Deepak Bhatt, MD: Icosapent Ethyl Reduces Event Risk in Patients with Prior Myocardial Infarction

An analysis of patients with a history of myocardial infarction from the REDUCE-IT trial is providing clinicians with further evidence of the effects of icosapent ethyl (Vascepa).

Results of the analysis, which were presented at the European Society of Cardiology (ESC) Congress 2021, suggest use of icosapent ethyl was associated with a 26% reduction in first MACE events and a 35% reduction in total MACE events.

“The benefits in these heart attack patients at-risk for another cardiovascular event are particularly important given these patients are at elevated risk for recurrent cardiovascular problems. These results further strengthen the case for pure eicosapentaenoic acid in the form of prescription icosapent ethyl as a key intervention beyond statins for meaningful risk reduction by physicians caring for this high-risk population,” said Deepak Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital, in a statement from Amarin.

The current REDUCE-IT analysis was designed with the intent of assessing whether or not a history of myocardial infarction might influence the results seen in the original REDUCE-IT trial. The original REDUCE-IT trial enrolled 8179 patients who were followed for a median of 4.9 years and concluded use of icosapent ethyl use was associated with a 25% reduction in relative risk of major adverse cardiovascular events including cardiovascular death, stroke, myocardial infarctions, hospitalization for unstable angina, or revascularization.

For the current analysis, investigators hoped to compare the effects seen among those with prior myocardial infarction, which included 1870 patients randomized to icosapent ethyl and 1823 randomized to placebo therapy. Using the same end points as the original REDUCE-IT trial, results of REDUCE-IT PRIOR MI indicate use of Icosapent Ethyl was associated with a 26% (HR, 0.74 [95% CI, 0.65-0.85]; P=.00001) relative risk reduction in first primary outcome events and a 35% (RR, 0.65 [95% CI, 0.56-0.77]; P=.0000001) relative risk reduction in total primary outcome events.

Further analysis indicated icosapent ethyl was associated with a 29% (HR, 0.71 [95%CI, 0.61-0.84]; P=.00006) risk reduction for first secondary composite endpoint events and a 32% (HR, 0.68 [95% CI, 0.57-0.82]; P=.00005) relative risk reduction for total events when using the secondary composite end point. Additional analyses were performed to assess the effect of icosapent ethyl on sudden cardiac death and cardiac arrest among patients with a history of prior myocardial infarction. In these analyses, results suggested icosapent ethyl was associated with a 40% (HR, 0.60 [95% CI, 0.380.94]; P=.02) reduction in risk of sudden cardiac death and a 56% (HR, 0.44 [95% CI, 0.21-0.89]; P=.02) reduction in risk of cardiac arrest compared to placebo therapy.

For more on the results of this REDUCE-IT analysis and what it means for clinicians, Practical Cardiology reached out to Bhatt and that conversation is the subject of this ESC Congress House Call.

This study, “Reduction in Ischemic Events, Including Cardiovascular Mortality, with Icosapent Ethyl in Patients with Prior Myocardial Infarction:REDUCE-IT PRIOR MI,” was presented at ESC Congress 2021.