Icosapent ethyl decreases CV event risk in smokers to level of never smokers
In current and former smokers, treatment with icosapent ethyl reduced CV event risk to levels observed in never smokers, according to new data from REDUCE-IT presented at the European Society of Cardiology Congress.
As Healio previously reported, in the main results of REDUCE-IT, icosapent ethyl (Vascepa, Amarin) lowered the primary endpoint of CV death, nonfatal MI, nonfatal stroke, coronary revascularization or unstable angina by 25% compared with placebo in patients with elevated triglycerides at high CV risk despite statin therapy.
For the present analysis, Michael Miller, MD, FACC, FAHA, chief of medicine at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia and vice chair of medicine at the University of Pennsylvania School of Medicine, and colleagues analyzed the effect of icosapent ethyl on smokers participating in REDUCE-IT.
“Cigarette smoking is the most preventable cause of cardiovascular disease,” Miller told Healio. “Even when smokers take effective therapies such as statins and antiplatelets, there remains residual atherothrombogenic risk. We wanted to see if icosapent ethyl would reduce that residual risk, as it reduces platelet aggregation and biomarkers of atherothrombotic risk.”
The analysis included 2,485 current or former smokers assigned icosapent ethyl (median age, 64 years; 20% women) and 2,428 current or former smokers assigned placebo (median age, 63 years; 20% women). The results were also published in European Heart Journal: Cardiovascular Pharmacotherapy.
Compared with placebo, icosapent ethyl was associated with reduction in time to first primary endpoint event (HR = 0.77; 95% CI, 0.68-0.87; P < .0001) and in total events (RR = 0.71; 95% CI, 0.61-0.82; P < .0001), according to the researchers.
In the cohort, assignment to icosapent ethyl was also associated with reduced risk for the key secondary composite endpoint of CV death, MI and stroke (HR = 0.77; 95% CI, 0.66-0.89; P = .0006), CV death/nonfatal MI (HR = 0.77; 95% CI, 0.65-0.9; P = .002), fatal or nonfatal MI (HR = 0.7; 95% CI, 0.57-0.85; P = .0004), urgent or emergent revascularization (HR = 0.74; 95% CI, 0.6-0.91; P = .004), hospitalization for unstable angina (HR = 0.74; 95% CI, 0.56-0.99; P = .04) and all-cause death/nonfatal MI/nonfatal stroke (HR = 0.81; 95% CI, 0.71-0.93; P = .004), the researchers found.
Icosapent ethyl consistently reduced risk for the primary composite endpoint in current smokers (P = .05), former smokers (P = .0002) and never smokers (P < .0001), Miller said during a presentation.
“In current and former smokers who took icosapent ethyl, CV risk was reduced to levels we see in never smokers,” Miller told Healio. “In addition to smoking cessation efforts, treatment with icosapent ethyl could be considered for CV risk reduction in smokers who meet the REDUCE-IT inclusion criteria.”
Reference:
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Miller M, et al. Optimal risk factor therapy in high-risk patients. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).
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