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Rounding the corner on residual risk: Implications of REDUCE‐IT for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease

Patients with established atherosclerotic cardiovascular (CV) disease remain at increased risk of major adverse cardiovascular events even during optimal lipid‐lowering therapy. Recent studies using the methods of Mendelian randomization, as well as analyses of data from large statin trials, have co...

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Autores principales: Baum, Seth J., Scholz, Kenneth P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Periodicals, Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727875/
https://www.ncbi.nlm.nih.gov/pubmed/31254481
http://dx.doi.org/10.1002/clc.23220
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author Baum, Seth J.
Scholz, Kenneth P.
author_facet Baum, Seth J.
Scholz, Kenneth P.
author_sort Baum, Seth J.
collection PubMed
description Patients with established atherosclerotic cardiovascular (CV) disease remain at increased risk of major adverse cardiovascular events even during optimal lipid‐lowering therapy. Recent studies using the methods of Mendelian randomization, as well as analyses of data from large statin trials, have concluded that elevated triglyceride (TG) levels contribute to that increased risk. Omega‐3 polyunsaturated fatty acids (omega‐3 PUFAs) from fish and shellfish (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) reduce TG levels when added to the diet in sufficient amounts, and they have favorable effects on several other markers of CV risk. However, trials of omega‐3 PUFAs have had inconsistent findings regarding CV risk reduction. Recently, the REDUCE‐IT (Reduction of Cardiovascular Events with EPA‐Intervention Trial) trial reported that treatment of such high‐risk patients with icosapent ethyl, a purified and stabilized ethyl ester of EPA, reduced the risk of the trial's primary CV endpoint by 25% (95% confidence intervals [CI], 32%‐17%; P < .001). To appreciate the clinical implications of this result, it is important to understand how the REDUCE‐IT trial differed from previous trials, especially with regard to patient enrollment criteria and treatment dosing. We discuss these design features relative to other trials. TG lowering can account for only part of the risk reduction seen with icosapent ethyl; we also consider other potential contributory mechanisms.
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spelling pubmed-67278752019-09-12 Rounding the corner on residual risk: Implications of REDUCE‐IT for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease Baum, Seth J. Scholz, Kenneth P. Clin Cardiol Reviews Patients with established atherosclerotic cardiovascular (CV) disease remain at increased risk of major adverse cardiovascular events even during optimal lipid‐lowering therapy. Recent studies using the methods of Mendelian randomization, as well as analyses of data from large statin trials, have concluded that elevated triglyceride (TG) levels contribute to that increased risk. Omega‐3 polyunsaturated fatty acids (omega‐3 PUFAs) from fish and shellfish (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) reduce TG levels when added to the diet in sufficient amounts, and they have favorable effects on several other markers of CV risk. However, trials of omega‐3 PUFAs have had inconsistent findings regarding CV risk reduction. Recently, the REDUCE‐IT (Reduction of Cardiovascular Events with EPA‐Intervention Trial) trial reported that treatment of such high‐risk patients with icosapent ethyl, a purified and stabilized ethyl ester of EPA, reduced the risk of the trial's primary CV endpoint by 25% (95% confidence intervals [CI], 32%‐17%; P < .001). To appreciate the clinical implications of this result, it is important to understand how the REDUCE‐IT trial differed from previous trials, especially with regard to patient enrollment criteria and treatment dosing. We discuss these design features relative to other trials. TG lowering can account for only part of the risk reduction seen with icosapent ethyl; we also consider other potential contributory mechanisms. Wiley Periodicals, Inc. 2019-06-29 /pmc/articles/PMC6727875/ /pubmed/31254481 http://dx.doi.org/10.1002/clc.23220 Text en © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Reviews
Baum, Seth J.
Scholz, Kenneth P.
Rounding the corner on residual risk: Implications of REDUCE‐IT for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease
title Rounding the corner on residual risk: Implications of REDUCE‐IT for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease
title_full Rounding the corner on residual risk: Implications of REDUCE‐IT for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease
title_fullStr Rounding the corner on residual risk: Implications of REDUCE‐IT for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease
title_full_unstemmed Rounding the corner on residual risk: Implications of REDUCE‐IT for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease
title_short Rounding the corner on residual risk: Implications of REDUCE‐IT for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease
title_sort rounding the corner on residual risk: implications of reduce‐it for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727875/
https://www.ncbi.nlm.nih.gov/pubmed/31254481
http://dx.doi.org/10.1002/clc.23220
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