One in three South Asians with ASCVD on statins are eligible for icosapent ethyl

A third of South Asians in Canada with known atherosclerotic cardiovascular disease (ASCVD) and who take statins would qualify to get additional treatment with icosapent ethyl (IPE). This is a significant-sized population who could benefit from the additional lowering of triglycerides using IPE, according to a study presented at the recent annual meeting of the Canadian Cardiovascular Society (CCS). This year’s CCS had 1,400 in-person delegates, over 350 online delegates and 130 sessions. Though a major study, the REDUCE-IT trial driving the use of IPE had very few non-white participants, according to a poster abstract presented by Canadian researchers. IPE is a highly purified preparation of eicosapentaenoic acid (EPA), which is an omega-3 fatty acid. It is used to treat severe hypertriglyceridemia (500 mg/dL and over). It is used as an adjunct to statin therapy to reduce the risk of cardiovascular events in people whose serum triglyceride levels are over 150 mg/dL. Read: DRUG QUIZ: Chronic heart failure In 2018, results from the REDUCE-IT trial confirmed that targeting residual elevated triglycerides with IPE reduces cardiovascular events and deaths. The trial randomized 8,179 patients with established atherosclerotic heart disease or diabetes and an additional risk factor, and on baseline statin therapy, to IPE (a highly purified and stable EPA ethyl ester) or placebo. IPE was found to confer benefits in terms of reduced events and lower mortality from the additional lowering of triglycerides. “Inasmuch as over 90% of the REDUCE-IT cohort were white, the generalization of its results to non-white populations is unclear. Compared with white individuals and other races/ethnicities, people of South Asian (SA) descent have higher levels of triglycerides and are at a markedly higher risk of developing atherosclerotic cardiovascular disease (ASCVD),” the study said. Researchers involved in the study were unavailable for comment. In fact, South Asians are more likely to have type 2 diabetes, have more severe and diffuse coronary artery disease and experience more complications following coronary revascularizations. They are younger at the time of cardiac catheterization, age of first hospitalization for heart failure and age of first myocardial infarction. About three-million Canadians identify as South Asian and are the largest visible minority in Canada. IPE was approved in Canada in 2020 and is recommended by the CCS in people with ASCVD and triglyceride levels of 1.5 to 5.6 mmol/L who are on maximally tolerated statin therapy. The REDUCE-IT Canada SA presented at the CCS enrolled 200 South Asians individuals who were aged 45 years and over with ASCVD, and who were on stable statin therapy. Participants were enrolled from four community cardiology (65%) and two family practice (35%) clinics across the Greater Toronto Area. The goal was to looks at the eligibility for use of IPE for residual CVD risk reduction in this population with ASCVD and determine how applicable REDUCE-IT results are to them. The majority, 82% were male and had a mean age of 67 years. Race and ethnicity were self-reported. A total of 57% had known diabetes, and they had a mean BMI of 26.5 kg/m2, LDL-C of 1.54 mmol/L and triglyceride levels of 1.19 mm/L. Most were on guideline-recommended lipid-lowering therapies with 75% on a high-intensity statin, 18% on ezetimibe, and 4% on a proprotein convertase subtilisin/kexin type 9 serine protease (PCSK9) inhibitor. “Even though the lipid levels of the REDUCE-IT Canada SA participants were generally well managed, our data suggest that approximately one-third of this ASCVD cohort would be eligible for IPE according to Health Canada and the 2021 CCS Dyslipidemia Guidelines,” the study said. It also noted that there may be other barriers to the therapy such as cost. Less than one-quarter, 22%, of the people in the study reported they had private health insurance, while 33% described challenges covering the cost of medication. The study concluded that “strategies aimed at improving access to IPE may offer additional opportunities to reduce vascular events in South Asians who are recognized as a high-risk population.” The 2021 CCS Dyslipidemia Guidelines state “because IPE is a purified form of ethyl EPA, the results of REDUCE-IT cannot be extrapolated to other nonprescription omega-3 fatty acids, which typically contain a mixture of EPA and docosahexaenoic acid (DHA).” The guideline adds “although the evidence for IPE to decrease the risk of CV events in patients with ASCVD, or with diabetes and ≥ 1 CVD risk factors is good, it is relatively new and most provincial drug plans do not yet cover this expensive medication.”

One in three South Asians with ASCVD on statins are eligible for icosapent ethyl

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