Cardiovascular Risk Reduction with Icosapent Ethyl

Bhatt et al. report that long-term supplementation with high doses of EPA reduced the risk of cardiovascular events in high-risk patients. This finding is partially in contrast to the recently reported results of meta-analyses of randomized clinical trials, mainly including trials of lower doses of polyunsaturated fatty acids.1,2 In our opinion, the positive effect observed by Bhatt et al. could have also been mediated by an effect of high doses of EPA on blood-pressure levels, which were not strictly monitored in the trial.3 In a comprehensive meta-analysis on the effects of n−3 fatty acids on blood pressure, including 70 randomized trials with an average dose of n−3 fatty acids of 3.8 g per day, patients with hypertension had a clinically relevant average decrease in systolic blood pressure of 4.5 mm Hg (95% confidence interval [CI], 2.8 to 6.1) and in diastolic blood pressure of 3.0 mm Hg (95% CI, 1.7 to 4.3).4 This effect is not negligible from either a clinical or an epidemiologic point of view.