Generalizability of the REDUCE-IT trial and cardiovascular outcomes associated with hypertriglyceridemia among patients potentially eligible for icosapent ethyl therapy: An analysis of the REduction of Atherothrombosis for Continued Health (REACH) registry

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:340

Article

Picard, Fabien^1,2  Bhatt, Deepak L.^3,4  Ducrocq, Gregory^1,5,6,7,8  Ohman, E. Magnus⁹  Goto, Shinya¹⁰  Eagle, Kim A.¹¹  Wilson, Peter W. F.¹²  Smith, Sidney C., Jr.¹³  Elbez, Yedid¹  Steg, Philippe Gabriel^{1,5,6,7,8,14,15} 

[1] FACT French Alliance Cardiovasc Trials, Paris, France

[2] Hop Cochin, Assistance Publ Hop Paris, Cardiol Dept, Paris, France

[3] Harvard Med Sch, Boston, MA 02215 USA

[4] Brigham & Womens Hosp, Heart & Vasc Ctr, Boston, MA USA

[5] Hop Bichat Claude Bernard, Paris, France

[6] Assistance Publ Hop Paris, Paris, France

[7] INSERM, Paris, France

[8] Univ Paris, Paris, France

[9] Duke Univ Med Ctr, Durham, NC USA

[10] Tokai Univ Sch Med, Dept Med, Isehara, Japan

[11] Univ Michigan, Ann Arbor, MI 48109 USA

[12] Atlanta VA Med Ctr, Decatur, GA USA

[13] Univ North Carolina Chapel Hill, Heart & Vasc Ctr, Chapel Hill, NC USA

[14] Imperial Coll London, ICMS, NHLI, London, England

[15] Hop Bichat Claude Bernard, Serv Cardiol, 46 Rue Henri Huchard, F-75018 Paris, France

关键词: Hypertriglyceridemia;    Dyslipidemia;    Cardiovascular events;    Icosapent ethyl;    Triglyceride;    Atherosclerosis;   

DOI  :  10.1016/j.ijcard.2021.08.031

来源: Elsevier

【 摘 要 】

Background: The REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) trial demonstrated that high-dose icosapent-ethyl reduced the risk of ischemic events in statin-treated patients with elevated triglycerides (TG) and either atherosclerotic cardiovascular disease (ASCVD) or diabetes plus at least one risk factor. Methods and results: Using data from REACH (Reduction of Atherothrombosis for Continued Health), a large international registry of outpatients with or at risk of ASCVD, we evaluated the proportion of patients potentially eligible for enrolment in REDUCE-IT and compared their outcomes to those excluded because of low TG. Among 62,464 patients with either ASCVD or diabetes enrolled in the REACH Registry, 1036/8418 (12.3%) patients in primary prevention and 6049/54046 (11.2%) patients in secondary prevention (11.3% overall) would have been eligible for inclusion in REDUCE-IT. Compared with patients excluded for low TG level, adjusted risk of the primary composite outcome of cardiovascular death, non-fatal myocardial infarction (MI), non-fatal stroke, unstable angina, or coronary revascularization was higher in the REDUCE-IT eligible group (HR:1.06, 95% CI:1.00-1.13, p = 0.04). In addition, unstable angina, non-fatal MI, percutaneous coronary intervention and coronary artery bypass grafting were also more frequent in the REDUCE-IT eligible group (HR:1.17, 95% CI:1.07-1.27, p < 0.001; HR:1.25, 95%CI:1.07-1.45, p < 0.001; HR:1.42, 95%CI:1.27-1.57, p < 0.001; HR:1.43, 95%CI:1.19-1.71, p < 0.001, respectively), whereas the adjusted risk of non-fatal stroke was lower (HR:0.64, 95%CI:0.54-0.75, p < 0.001). Conclusion: In this large international registry of patients with or at high-risk of ASCVD, 11.3% met the REDUCE-IT trial selection criteria. REDUCE-IT eligible patients were found to be at higher risk of cardiac atherothrombotic events, but at lower risk of stroke than trial-ineligible patients with lower TG.

【 授权许可】

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