Cardiovascular Disease Management with Vascepa

Patient Eligibility and Treatment Guidelines

The American College of Cardiology recommends adding Vascepa (icosapent ethyl) 4 g/day to patients with established cardiovascular disease or diabetes with additional risk factors, who are on statin therapy with controlled LDL-C (41-100 mg/dL), and have persistently elevated triglycerides (≥135 mg/dL) 1, 2
The American Heart Association suggests considering icosapent ethyl as first-line therapy for patients with type 2 diabetes and coronary artery disease whose triglycerides remain elevated (>135 mg/dL) despite maximally tolerated statin and lifestyle changes 2, 5
Patients should have optimized lifestyle modifications (diet, weight loss, alcohol reduction) before initiating icosapent ethyl therapy 1, 6

The REDUCE-IT trial demonstrated a 25% relative risk reduction in the primary composite endpoint (cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina) with icosapent ethyl 4 g/day 1
Icosapent ethyl 4 g/day reduced the key secondary endpoint of cardiovascular death, nonfatal MI, or nonfatal stroke by 26% 1, 7
A 20% reduction in cardiovascular mortality was observed with icosapent ethyl 4 g/day 1, 7
The American Diabetes Association and American College of Cardiology recommend icosapent ethyl for cardiovascular risk reduction in patients with diabetes and established cardiovascular disease 8, 3, 7

The recommended dose of icosapent ethyl is 2 g twice daily (total 4 g/day) with food, as demonstrated in the REDUCE-IT trial 7

Icosapent ethyl 4 g/day reduces median triglycerides by approximately 19-20% 1, 8
No increase in LDL-C is observed with icosapent ethyl 4 g/day 1
Icosapent ethyl 4 g/day reduces non-HDL-C by approximately 13% 1

Monitor patients for atrial fibrillation/flutter, as the risk increased from 2.1% with placebo to 3.1% with icosapent ethyl (P=0.004) 1, 7
Monitor patients for bleeding, as serious bleeding events occurred in 2.7% versus 2.1% with placebo (P=0.06) 1

The REDUCE-IT results should not be extrapolated to other omega-3 fatty acid products, as icosapent ethyl is a high-purity EPA ethyl ester (≥96% EPA) without DHA 7, 9
The STRENGTH trial using a different omega-3 carboxylic acid formulation (containing both EPA and DHA) showed no cardiovascular benefit (HR 0.99, P=0.84) 1