When looking at published CVOT's only Prescription Icosapent Ethyl added to Statin Therapy has been shown to Reduce Cardiovascular Mortality

Cardiovascular death maybe a more patient-centric endpoint than a composite CV endpoint that encompasses CV-related mortality along with nonfatal CV events and procedures.

As someone who has been in the trenches seeing patients on a daily basis for over 35 years few things are as shocking to us Physicians/Providers as having one of our patients die from cardiovascular disease -especially sudden ,unexpected cardiac death.This is why I envisioned this manuscript.

I want to personally thank all my wonderful co-authors for all their work in seeing this manuscript to fruition.

This review found that ezetimibe,evolocumab,alirocumab,and IPE are effective,add-on,lipid-modulating therapies that can address the residual CV risk that persists in patients treated with statins.Additionally ,bempedoic acid reduces CV risk in patients intolerant to statins.Each of these therapies has demonstrated significant reduction in CV risk in their respective CV outcomes trials as measured by primary composite CV endpoints;however,when they are separately examined ,the more patient-centric outcome of CV-related mortality was only significantly reduced by IPE.

Unlike other add-on therapies that primarily exert LDL-C-lowering effects,it is thought that the mechanisms underlying CV risk reduction with IPE are due to the pleiotropic effects of EPA that extend beyond cholesterol and TG lowering.These pleiotropic effects of EPA have been extensively reviewed and include anti-inflammatory,anti-oxidation,anti-arrhythmic,anti-thrombotic,pro-resolvin,anti-platelet mechanisms and cell membrane stability/signaling effects.(Nelson JR et al.Postgrad Med.2021,133(6):651-64)(Trivedi K et al.Postgrad Med.2021,133(1):28-41)

Unfortunately,prescription IPE is under-utilized and using REDUCE-IT USA event rates ,FDA eligibility criteria,and National Health and Nutrition Examination Survey data ,an estimated 4.6 million US adults would be eligible for IPE and 27,377 CV DEATHS would be prevented over 4.9 years(Wong ND et al.Am J.Cardiol.2020,134:62-68.)!!!