[Real-world triglyceride levels in secondary prevention: insights from the JET-LDL registry]

Hypertriglyceridemia is a common finding in patients with coronary artery disease (CAD), contributing to the residual cardiovascular risk in this population. In CAD patients with persistently elevated triglyceride levels despite lipid-lowering therapies, treatment with icosapent ethyl (IPE), compared to placebo, significantly lowered the risk of ischemic events. We aimed to quantify the burden of real-world patients with high triglyceride levels despite optimal lipid-lowering therapy, and to provide the potential use of IPE as a therapeutic strategy of secondary prevention.

We used the data of the multicenter and observational JET-LDL registry, which included 1095 patients with acute coronary syndrome undergoing percutaneous coronary intervention with at least one stent implantation at 35 Italian hospitals. In the present subanalysis, we investigated fasting triglyceride levels at index hospitalization and after 3 months of follow-up, and their relationship with LDL-cholesterol values. We also identified patients potentially eligible for IPE prescription based on inclusion/exclusion criteria of the REDUCE-IT trial and of the Italian Medicines Agency (AIFA).

Triglyceride levels at baseline and at 3-month follow-up were 109 (82.5-147) mg/dl and 98 (75-130) mg/dl, respectively. The reduction of triglycerides was also statistically significant (p<0.01) comparing paired matched patients. At 3 months, 15.6% of patients met the inclusion laboratory criteria of the REDUCE-IT trial, making them eligible for IPE based on these parameters. Additionally, 14.5% of patients were eligible according to AIFA authorized guidelines for the use of IPE, whereas only 0.2% qualified under the criteria for reimbursement.

A non-negligible proportion of patients met the REDUCE-IT triglyceride cut-off levels for IPE prescription at 3-month follow-up post-acute coronary syndromes. However, the prescription of IPE can be very limited by the current restrictive reimbursement criteria.