Comparative Risk of Atrial Fibrillation Onset in Statin-Treated Patients Initiating Icosapent Ethyl and Omega-3 Acid...

Icosapent ethyl (IPE) and omega-3-acid ethyl esters (docosahexaenoic acid [DHA]/eicosapentaenoic acid [EPA]) are approved as adjunct therapies to statins for reducing cardiovascular events in at-risk patients. However, concerns remain regarding a potential link between IPE and atrial fibrillation (AF). We compared the risk of AF onset in patients who initiated IPE versus DHA/EPA as adjuncts to statin therapy.

We conducted a retrospective cohort study using the Merative MarketScan Commercial Claims and Medicare Supplemental database in the United States. An active-comparator, new-user study design was applied. Adults diagnosed with dyslipidemia and receiving statin therapy who initiated IPE or DHA/EPA between January 2013 and June 2021 were identified. A propensity score-matched cohort was created using baseline demographic characteristics, comorbidities, and medication dispensing records, with exact matching on therapy initiation period. Patients were followed for up to 2 years while they were on IPE or DHA/EPA therapy to identify incident AF. Cumulative incidence was estimated using Kaplan-Meier methods, and risks between groups were compared using Cox proportional hazards analysis.

The propensity score-matched cohort included 17 635 participants, with a mean age of 55 years, and was predominantly men (65.4%). Over 2 years, the cumulative incidence of AF from IPE and DHA/EPA was 5.20% (95% CI, 4.62%-5.84%) and 4.07% (95% CI, 3.58%-4.62%) respectively, resulting in a hazard ratio of 1.21 (95% CI, 1.03-1.42).

These findings suggest that, in adult patients who are AF naïve, IPE may be associated with a higher risk of AF compared with DHA/EPA when used as add-on therapy with statins.