Tools for Practice Outils pour la pratique

#277 Somethin’ Fishy: Prescription variants of Omega-3 to prevent cardiovascular disease 

Do prescription variants of omega-3’s, like icosapent, reduce the risk of cardiovascular events when added to statins?

In high risk patients, icosapent reduced cardiovascular events to 17% from 22% on placebo after 5 years. In lower risk patients, Eicosapentaenoic Acid (EPA) ethyl ester reduced major cardiovascular events to 2.8% from 3.5% with control after 5 years. Whether these products differ from each other or traditional omega-3 fatty acids (that don’t show cardiovascular benefit) is unknown. Cost will likely limit use.  

CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

Focusing on patient-oriented outcomes from large randomized controlled trials (RCTs) where prescription EPA products were added to statins. 
  • Icosapent: 
    • REDUCE-IT:18179 patients (70% secondary prevention), randomized to icosapent 2g twice daily or placebo. Mean age 64 years, 72% male. After ~5 years: 
      • Composite of cardiovascular events: 17.2% versus 22.0% placebo. Number needed to treat (NNT)=21. 
      • All-cause mortality: 6.7%, versus 7.6% placebo; no difference. 
      • Atrial fibrillation: 5.3% versus 3.9% placebo; number needed to harm (NNH)=71. 
    • EPA ethyl ester: 
      • JELIS:218,645 Japanese (~80% primary prevention) patients with total cholesterol >6.5mmmol/L, randomized (open label) to EPA ethyl ester 1.8 g/day plus statin or statin alone. Mean age 61, 69% female. After ~5 years: 
        • Major coronary events: 2.8% EPA versus 3.5% (NNT=143). 
        • All-cause mortality: no difference. 
        • Adverse events leading to discontinuation: 11.7% EPA ethyl ester plus statin versus 7.2% statin (NNH=23). 
  • Traditional Omega-3’s are made up of EPA and decosahexaenoic acid (DHA). 
    • Icosapent is an ethyl form of EPA,1 a type of long chain omega-3 fatty acid.3 
    • Systematic reviews of omega-3's do not generally find benefit in the prevention of cardiovascular disease4,5 particularly when examining high quality studies.5 
  • Evidence gaps include: 
    • A small secondary prevention trial has not been published.6 
    • Additional trials evaluating EPA on cardiovascular outcomes are not being conducted.7 
    • No studies compare EPA products. 
    • Concerns exist with approving medications on single trial results.8 
  • Only icosapent is approved in Canada.9 
    • Cost (~$3600/year) requires >40% reduction to approach cost effectiveness.10 

Latest Tools for Practice
Derniers outils pour la pratique

#359 Topical corticosteroids for atopic dermatitis - More than skin deep

What are the benefits/harms of topical corticosteroids for atopic dermatitis in adults/children?
Read Lire 0.25 credits available Crédits disponibles

#358: Any berry good solutions to preventing UTIs: Cranberries?

Do cranberry products prevent recurrent urinary tract infections (UTIs)?
Read Lire 0.25 credits available Crédits disponibles

#357: Overcoming Resistance: Antipsychotics for difficult to treat depression

In patients with treatment-resistant depression, is adding an atypical antipsychotic to current therapy safe and effective?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

  • Allison Paige MD CCFP
  • Joey Ton PharmD
  • Michael R Kolber MD CCFP MSc

1. Bhatt DL, Steg PG, Miller M, et al. N Engl J Med. 2019; 380(1):11-22.

2. Yokoyama M, Origasa H, Matsuzaki M, et al. Lancet. 2007; 369(9567):1090-8.

3. Brinton EA, Mason RP. Lipids Health Dis. 2017; 16:23.

4. Aung T, Halsey J, Kromhout D, et al. JAMA Cardiol. 2018; 3:225-34.

5. Abdelhamid AS, Brown TJ, Brainard JS, et al. Cochrane Database Syst Rev. 2020; 3(2):CD003177.

6. NIH. U.S. National Library of Medicine. Trial # NCT03192579. Available at Accessed Oct 30, 2020.

7. NIH. U.S. National Library of Medicine. Available at Accessed Oct 30, 2020.

8. Haslam A, Prasad V. Circ Cardiovasc Qual Outcomes. 2019;12:e005494.

9. Health Canada Prescription Drug List (PDL): Multiple additions. Available at: Accessed Sept 29, 2020.

10. Canadian Agency for Drugs and Technologies in Health. Available at: Last accessed: Sept 8, 2020.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.