Adding Icosapent Ethyl to Statin Therapy Reduces Stroke Risk by 36%, Study Finds

Deepak Bhatt, MD

The latest analysis of the REDUCE-IT trial suggests adding icosapent ethyl (Vascepa) to treatment algorithms that already included statins could further reduce a patient’s risk of stroke.

Results of the analysis, which was presented at the American Stroke Association’s International Stroke Conference (ISC) 2021, indicate patients with increased triglycerides receiving triglycerides in addition to statin therapy reduced their risk of ischemic stroke by an additional 36%.

“Icosapent ethyl is a new way to further reduce the risk of stroke in patients with atherosclerosis or who are at high risk of stroke, who have elevated triglyceride levels and are already taking statins,” said Deepak L. Bhatt, MD, MPH, lead author of the study and executive director of interventional cardiovascular programs at the Brigham and Women’s Hospital Heart & Vascular Center in Boston, in a statement.

This latest analysis of the landmark trial adds to the risk reduction profile associated with icosapent ethyl and demonstrated through the multitude of REDUCE-IT analyses that have been presented at major conferences since initial results were released in 2018. Briefly, the 8000-person multicenter trial found the omega-3 based medication not only reduced triglyceride levels but was also associated with significant reductions in major cardiovascular events.

Check out this video interview with Deepak Bhatt, MD, MPH, where he discusses the results of CardioLink-9, which examined icosapent ethyl in outpatients with COVID-19.

While a previous analysis found use of icosapent ethyl reduced total ischemic events by 32% (P <.000001), the ISC 2021 analysis was designed to examine prespecified and post-hoc stroke endpoints. Results of the analysis indicated event rates for first fatal or nonfatal stroke events were 2.4% among those receiving icosapent ethyl and 3.3% for those randomized to placebo (HR, 0.72; 95% CI, 0.55-0.93; P=.01, [RRR, 28; ARR, 0.9%; NNT=114).

Based on the results of their analyses, investigates concluded for every 1000 patients treated for 5 years with icosapent ethyl, approximately 14 stroke events were averted. Additionally, ischemic stroke time to first event rates were 2.0% with icosapent ethyl and 3.0% for placebo (HR, 0.64; 95% CI, 0.49-0.85; P=.002). When examining hemorrhagic stroke, investigators found lower rates within the icosapent ethyl group versus placebo but this failed to reach statistical significance (0.3% vs 0.2%; P=.55).

In the aforementioned statement, Bhatt pointed out there was an increase in risk of bleeding events seen with icosapent ethyl and these results of the REDUCE-it analyses should not imply the same effects would be seen with other omega-3-based medications.

“It is very different in terms of purity compared to omega-3 fatty acid supplements available over-the-counter, and these results do not apply to supplements,” added Bhatt.

This study, “Reduction in Ischemic Stroke With Icosapent Ethyl - Insights From REDUCE-IT,” was presented at ISC 2021 and published in advance in Stroke.