Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk

Olshansky, Brian; Bhatt, Deepak L.; Chung, Mina K.

doi:10.1001/jama.2021.0824

Cited by 9 publications

(5 citation statements)

References 5 publications

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“…These findings of the overall REDUCE‐IT trial and this present analysis contrast sharply with neutral results from other contemporary clinical trials of moderate‐to high‐dose omega‐3 fatty acid supplementation, such as the recent STRENGTH (Long‐Term Outcomes Study to Assess Statin Residual Risk With Epanova in High Cardiovascular Risk Patients With Hypertriglyceridemia) and OMEMI (The Omega‐3 Fatty Acids in Elderly with Myocardial Infarction) trials. 34 , 35 , 36 As well, older clinical trials have shown mixed results with respect to prevention of MACE events. 37 , 38 , 39 , 40 , 41 In contrast, EPA in a highly purified form has shown a 19% benefit with respect to MACE in the open‐label JELIS (Japan EPA Lipid Intervention Study) at 1.8 g per day and a 25% reduction in MACE at 4 g per day in REDUCE‐IT.…”

Section: Discussionmentioning

confidence: 99%

Treatment With Icosapent Ethyl to Reduce Ischemic Events in Patients With Prior Percutaneous Coronary Intervention: Insights From REDUCE‐IT PCI

Peterson

Bhatt

Steg

et al. 2022

JAHA

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Background Patients who undergo percutaneous coronary intervention (PCI) are at increased risk for recurrent cardiovascular events despite aggressive medical therapy. Methods and Results This post hoc analysis focused on the subset of patients with prior PCI enrolled in REDUCE‐IT (Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial), a multicenter, randomized, double‐blind, placebo‐controlled trial of icosapent ethyl versus placebo. Icosapent ethyl was added to statins in patients with low‐density lipoprotein cholesterol <100 mg/dL and fasting triglycerides 135–499 mg/dL. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization. There were 8179 patients randomized in REDUCE‐IT followed for a median of 4.9 years, and 3408 (41.7%) of them had a prior PCI with a median follow‐up of 4.8 years. These patients were randomized a median of 2.9 years (11 days to 30.7 years) after PCI. Among patients treated with icosapent ethyl versus placebo, there was a 34% reduction in the primary composite end point (hazard ratio [HR], 0.66; 95% CI, 0.58–0.76; P <0.001; number needed to treat 4.8 years =12) and a 34% reduction in the key secondary composite end point of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke (HR, 0.66; 95% CI, 0.56–0.79; P <0.001; NNT 4.8 years =19) versus placebo. Similarly, large reductions occurred in total coronary revascularizations and revascularization subtypes. There was also a 39% reduction in total events (rate ratio, 0.61; 95% CI, 0.52–0.72; P <0.001). Conclusions Among patients treated with statins with elevated triglycerides and a history of prior PCI, icosapent ethyl substantially reduced the risk of recurrent events during an average of ~5 years of follow‐up with a number needed to treat of only 12. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01492361.

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Section: Discussionmentioning

confidence: 99%

Treatment With Icosapent Ethyl to Reduce Ischemic Events in Patients With Prior Percutaneous Coronary Intervention: Insights From REDUCE‐IT PCI

Peterson

Bhatt

Steg

et al. 2022

JAHA

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“…Early studies in patients treated with EPA demonstrated reduced plaque volume, decreased inflammation, increased nitric oxide release, and higher rates of membrane stabilization. [7][8][9][10][11][12][13][14][15] In light of these positive findings, the Reduction of Cardiovascular Events with Icosapent Ethyl (IPE) -Intervention Trial (REDUCE-IT) was designed to explore, in a randomized fashion, the role of IPE in reducing adverse cardiovascular events and whether it too could mitigate ischemic risk to the degree IPE had done in JELIS. 16 The results of the trial were overwhelmingly positive, and since the original publication of the trial, there have been a myriad of subsequent analyses confirming the benefit of IPE in various patient groups.…”

Section: Introductionmentioning

confidence: 99%

Benefits of icosapent ethyl for enhancing residual cardiovascular risk reduction: A review of key findings from REDUCE-IT

Bhatt¹,

Mason²,

Miller³

et al. 2022

Journal of Clinical Lipidology

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“…The AQUAMARINE EPA/DHA randomized study was the first prospective and serial CMR study to investigate the antiatherogenic effect of EPA/DHA events under statin Regarding this contradiction in results between these studies, there has been much debate [12][13][14][15] , such as differences in the action of EPA and EPA/DHA, differences in the severity of participants between these studies, and the difference the value of high-dose EPA for the preventive treatment of atherosclerotic cardiovascular disease 3, 4) . However, the recently published STRENGTH study showed inconsistent results with no additional preventive effect with 4-g EPA/DHA on cardiovascular The comparisons of the group data (D) show that there were no significant differences in absolute changes in the PMR in the total lesion analysis.…”

Section: Discussionmentioning

confidence: 99%

Effect of Eicosapentaenoic Acid/Docosahexaenoic Acid on Coronary High-Intensity Plaques Detected Using Noncontrast T1-weighted Imaging: The AQUAMARINE EPA/DHA Randomized Study

Nakao,

Noguchi,

Miura

et al. 2024

JAT

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Aim: Omega-3 fatty acids have emerged as a new option for controlling the residual risk for coronary artery disease (CAD) in the statin era. Eicosapentaenoic acid (EPA) is associated with reduced CAD risk in the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention trial, whereas the Statin Residual Risk with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia trial that used the combination EPA/docosahexaenoic acid (DHA) has failed to derive any clinical benefit. These contradictory results raise important questions about whether investigating the antiatherosclerotic effect of omega-3 fatty acids could help to understand their significance for CAD-risk reduction. Methods: The Attempts at Plaque Vulnerability Quantification with Magnetic Resonance Imaging Using Noncontrast T1-weighted Technic EPA/DHA study is a single-center, triple-arm, randomized, controlled, openlabel trial used to investigate the effect of EPA/DHA on high-risk coronary plaques after 12 months of treatment, detected using cardiac magnetic resonance (CMR) in patients with CAD receiving statin therapy. Eligible patients were randomly assigned to no-treatment, 2-g/day, and 4-g/day EPA/DHA groups. The primary endpoint was the change in the plaque-to-myocardium signal intensity ratio (PMR) of coronary high-intensity plaques detected by CMR. Coronary plaque assessment using computed tomography angiography (CTA) was also investigated.Results: Overall, 84 patients (mean age: 68.2 years, male: 85%) who achieved low-density lipoprotein cholesterol levels of ＜100 mg/dL were enrolled. The PMR was reduced in each group over 12 months. There were no significant differences in PMR changes among the three groups in the primary analysis or analysis including total lesions. The changes in CTA parameters, including indexes for detecting high-risk features, also did not differ. Conclusion:The EPA/DHA therapy of 2 or 4 g/day did not significantly improve the high-risk features of coronary atherosclerotic plaques evaluated using CMR under statin therapy.

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Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk

Cited by 9 publications

References 5 publications

Treatment With Icosapent Ethyl to Reduce Ischemic Events in Patients With Prior Percutaneous Coronary Intervention: Insights From REDUCE‐IT PCI

Treatment With Icosapent Ethyl to Reduce Ischemic Events in Patients With Prior Percutaneous Coronary Intervention: Insights From REDUCE‐IT PCI

Benefits of icosapent ethyl for enhancing residual cardiovascular risk reduction: A review of key findings from REDUCE-IT

Effect of Eicosapentaenoic Acid/Docosahexaenoic Acid on Coronary High-Intensity Plaques Detected Using Noncontrast T1-weighted Imaging: The AQUAMARINE EPA/DHA Randomized Study

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