Chester County Medicine Winter 2020 - 13

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supplemental fish oil in order to reduce the risk of a second
cardiac event. However, despite the high consumer value of this
supplement, data had been lacking on the effect of fish oil on
the prevention of a first heart attack. In 2018, the Journal of the
American Medical Association (JAMA) published a meta-analysis
on the effect of fish oil on cardiovascular health. In this analysis it
was concluded that the consumption of omega-3 fatty acids has
neither a significant effect on the prevention of fatal or non-fatal
coronary heart disease nor reduces the risk of a major vascular
events. Furthermore, this analysis was unable to support previous
findings that fish oil or omega-3 fatty acid supplementation should
be used in patients with a history of CHD.
Gemfibrozil is a lipid reducing agent used in patients with
high triglycerides that also can lower risk of major cardiac events.
A study conducted at the VA in 1999 indicated that use of
Gemfibrozil was associated with a reduced risk in major cardiac
events in patients whose primary lipid imbalance was a low HDL
and high triglycerides. This study was among the first to elucidate
the impact of increasing HDL and reducing triglycerides without
reducing LDL on cardiovascular health - and provide evidence for
a pharmacologic agent that could do so. In addition to Gemfibrozil,
another class of medications called fenofibrates has been used to
lower lipid levels in patients at risk for CVD. As of 2019, the ACC
recommends that fenofibrates be used over Gemfibrozil in patients
who require fibrate therapy.
It has been commonly observed that patients with elevated
triglycerides are at an increased risk for ischemic events. The New
England Journal of Medicine recently published the REDUCE-IT
trial which was conducted by Brigham and Women's Hospital
Heart and Vascular Center and Harvard Medical School. They
studied the impact of using Icosapentethyl (Fig. X) - an ultrapurified omega-3-fatty acid proven to lower triglycerides, in
combination with statin therapy in patients over the age of 45 with
either established CVD or patients over the age of 50 with diabetes
and at least one additional risk factor.

Figure 2: Molecule of Icosapent Ethyl
The study found that patients receiving icosapentethyl in
addition to their statin therapy had a significant reduction in
cardiac events as compared to placebo with statin use. However,
use of icosapentethyl along with statin therapy was associated with
increased risk of hospitalization from atrial fibrillation or atrial
flutter. Additionally, bleeding complications were observed in 2.7%
of patients in the experimental group. The study was conducted
comparing two groups - group A (icosapentethyl + statin use)
and group B (placebo + statin use). Across all endpoints evaluating
cardiovascular health there was a statistically significant reduction in
the number of cardiac events and complications. (Figure 2)
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Chester County Medicine Winter 2020

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