The role of eicosapentaenoic acid in reducing important cardiovascular events, including coronary revascularization

Prog Cardiovasc Dis. 2021 Nov-Dec:69:3-10. doi: 10.1016/j.pcad.2021.08.003. Epub 2021 Aug 20.

Abstract

The omega-3 fatty acid eicosapentaenoic acid has an important role in human health. The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) examined the prescription omega-3 fatty acid icosapent ethyl (IPE) in patients with established cardiovascular disease (CVD) or with diabetes plus additional CVD risk factors. The trial found a large reduction in CVD events, including significant reductions in CVD death, myocardial infarction, stroke, coronary revascularization, and hospitalization for unstable angina. These results led to the regulatory approval of IPE in a population similar to REDUCE-IT participants in the United States, Canada, United Kingdom, and the European Union. Moreover, multiple international guidelines have endorsed the use of IPE in such individuals. A secondary analysis of REDUCE-IT examined the endpoint of coronary artery revascularization. This analysis showed a significant reduction not only in coronary revascularization overall but also in elective, urgent, and emergent coronary revascularization. Additionally, IPE significantly reduced the need for both percutaneous coronary intervention and for coronary artery bypass graft surgery. Coronary imaging studies have demonstrated significant decreases in rates of plaque progression with IPE, with significant effects within 6-9 months. In parallel, experimental findings corroborate several effects of IPE that provide mechanisms that could contribute to the profound reductions in multiple types of ischemic events, including percutaneous and surgical coronary revascularization. Future trials should explore potential benefits of initiation of IPE at the time of revascularization in broader populations, potentially in conjunction with loading doses.

Keywords: Cardiovascular disease; Coronary artery bypass graft surgery; Eicosapentaenoic acid; Omega-3 fatty acids; Percutaneous coronary intervention.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cardiovascular Diseases* / prevention & control
  • Coronary Artery Bypass
  • Eicosapentaenoic Acid / therapeutic use
  • Fatty Acids, Omega-3*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Myocardial Infarction
  • Risk Factors
  • United States

Substances

  • Fatty Acids, Omega-3
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Eicosapentaenoic Acid