Icosapent Ethyl: Niche Drug or for the Masses?

Despite achieving optimal levels of low-density lipoprotein cholesterol (LDL-C) with statins, the risk of atherosclerotic cardiovascular disease (ASCVD) persists. The purpose of this review is to outline the effects of icosapent ethyl (IPE), an ultra-purified eicosapentaenoic acid (EPA) on ASCVD risk assessment.

Many studies have shown that elevated triglycerides (TG) contribute to increased risk of ASCVD. However, the only outcomes trial to date to demonstrate a benefit in patients with elevated TG beyond its lipid-lowering properties is REDUCE-IT. Yet, despite IPE demonstrating a relatively modest reduction in TG (~ 20%), there was a 25% relative risk reduction in the primary endpoint and a 30% reduction in total events. Sub-analysis of REDUCE-IT also showed a statically significant decrease in cardiac arrest (HR 0.52 (0.31-0.86), p = 0.01) and sudden cardiac death (HR 0.69 (0.50-0.96), p = 0.03). The CVD benefits observed in REDUCE-IT coincide with on-treatment EPA levels. Icosapent ethyl's multiple bioactive properties contribute to CVD risk reduction beyond TG lowering effects. Because patients with a REDUCE-IT-like profile are highly prevalent in the USA and abroad, IPE should not be viewed as a niche drug, but rather part of a proven armamentarium that deserves widespread use in appropriate patients at elevated ASCVD risk.