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Krishnaraj A, Bakbak E, Teoh H, Bhatt DL, Quan A, Puar P, Lambotharan B, Kirubaharan A, Firoz IN, Meglis G, Yanagawa B, Bari B, Kirubaharan R, Vijayaraghavan R, Hess DA, Demchuk AM, Mancini GBJ, Tanguay JF, Tardif JC, Voisine P, Leiter LA, Verma S. Generalizability of the REDUCE-IT trial to South Asians with cardiovascular disease. Med (N Y) 2023; 4:130-138.e1. [PMID: 36630964 DOI: 10.1016/j.medj.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND South Asians (SAs) represent ∼25% of the world's population and account for >50% of global cardiovascular (CV) deaths, yet they continue to be underrepresented in contemporary clinical trials. The REDUCE-IT study demonstrated in a high-risk and predominantly White population that icosapent ethyl (IPE) lowered major adverse cardiovascular events by 25%. We sought to determine the generalizability of these results to a high-risk population of SAs with established CV disease living in Canada. METHODS This was a cross-sectional observational study of 200 statin-treated SAs (≥45 years) with atherosclerotic CV disease (ASCVD) (NCT05271591). SA ethnicity was self-identified as being of Anglo-Indian, Bangladeshi, Bengali, Bhutanese, Goan, Gujarati, Indian, Jatt, Kashmiri, Maharashtrian, Malayali, Nepali, Pakistani, Punjabi, Sindhi, Sinhalese, Sri Lankan, Tamil, Telugu, or other SA. ASCVD was defined as the presence of coronary, carotid, or peripheral atherosclerosis. FINDINGS Mean age of the cohort was 67 years, where 82% were men and 57% had diabetes. The predominant ASCVD phenotype was coronary artery disease (94%). Mean (SD) baseline LDL-C and triglycerides were 1.70 (0.8) mmol/L and 1.42 (1.0) mmol/L, respectively. Three-quarters were on high-intensity statin therapy. According to the Health Canada/Canadian Cardiovascular Society Guidelines and FDA-approved indication, 33% and 25% of the participants were, respectively, eligible for IPE. CONCLUSIONS A large proportion of high-intensity, statin-treated, high-risk patients with ASCVD and of self-reported SA ethnicity are eligible for IPE. These data have important translational implications for SAs who are at a disproportionately higher risk of CV morbidity and mortality. FUNDING This study was funded by an unrestricted grant provided by HLS Therapeutics Inc, Canada.
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Affiliation(s)
- Aishwarya Krishnaraj
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Ehab Bakbak
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Adrian Quan
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Pankaj Puar
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Bhaavani Lambotharan
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Aathmika Kirubaharan
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Irene N Firoz
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Gus Meglis
- North York Diagnostic and Cardiac Centre, Toronto, ON, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Basel Bari
- Markham Health+Plex Medical Centre, Markham, ON, Canada
| | | | - Ram Vijayaraghavan
- Scarborough Heart Health Institute, Scarborough Health Network, Scarborough, ON, Canada
| | - David A Hess
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Robarts Research Institute, and Department of Physiology and Pharmacology, Western University, London, ON, Canada; Division of Vascular Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - G B John Mancini
- Division of Cardiology and the Centres for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Pierre Voisine
- Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université Laval, Québec City, QC, Canada
| | - Lawrence A Leiter
- Division of Endocrinology and Metabolism, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; North York Diagnostic and Cardiac Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
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