Cardiovascular Journal of Africa: Vol 32 No 2 (MARCH/APRIL 2021)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 2, March/April 2021 AFRICA 61
CIED, and which may include the initiation of anticoagulation
in higher-risk patients.
Philasande Mkoko, MB ChB, MMed, FCP, Cert Card,
Ashley Chin, MB ChB, MPhil, FCP, Cert Card, EHRS
Department of Medicine, Division of Cardiology, University of
Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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Omega-3 based medicine plus statins may lower stroke risk another 36%
Taking the triglyceride-lowering prescription medicine
icosapent ethyl cut the risk of stroke by an additional 36%
in people at increased risk of cardiovascular disease who
already have their bad cholesterol levels under control using
statin medications, according to preliminary research to be
presented at the American Stroke Association’s International
Stroke Conference 2021. The study’s results do not apply to
supplements available over the counter, stressed the statement
released by the American Stroke Association.
‘Icosapent ethyl is a new way to further reduce the risk
of stroke in patients with atherosclerosis or who are at high
risk of stroke, who have elevated triglyceride levels and
are already taking statins,’ said Dr Deepak L Bhatt, lead
author of the study and executive director of interventional
cardiovascular programmes at the Brigham and Women’s
Hospital Heart & Vascular Centre in Boston.
Icosapent ethyl is a prescription medication that is a highly
purified formof the omega-3 fatty acid eicosapentaenoic acid.
‘It is very different in terms of purity compared to omega-3
fatty acid supplements available over the counter, and these
results do not apply to supplements,’ said Bhatt, who is also
professor of medicine at Harvard Medical School.
Icosapent ethyl was first approved in July 2012 by the US
Food and Drug Administration as an adjunct treatment to
dietary changes to lower triglycerides in people with extremely
high levels of triglycerides (higher than 500 mg/dl = 5.65 mmol/l).
Triglycerides are fats from food that are carried in the blood;
normal levels for an adult are below 150 mg/dl (1.7 mmol/l).
In late 2018, the REDUCE-IT trial, an 8 000-person
multinational study, demonstrated that icosapent ethyl could
benefit people with heart disease, diabetes or triglyceride levels
above 150 mg/dl and whose low-density lipoprotein (LDL)
(bad) cholesterol levels were already under control using statin
medication. In the trial, adding icosapent ethyl (compared with a
placebo) reduced the risk of serious cardiovascular events (heart
attack, heart-related death, stroke, need for an artery-opening
procedure or hospitalisation for heart-related chest pain) by 25%.
In December 2019, the FDA approved icosapent ethyl as
a secondary treatment to reduce the risk of cardiovascular
events among adults with elevated triglyceride levels, and it is
now recommended in some professional guidelines. Icosapent
ethyl is not included in the American Heart Association’s
2018 cholesterol guidelines that were published online prior
to the availability of the REDUCE-IT primary results.
In the current analysis, REDUCE-IT Stroke, researchers
performed an additional analysis of the impact of icosapent
ethyl on stroke in the same 8 000 participants of the original
REDUCE-IT trial. They found the risk of a first fatal or
non-fatal ischaemic stroke was reduced by 36% for patients
treated with icosapent ethyl; for every 1 000 patients treated
with icosapent ethyl for five years, about 14 strokes were
averted; and the risk of a bleeding stroke was very low, and
no difference was found among those taking icosapent ethyl.
‘Know your triglyceride levels. If they are elevated, ask
your doctor if you should be taking icosapent ethyl to further
reduce your risk of heart attack and stroke,’ Bhatt said.
‘Your doctor may also recommend that you change your
diet, exercise, lose weight if needed to lower your triglyceride
levels, and may prescribe a statin medication if you need to
lower your LDL cholesterol levels.’
‘One study limitation is that icosapent ethyl may increase
the risk of minor bleeding,’ Bhatt added.
Source: Medical Brief 2020