Icosapent Ethyl: Niche Drug or for the Masses?

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.