridemia is an important contributor to this risk. However, prior medications with triglyceride-lowering effects have not demonstrated an ability to reduce adverse clinical outcomes in the statin era.\n\n\nAREAS COVERED\nThe present review summarizes evidence and recommendations related to triglyceride-lowering therapy in the primary and secondary preventive settings. We provide an overview of findings from recent meta-analyses, important observational studies, and a detailed description of landmark trials, including the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT). We further review recommendations from current guidelines.\n\n\nEXPERT OPINION\nIcosapent ethyl is a stable, highly purified ethyl ester of eicosapentaenoic acid that safely and effectively reduces the risk of incident cardiovascular events in the contemporary setting. It is prescribed at a dose of 2 grams twice daily and is indicated in patients at high cardiovascular risk who have fasting or non-fasting triglyceride levels ≥150 mg/dl despite maximally tolerated statin treatment, or in individuals with triglyceride levels ≥500 mg/dl. Conversely, n-3 fatty acid medications containing a combination of eicosapentaenoic acid and docosahexaenoic acid are not indicated for reduction of cardiovascular risk and should be actively deprescribed.