REDUCE-IT: high-dose EPA in people with high triglycerides

What does the research say?

In people with heart disease or diabetes, raised triglycerides and already taking statins, a prescription-strength dose of purified EPA (a type of omega-3) reduced heart attacks, strokes and other cardiovascular events by about a quarter compared with placebo.

The science

Participants were randomised to 4 g a day of icosapent ethyl, a highly purified EPA medicine, or a mineral oil placebo, and followed for a median of about 5 years.

The main combined outcome (cardiovascular death, heart attack, stroke, procedures to open arteries and unstable angina) occurred in 17.2% of the EPA group and 22.0% of the placebo group, a 25% relative reduction.

Key findings

• 25% relative reduction in major cardiovascular events.
• Benefits were seen in people already on statins.
• Slightly more hospital admissions for atrial fibrillation in the EPA group.

Limitations

• This was a prescription medicine at a high dose, not fish oil capsules or oily fish.
• The mineral oil placebo may have slightly raised cholesterol in the control group, which could exaggerate the benefit.
• Only high-risk people with raised triglycerides were included.
• High-dose omega-3 should only be taken under medical supervision.

References

1. Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380(1):11–22. doi.org/10.1056/NEJMoa1812792