Can icosapent ethyl prevent cardiovascular events and mortality in patients that have had previous heart attacks?

This study examined the effect of icosapent ethyl (IPE; Vascepa) on major cardiovascular events (MACEs) in statin-treated patients that had previous heart attacks (myocardial infarction; MI). The data showed that patients treated with IPE had large and significant reductions in MACEs.

Ischemic events are associated with a reduction in blood supply in organs such as the heart, resulting in reduced levels of oxygen and nutrients. They are strongly linked to the occurrence of a MACE. Mace include MI, stroke and death due to hearth disease. High blood levels of “bad cholesterol” (LDL-C) and triglycerides increase cardiovascular (CV) risks in patients. Effective therapeutic options that target high levels of LDL-C and triglycerides are available. However, they do not eliminate residual CV risks.

The most common medications that reduce blood cholesterol are statins such as atorvastatin (Lipitor) or rosuvastatin (Crestor). IPE is an additional medication that may be used to reduce the risk of MACE by treating high levels of triglycerides and LDL-C. It works by reducing the production of triglycerides in the liver and increasing the elimination of blood fats from the blood. It is frequently used together with a statin.

Previous studies showed a lowered occurrence of MACE in patients treated with IPE compared to placebo. However, the effect of IPE on ischemic events in patients with a previous MI remain unknown.

This study included 3,693 patients from with a prior MI. 1,870 patients received IPE and 1,823 patients were given a placebo. All patients had been treated with a statin and had controlled blood cholesterol. The average baseline level of LDL-C was 75 mg/dL. The average triglyceride level was 220 mg/dL. Patients were evaluated based on MACE (CV death, MI, stroke, coronary revascularization or hospitalization for unstable angina). Patients were followed for an average of 4.8 years.

Patients treated with IPE had a 36% reduction in the risk of MACE compared to those that had placebo. The risk of another MI was reduced by 34%. The risk of CV death was decreased by 30% compared to placebo. All-cause mortality rate was also reduced by 20%. Sudden cardiac death was reduced by 40%.

The study showed that patients with a prior MI that received IPE treatment had significant risk reductions in MACE compared to placebo.

Patients were not enrolled at the time of MI. Further studies are needed in this group of patients. The study was funded by Amarin Pharma, the manufacturer of IPE.