Published on November 24, 2020

Patients at high risk of ischemic events see 25% overall decreased risk among those taking 4g icosapent ethyl (E-EPA) per day

Ischemic events, “ischemic” meaning blocked blood and oxygen, are health consequences having to do with the heart, blood vessels, and blood supply, and include events such as heart attack, stroke, and angina. There have been many studies on the benefits of omega-3 fatty acids for cardiovascular health and the prevention of ischemic events. A meta-analysis of 40 randomized controlled trials that used supplementation of EPA and DHA found a preventive effect of supplementation on cardiovascular disease (CVD), with a stronger effect associated with higher doses especially for CVD events and heart attack. Another study found a significantly lower risk for all-cause mortality, cardiovascular disease mortality, and death from heart attack among habitual fish oil users. The VITAL trial, which focused on cancer and cardiovascular health, found several significant benefits among those assigned to omega-3s (1000 mg/day) vs. placebo.

These studies and more have shown that the intake of omega-3 fatty acids, specifically DHA and EPA, may benefit cardiovascular health and help prevent disease risk, as well as mortality. The following study was designed to test the effects of icosapent ethyl, a slightly modified, highly purified version of the omega-3 fatty acid eicosapentaenoic acid ethyl ester (E-EPA). One of its known effects is to lower triglyceride levels and therefore help prevent ischemic events.

REDUCE-IT Trial Determines Effect of E-EPA on Ischemic Events

Bhatt et al. conducted a study named REDUCE-IT – a multicenter, randomized, double-blind, placebo controlled trial. Trial enrollees included 8179 patients from 473 different sites in 11 countries, all who had either previous diagnoses of cardiovascular disease, or diabetes with an additional cardiovascular risk factor. The median age was 64 years. All patients were also on statins and had to have certain cholesterol blood markers in order to qualify for the study. Patients were then randomized to receive either 4g icosapent ethyl per day (2g twice daily) or placebo. Patients were then followed for a median of 4.9 years to see whether or not they experienced ischemic events, such as cardiovascular death, nonfatal heart attack, nonfatal stroke, and other outcomes involving cardiovascular health.

What were the results of this study?

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A total of 1606 of the tracked ischemic events occurred among all patients. Among those in the group receiving icosapent ethyl, 17% experienced one of the ischemic events listed above, compared to 22% in the placebo group – there was an overall 25% lower risk among the icosapent ethyl group (p<0.001).

Specifically, the icosapent ethyl group saw a 31% lower risk of having a fatal or nonfatal heart attack, a 35% lower risk of urgent or emergency revascularization (meaning the blood supply was restored), 20% lower risk of cardiovascular death, 32% lower risk of hospitalization for unstable angina, and a 28% lower risk for having a fatal or nonfatal stroke. Also seen after 1 year (from baseline) was a median drop in triglyceride level of 18% in the icosapent ethyl group, and a median increase of 2% in the placebo group (p<0.001).

In summary, this study found that among those with high triglyceride levels who were on statins and at risk of major ischemic events, taking 4g per day of a slightly modified, purified form of the essential fatty acid EPA significantly lowered the risk of ischemic events, including cardiovascular death.

How to Know You’re Getting Enough Omega-3s?

The only way to make sure that your target level of omega-3s has been reached is to measure your Omega-3 Index. If your resulting level is below your target, using the Omega-3 Calculator to help determine a new supplementation amount along with information provided on how to support and maintain a healthy omega-3 level. Re-testing after 3 to 6 months allows you to ensure your target has been reached, or gives you the opportunity to adjust your routine as needed.

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