Generalizability of the REDUCE-IT trial to South Asians with cardiovascular disease.

Aishwarya Krishnaraj, Ehab Bakbak, Hwee Teoh, Deepak L Bhatt, Adrian Quan, Pankaj Puar, Bhaavani Lambotharan, Aathmika Kirubaharan, Irene N Firoz, Gus Meglis, Bobby Yanagawa, Basel Bari, Rajaratnam Kirubaharan, Ram Vijayaraghavan, David A Hess, Andrew M Demchuk, G B John Mancini, Jean-François Tanguay, Jean-Claude Tardif, Pierre Voisine, Lawrence A Leiter, Subodh Verma

Journal: Med (New York, N.Y.) 2023;4(2):130-138.e1

PMID: 36630964

Free Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

South Asians (SAs) represent ∼25% of the world's population and account for >50% of global cardiovascular (CV) deaths, yet they continue to be underrepresented in contemporary clinical trials. The REDUCE-IT study demonstrated in a high-risk and predominantly White population that icosapent ethyl (IPE) lowered major adverse cardiovascular events by 25%. We sought to determine the generalizability of these results to a high-risk population of SAs with established CV disease living in Canada.

METHODS

This was a cross-sectional observational study of 200 statin-treated SAs (≥45 years) with atherosclerotic CV disease (ASCVD) (NCT05271591). SA ethnicity was self-identified as being of Anglo-Indian, Bangladeshi, Bengali, Bhutanese, Goan, Gujarati, Indian, Jatt, Kashmiri, Maharashtrian, Malayali, Nepali, Pakistani, Punjabi, Sindhi, Sinhalese, Sri Lankan, Tamil, Telugu, or other SA. ASCVD was defined as the presence of coronary, carotid, or peripheral atherosclerosis.

FINDINGS

Mean age of the cohort was 67 years, where 82% were men and 57% had diabetes. The predominant ASCVD phenotype was coronary artery disease (94%). Mean (SD) baseline LDL-C and triglycerides were 1.70 (0.8) mmol/L and 1.42 (1.0) mmol/L, respectively. Three-quarters were on high-intensity statin therapy. According to the Health Canada/Canadian Cardiovascular Society Guidelines and FDA-approved indication, 33% and 25% of the participants were, respectively, eligible for IPE.

CONCLUSIONS

A large proportion of high-intensity, statin-treated, high-risk patients with ASCVD and of self-reported SA ethnicity are eligible for IPE. These data have important translational implications for SAs who are at a disproportionately higher risk of CV morbidity and mortality.

FUNDING

This study was funded by an unrestricted grant provided by HLS Therapeutics Inc, Canada.

Address: Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.; Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada.; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA.; Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada.; North York Diagnostic and Cardiac Centre, Toronto, ON, Canada.; Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.; Markham Health+Plex Medical Centre, Markham, ON, Canada.; Fenton Medical Centre, Markham, ON, Canada.; Scarborough Heart Health Institute, Scarborough Health Network, Scarborough, ON, Canada.; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Robarts Research Institute, and Department of Physiology and Pharmacology, Western University, London, ON, Canada; Division of Vascular Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada.; Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, AB, Canada.; Division of Cardiology and the Centres for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada.; Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada.; Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université Laval, Québec City, QC, Canada.; Division of Endocrinology and Metabolism, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.; Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; North York Diagnostic and Cardiac Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].

DOI: 10.1016/j.medj.2022.12.008

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MeSH Terms: Humans, Cardiovascular Diseases, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Bhutan, India, Cross-Sectional Studies, South Asian People, Canada, Atherosclerosis