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Review
. 2020 Mar;29(1):2-11.
doi: 10.1055/s-0040-1701639. Epub 2020 Feb 25.

Triglycerides and Cardiovascular Outcomes-Can We REDUCE-IT ?

Akshyaya Pradhan  1 , Monika Bhandari  1 , Pravesh Vishwakarma  1 , Rishi Sethi  1
Affiliations
Review

Triglycerides and Cardiovascular Outcomes-Can We REDUCE-IT ?

Akshyaya Pradhan et al. Int J Angiol. 2020 Mar.

Abstract

The causal linkage between triglycerides and coronary artery disease has been controversial. Most of the trials hitherto have shown marginal or no beneficial effects of reduction of triglycerides (with fibrates) on top of low-density lipoprotein (LDL) reduction. But a significant residual cardiovascular risk remains even after use of high dose of statins. Omega-3 fatty acids have been shown to reduce triglyceride levels and some old trials have shown the benefits of fish oils in reducing cardiovascular events. However, barring a few trials most of the large trials of omega-3 fatty acids are negative. Recently, few large trials have been conducted to see the effects of high dose omega-3 fatty acids on cardiovascular outcomes and some of them have shown promising results on top of LDL reduction.

Keywords: cardiovascular disease; omega-3 fatty acids; statins; triglycerides.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Residual CV risk after high dose and primary prevention statin trials. The upper panel ( A ) represents secondary prevention trials of statin therapy while the lower panel ( B ) depicts primary prevention studies. AFCAPS, Air Force Coronary Atherosclerosis Prevention Study; ASCOT LLA, the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm; A to Z, Aggrastat-to-Zocor; CARDS—the Collaborative Atorvastatin Diabetes Study; CARE, cholesterol recurrent events; CV, cardiovascular; IDEAL, incremental decrease in clinical end points through aggressive lipid lowering; LIPID, long-term intervention with pravastatin in ischemic disease; PROVE IT, PRavastatin Or Atorvastatin Evaluation and Infection Therapy; 4S, Scandinavian Simvastatin Survival Study; TNT, treating to new targets; WOSCOPS, the West of Scotland Coronary Prevention Study.
Fig. 2
Fig. 2
Potential benefits of omega-3 fatty acids. hs-CRP, high sensitivity C-reactive protein; ICAM-1, intracellular adhesion molecule 1; IL-6, interleukin-6; IL-10, interleukin-10; Lp-LPA2, lipoprotein lipase 2; MMP, matrix metalloproteinases; ox-LDL-C, oxidized low-density lipoprotein cholesterol.
Fig. 3
Fig. 3
Salient features of REDUCE-IT. CVD, cardiovascular disease; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; JELIS, Japan EPA Lipid Intervention Study; LDL-C, low-density lipoprotein cholesterol; REDUCE-IT, Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial.
Fig. 4
Fig. 4
Reduction in end points in REDUCE-IT. CV, cardiovascular; REDUCE-IT, Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial.
Fig. 5
Fig. 5
Triglyceride lowering efficacy of currently available agents. *—In clinical trials, the efficacy varied with baseline TG levels (>500 mg or <500 mg) and dose of omega-3 FA used (Low: 2 g/d, Mid: 3 g/d, High: 4 g/d). #—The TG lowering was higher with immediate release (20–50%) than an extended release preparation (10–30%). FA, fatty acids; TG, triglyceride.
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