TY - JOUR
T1 - Association between REDUCE-IT criteria, coronary artery disease severity, and cardiovascular events
T2 - the Western Denmark Heart Registry
AU - Mortensen, Martin Bødtker
AU - Dzaye, Omar
AU - Razavi, Alexander C.
AU - Jensen, Jesper Møller
AU - Steffensen, Flemming Hald
AU - Bøtker, Hans Erik
AU - Cainzos-Achirica, Miguel
AU - Sørensen, Henrik Toft
AU - Maeng, Michael
AU - Blaha, Michael J.
AU - Nasir, Khurram
AU - Nørgaard, Bjarne Linde
N1 - Funding Information:
Conflict of interest: Michael Blaha reports grants from the National Institutes of Health, US Food and Drug Administration, American Heart Association, and Aetna Foundation; grants and personal fees from Amgen; and personal fees from Sanofi, Regeneron, Novartis, Bayer, and Novo Nordisk outside the submitted work. The other authors have reported that they have no relationships relevant to the contents of this article to disclose.
Funding Information:
This study was funded by Aarhus University Hospital.
Publisher Copyright:
© 2022 The Author(s).
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Aims: The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) trial demonstrated that icosapent ethyl lowered the risk of atherosclerotic cardiovascular disease (ASCVD) among patients with elevated triglycerides. However, how to appropriately implement its use in clinical practice is not well-defined. We aimed to determine whether plaque burden as assessed by coronary artery calcium (CAC) could stratify ASCVD risk among patients eligible for icosapent ethyl. Methods and results: Among 23 759 patients who underwent computed tomography angiography (CTA) in the Western Denmark Heart Registry, we identified eligibility for the REDUCE-IT trial. A total of 2146 participants (9%) met enrolment criteria for REDUCE-IT. During a median of 4.3 years of follow-up, 146 ASCVD events occurred. Overall, there was a stepwise increase in ASCVD event rates per 1000 person-years with increasing CAC (CAC = 0: 10.5, CAC 1-299: 18.7, CAC ≥300: 49.8). REDUCE-IT-eligible patients with CAC ≥300 had a multivariable-adjusted hazard ratio of 3.1 compared with CAC = 0 (95% confidence interval: 1.9-4.9). Coronary artery calcium differentiated risk similarly in patients with and without obstructive coronary artery disease (CAD). Overall, the 5-year estimated number needed to treat to prevent one event with icosapent ethyl was 45 and ranged from 87 in those with CAC = 0 to 17 in those with CAC ≥300. Some patients with non-obstructive CAD had lower estimated number needed to treat than patients with obstructive CAD when their plaque burden was higher. Conclusion: Atherosclerotic plaque burden as assessed by CAC can identify REDUCE-IT-eligible patients who are expected to derive most, and least, absolute benefit from treatment with icosapent ethyl regardless of obstructive versus non-obstructive CAD status.
AB - Aims: The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) trial demonstrated that icosapent ethyl lowered the risk of atherosclerotic cardiovascular disease (ASCVD) among patients with elevated triglycerides. However, how to appropriately implement its use in clinical practice is not well-defined. We aimed to determine whether plaque burden as assessed by coronary artery calcium (CAC) could stratify ASCVD risk among patients eligible for icosapent ethyl. Methods and results: Among 23 759 patients who underwent computed tomography angiography (CTA) in the Western Denmark Heart Registry, we identified eligibility for the REDUCE-IT trial. A total of 2146 participants (9%) met enrolment criteria for REDUCE-IT. During a median of 4.3 years of follow-up, 146 ASCVD events occurred. Overall, there was a stepwise increase in ASCVD event rates per 1000 person-years with increasing CAC (CAC = 0: 10.5, CAC 1-299: 18.7, CAC ≥300: 49.8). REDUCE-IT-eligible patients with CAC ≥300 had a multivariable-adjusted hazard ratio of 3.1 compared with CAC = 0 (95% confidence interval: 1.9-4.9). Coronary artery calcium differentiated risk similarly in patients with and without obstructive coronary artery disease (CAD). Overall, the 5-year estimated number needed to treat to prevent one event with icosapent ethyl was 45 and ranged from 87 in those with CAC = 0 to 17 in those with CAC ≥300. Some patients with non-obstructive CAD had lower estimated number needed to treat than patients with obstructive CAD when their plaque burden was higher. Conclusion: Atherosclerotic plaque burden as assessed by CAC can identify REDUCE-IT-eligible patients who are expected to derive most, and least, absolute benefit from treatment with icosapent ethyl regardless of obstructive versus non-obstructive CAD status.
KW - Cardiovascular disease risk
KW - Cohort study
KW - Computed tomography angiography
KW - Coronary artery calcium
KW - Coronary artery disease
KW - Epidemiology
KW - Obstructive vessel disease
KW - Calcium
KW - Humans
KW - Triglycerides
KW - Plaque, Atherosclerotic
KW - Coronary Artery Disease/diagnostic imaging
KW - Denmark/epidemiology
KW - Vascular Calcification/diagnostic imaging
KW - Atherosclerosis
KW - Registries
KW - Risk Assessment/methods
KW - Coronary Angiography/methods
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U2 - 10.1093/eurjpc/zwac104
DO - 10.1093/eurjpc/zwac104
M3 - Article
C2 - 35653637
AN - SCOPUS:85140274507
SN - 2047-4873
VL - 29
SP - 1802
EP - 1810
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 13
ER -