Clinical trials of eicosapentaenoic acid (EPA) prescription products for the treatment of hypertriglyceridemia

ABSTRACT

Introduction: Hypertriglyceridemia is common and increases cardiovascular risk. Fish oil decreases triglyceride levels, but also increases low-density lipoprotein (LDL) cholesterol, which may negate any cardiovascular benefits. EPA, a component of fish oil, reduces triglyceride levels without increasing LDL cholesterol.

Areas covered: Two forms of purified EPA ethyl ester are available on prescription. This review considers the clinical trials of these purified esters to treat hypertriglyceridemia and shows that the EPA ethyl esters reduce triglyceride levels and reduce cardiovascular events.

Expert opinion: To date, the effects of the purified EPA ethyl esters on cardiovascular events have only been tested in subjects taking statins. With statin treatment, if hypertriglyceridemia persists, it may be worthwhile considering adding an EPA ethyl ester. However, as the fibrates reduce the triglyceride levels by similar amounts to the EPA ethyl esters, while increasing the levels of HDL cholesterol, they are an alternative to EPA ethyl esters in combination with statins. As the proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors reduce triglycerides to a similar extent to the EPA ethyl ester, while reducing LDL cholesterol levels to a greater extent than the statins, they should be considered as an alternative to the statin/EPA ethyl ester combination.

KEYWORDS:

• Cardiovascular
• clinical trials
• eicosapentaenoic acid
• hypertriglyceridemia
• icosapent ethyl
• ethyl icosapentate
• LDL cholesterol

Article highlights

• Despite widespread statin use, heart disease and stroke remain leading causes of death.

• Hypertriglyceridemia is common and increases cardiovascular risk.

• Eicosapentaenoic acid (EPA) reduces triglyceride levels without increasing LDL cholesterol.

• In clinical trials, EPA ethyl esters reduce triglyceride levels and reduce cardiovascular events.

• More studies are needed to determine how the EPA ethyl esters should be used in practice.

This box summarizes key points contained in the article.

Declaration of interest

This author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.