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Toth PP, Ferrières J, Waters M, Mortensen MB, Lan NSR, Wong ND. Global eligibility and cost effectiveness of icosapent ethyl in primary and secondary cardiovascular prevention. Front Cardiovasc Med 2023; 10:1220017. [PMID: 37719970 PMCID: PMC10501481 DOI: 10.3389/fcvm.2023.1220017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023] Open
Abstract
Icosapent ethyl (IPE) is a purified eicosapentaenoic acid-only omega-3 fatty acid that significantly reduced cardiovascular (CV) events in patients receiving statins with established cardiovascular disease (CVD) and those with diabetes and additional risk factors in the pivotal REDUCE-IT trial. Since the publication of REDUCE-IT, there has been global interest in determining IPE eligibility in different patient populations, the proportion of patients who may benefit from IPE, and cost effectiveness of IPE in primary and secondary prevention settings. The aim of this review is to summarize information from eligibility and cost effectiveness studies of IPE to date. A total of sixteen studies were reviewed, involving 2,068,111 patients in the primary or secondary prevention settings worldwide. Up to forty-five percent of patients were eligible for IPE, depending on the selection criteria used (ie, REDUCE-IT criteria, US Food and Drug Administration label, Health Canada label, practice guidelines) and the population studied. Overall, eight cost-effectiveness studies across the United States, Canada, Germany, Israel, and Australia were included in this review and findings indicated that IPE is particularly cost effective in patients with established CVD.
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Affiliation(s)
- Peter P. Toth
- CGH Medical Center, Sterling, IL, United States
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Max Waters
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | | | - Nick S. R. Lan
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, WA, Australia
- Medical School, The University of Western Australia, Crawley, WA, Australia
| | - Nathan D. Wong
- Division of Cardiology, University of California, Irvine, CA, United States
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An opportunity to improve secondary prevention with icosapent ethyl in patients who have undergone coronary artery bypass graft surgery. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 41:170-172. [PMID: 34974987 DOI: 10.1016/j.carrev.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Icosapent ethyl reduces cardiovascular events in high-risk patients with hypertriglyceridaemia on statin therapy. However, it is not widely available and the potential application following coronary artery bypass graft (CABG) surgery is not well-established. We aimed to determine the real-world percentage of CABG surgery patients who may be eligible for the therapy. METHODS A retrospective analysis was performed between February 2015 and August 2020 in an Australian hospital. Patients were included if a lipid profile was performed at least three weeks following CABG surgery. Data was extracted from electronic medical records. Eligibility for icosapent ethyl was defined according to inclusion criteria from the REDUCE-IT trial. RESULTS Of 484 patients with follow-up lipid profiles, 21 (4.3%) were not eligible for icosapent ethyl based on age and 39 (8.1%) were not prescribed statin therapy or were prescribed a fibrate. After applying triglyceride and low-density lipoprotein cholesterol level criteria, 124 (25.6%) patients were potentially eligible for icosapent ethyl therapy. Of those eligible, high-intensity statin therapy were prescribed in 108 (87.1%). DISCUSSION A substantial percentage of CABG surgery patients may be eligible for icosapent ethyl and could potentially benefit from its cardiovascular protection. Further research should evaluate the additional cardiovascular benefits of icosapent ethyl in this very high-risk group of patients who are already treated with high-intensity statins.
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Picard F, Bhatt DL, Ducrocq G, Ohman EM, Goto S, Eagle KA, Wilson PWF, Smith SC, Elbez Y, Steg PG. 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. Int J Cardiol 2021; 340:96-104. [PMID: 34450192 DOI: 10.1016/j.ijcard.2021.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/29/2021] [Accepted: 08/20/2021] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Fabien Picard
- FACT (French Alliance for Cardiovascular Trials), Paris, France; Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Grégory Ducrocq
- FACT (French Alliance for Cardiovascular Trials), Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, and INSERM U1148, Paris, France; Université de Paris, Paris, France
| | | | - Shinya Goto
- Department of Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Kim A Eagle
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Peter W F Wilson
- Atlanta VA Medical Center and Emory Cardiovascular Research Institute, GA, USA
| | - Sidney C Smith
- Heart and Vascular Center, University of North Carolina at Chapel Hill, NC, USA
| | - Yedid Elbez
- FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, and INSERM U1148, Paris, France; Université de Paris, Paris, France; NHLI Imperial College, ICMS, Royal Brompton Hospital, London, United Kingdom.
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Beeraka NM, Tomilova IK, Batrak GA, Zhaburina MV, Nikolenko VN, Sinelnikov MY, Mikhaleva LM. Recent Insights into the Nutritional Antioxidant Therapy in Prevention and Treatment of Diabetic Vascular Complications - A comprehensive Review. Curr Med Chem 2021; 29:1920-1935. [PMID: 34375177 DOI: 10.2174/0929867328666210810142527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
Abstract
Diabetes mellitus (DM) and DM-induced vascular complications are a significant global healthcare problem causing a decrease in patient quality of life. The main reason for the disability and mortality of patients is rapidly progressing micro- and macroangiopathies. Currently, free radical oxidation is recognized as one of the main mechanisms in the development of DM and associated complications. Under normal physiological conditions, the level of free radicals and antioxidant defense capabilities is balanced. However, imbalance occurs between the antioxidant defense system and pro-oxidants during chronic hyperglycemia and may invoke formation of excess free radicals, leading to activation of lipid peroxidation and accumulation of highly toxic products of free radical oxidation. This is accompanied by varying degrees of insulin deficiency and insulin resistance in DM patients. Simultaneously with the activation of free radical generation, a decrease in the activity of antioxidant defense factors (superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, vitamins C and E) and an acceleration of diabetic complications is seen. Therefore, we hypothesize that antioxidants may play a positive role in the treatment of DM patients to prevent DM-induced vascular complications. However this has not been sufficiently studied. In this review, we discuss recent insights into the potential underlying mechanisms of oxidative stress induced diabetic complications, and implications of antioxidants in mitigation of DM-induced vascular complications.
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Affiliation(s)
- Narasimha M Beeraka
- Center of Excellence in Regenerative Medicine and Molecular Biology (CEMR), Department of Biochemistry, JSS Academy of Higher Education & Research (JSS AHER),Mysuru, Karnataka, India
| | - Irina K Tomilova
- Federal State Budgetary Educational Institution of Higher Education Ivanovo State Medical Academy, Ministry of Health of the Russian Federation, Ivanovo. Russian Federation
| | - Galina A Batrak
- Center of Excellence in Regenerative Medicine and Molecular Biology (CEMR), Department of Biochemistry, JSS Academy of Higher Education & Research (JSS AHER),Mysuru, Karnataka, India
| | - Maria V Zhaburina
- Center of Excellence in Regenerative Medicine and Molecular Biology (CEMR), Department of Biochemistry, JSS Academy of Higher Education & Research (JSS AHER),Mysuru, Karnataka, India
| | - Vladimir N Nikolenko
- Sechenov First Moscow State Medical University (Sechenov University), Moscow 119146. Russian Federation
| | - Mikhail Y Sinelnikov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow 119146. Russian Federation
| | - Liudmila M Mikhaleva
- Research Institute of Human Morphology, Russian Academy of Medical Science, Moscow 117418. Russian Federation
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Lan NSR, Burns K, Bell DA, Watts GF. Best practice for treating dyslipidaemia in patients with diabetes based on current international guidelines. Curr Opin Endocrinol Diabetes Obes 2021; 28:104-113. [PMID: 33278128 DOI: 10.1097/med.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Dyslipidaemia is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD) in type 2 diabetes. We provide an in-context overview of recent trials of lipid-lowering pharmacotherapies and of recommendations from international guidelines for managing dyslipidaemia in patients with diabetes. RECENT FINDINGS Clinical trials have demonstrated that patients with diabetes derive greater benefits from ezetimibe and proprotein convertase subtilisin-kexin type 9 inhibitors owing to the higher absolute ASCVD risk compared with patients without diabetes. Pure eicosapentaenoic acid ethyl ester therapy should be considered in high risk patients with diabetes and hypertriglyceridaemia who have well controlled low-density lipoprotein cholesterol on statin therapy. International guidelines from USA, Canada and Europe have been updated to support a more intensive approach to treating dyslipidaemia in diabetes. SUMMARY Dyslipidaemia should be identified and treated intensively as part of overall diabetes management to reduce ASCVD risk. Although lifestyle modifications and statin therapy remain the cornerstone of management, add-on therapies should be strongly considered depending on the absolute risk of ASCVD and the degree of dyslipidaemia.
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Affiliation(s)
- Nick S R Lan
- Departments of Internal Medicine and Cardiology, Royal Perth Hospital
| | - Kharis Burns
- Medical School, University of Western Australia
- Department of Endocrinology and Diabetes, Royal Perth Hospital
| | - Damon A Bell
- Departments of Internal Medicine and Cardiology, Royal Perth Hospital
- Medical School, University of Western Australia
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth and Fiona Stanley Hospitals
- Department of Biochemistry, Clinipath Pathology, Perth, Western Australia, Australia
| | - Gerald F Watts
- Departments of Internal Medicine and Cardiology, Royal Perth Hospital
- Medical School, University of Western Australia
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