(P205) TREATMENT IMPLICATIONS OF THE REDUCE-IT RESULTS TO PEOPLE OF SOUTH ASIAN (SA) DESCENT LIVING IN CANADA WITH KNOWN ATHEROSCLEROTIC CARDIOVASCULAR DISEASE(THE REDUCE-IT CANADA SA STUDY)

Background: The REDUCE-IT trial demonstrated that icosapent ethyl (IPE), a highly purified eicosapentaenoic acid ethyl ester, lowers cardiovascular (CV) events and CV death in statin-treated individuals with mild-moderate hypertriglyceridemia, relatively well-controlled low-density lipoprotein cholesterol (LDL-C) levels and with either known CV disease or diabetes with other risk factors. Inasmuch as over 90% of the REDUCE-IT cohort were White, the generalization of its results to non-White populations is unclear. Compared with White individuals and other races/ethnicities, people of South Asian (SA) descent have higher levels of triglycerides and are at a markedly higher risk of developing atherosclerotic cardiovascular disease (ASCVD). Given that SAs represent the largest visible minority in Canada, the overarching goal of the REDUCE-IT Canada SA study was to determine eligibility for use of IPE for residual CV risk reduction in SAs in Canada who have ASCVD.

METHODS AND RESULTS: The REDUCE-IT Canada SA study enrolled 200 SA individuals (≥45 years) with ASCVD on stable statin therapy from 4 community cardiology (65%) and 2 family practice (35%) clinics across the Greater Toronto Area. Race/ethnicity and medical coverage status were self-reported; all other variables were extracted from medical records. Most (82%) were men; 57% had known diabetes. The median [IQR] age, body mass index, A1C, LDL-C, high-density lipoprotein cholesterol, and triglyceride levels for the cohort were 67 years (59.8, 74.0), 26.0 kg/m2 (23.8, 28.4), 6.5% (5.9, 7.3), 1.5 mmol/L (1.1, 2.0), 1.1 mmol/L (1.0, 1.3), and 1.2 mmol/L (0.9, 1.7), respectively. Despite most being on guideline-recommended lipid-lowering therapies - 75% on a high-intensity statin, 18% on ezetimibe, and 4% on a proprotein convertase subtilisin/kexin type 9 serine protease (PCSK9) inhibitor - 33% of the REDUCE-IT Canada SA cohort fulfilled the Health Canada and 2021 Canadian Cardiovascular Society (CCS) Dyslipidemia Guidelines eligibility criteria for IPE therapy. Less than one-quarter (22%) of this contemporary cohort of SAs reported having access to private health insurance, while 33% described challenges covering the cost of medication.

Conclusion: Even though the lipid levels of the REDUCE-IT Canada SA participants were generally well managed, our data suggest that approximately one-third of this ASCVD cohort would be eligible for IPE according to Health Canada and the 2021 CCS Dyslipidemia Guidelines. Strategies aimed at improving access to IPE may offer additional opportunities to reduce vascular events in SAs who are recognized as a high-risk population.