From the Guidelines
For a patient with high triglycerides and a history of heart valve issues and stroke, Vascepa (icosapent ethyl) is the preferred treatment over Lovaza (omega-3-acid ethyl esters) due to its proven cardiovascular benefits in reducing cardiovascular events, including stroke, as demonstrated in the REDUCE-IT trial 1.
Key Considerations
- Vascepa contains only purified EPA (eicosapentaenoic acid) without DHA (docosahexaenoic acid), which may be advantageous as DHA can potentially raise LDL cholesterol levels.
- The REDUCE-IT trial showed that Vascepa at a dose of 2 grams twice daily reduced triglycerides by 20-30% and provided anti-inflammatory and antithrombotic effects beneficial for patients with prior cardiovascular events 1.
- Common side effects of Vascepa include arthralgia, peripheral edema, and atrial fibrillation, and patients should be monitored for potential bleeding risk, especially if on anticoagulants.
Comparison with Lovaza
- Lovaza (omega-3-acid ethyl esters) is not as effective as Vascepa in reducing cardiovascular events and may not be suitable for patients with established cardiovascular disease.
- The choice between Vascepa and Lovaza should be based on the patient's specific clinical profile and the presence of cardiovascular risk factors.
Clinical Guidance
- Patients with high triglycerides and a history of heart valve issues and stroke should be treated with Vascepa (icosapent ethyl) at a dose of 2 grams twice daily to reduce cardiovascular events.
- Patients should take Vascepa with food to improve absorption and should be monitored for potential bleeding risk, especially if on anticoagulants.
- The use of Vascepa should be considered in the context of overall cardiovascular risk management, including lifestyle modifications and other evidence-based therapies.
From the Research
Comparison of Lovaza and Vascepa for High Triglycerides
- Lovaza and Vascepa are both omega-3 fatty acid formulations used to treat high triglycerides.
- Vascepa, which contains icosapent ethyl, a purified formulation of eicosapentaenoic acid (EPA), has shown compelling evidence in lowering residual cardiovascular risk in patients with hypertriglyceridemia and treated with statins 2.
- In contrast, Lovaza is a combination of EPA and docosahexaenoic acid (DHA), and its effectiveness in reducing cardiovascular risk is less clear.
Patient with History of Heart Valve and Stroke
- Patients with a history of heart valve and stroke are at increased risk of cardiovascular events, and managing their triglyceride levels is crucial to reducing this risk 3.
- The use of omega-3 fatty acid formulations such as Vascepa may be beneficial in reducing residual cardiovascular risk in these patients, especially when used in conjunction with statins 2.
- However, the choice between Lovaza and Vascepa should be based on individual patient needs and medical history, and should be made in consultation with a healthcare provider.
Treatment Options for High Triglycerides
- Fibrates are the best-established agents for triglyceride level lowering and are generally used as first-line treatment of triglyceride levels greater than 500 mg/dL 4.
- Statins are the best-established agents for atherosclerotic cardiovascular disease prevention, and are usually used as first-line treatment of triglyceride levels less than 500 mg/dL 4.
- Omega-3 fatty acid formulations such as Vascepa may be used as an adjunct to statin therapy to further reduce triglyceride levels and cardiovascular risk 2.