Icosapent ethyl plus statins reduces total plaque volume

The pre-specified, interim, 9-month follow-up analysis from the EVAPORATE trial suggests that icosapent ethyl 4 g/day did not reduce low attenuation plaque volume compared with placebo, although it did reduce total plaque volume, as assessed by coronary CT angiography.

Prof. Matthew J. Budoff (UCLA, USA) presented the early results from EVAPORATE, which aimed to assess the efficacy of icosapent ethyl in addition to statin therapy in reducing plaque burden among patients with known angiographic coronary artery disease [1].

Patients between 30-85 years of age with persistently high triglycerides (135-499 mg/dL) were randomised 1:1 to either icosapent ethyl 4 g/day (n=40) or placebo (n=40). In each arm, 30% had a family history of coronary artery disease. The primary outcome was the percentage change in low attenuation plaque volume.

At 9 months follow-up, the primary outcome was not met; the icosapent ethyl arm had 94% change in low attenuation plaque volume, whereas participants in the placebo arm had a mean 74% change (P=0.47). No differences were observed either for the secondary outcome of change in fibrofatty plaque volume: 25% versus 87% (P=0.65). However, the other secondary outcome of total plaque volume was significantly reduced by 26% in the icosapent ethyl arm versus 15% in the placebo arm (P=0.0004).

In conclusion, the results of this trial at 9 months indicate that icosapent ethyl 4 g/day does not reduce low attenuation plaque volume compared with placebo but does reduce total plaque volume, as assessed by coronary CT angiography. The planned total duration of follow-up is 18 months, which may yet alter these preliminary data analysed at 9 months.

1. Budoff MJ, et al. EVAPORATE- Effect of icosapent ethyl on progression of coronary atherosclerosis in patients on statin therapy with elevated triglycerides. LBS06, AHA Scientific Sessions 2019, 14-18 November, Philadelphia, USA.



Posted on 26 February 202027 March 2024