Dr Craig Granowitz PhD
SVP, Chief Medical Officer, Amarin
The European Society of Cardiology (ESC) branded CVD “the biggest epidemic in human history”. It has affected the greatest numbers; it has had the greatest cost and it is not over yet.1
Cardiovascular disease (CVD) is Europe’s biggest killer.1 Each year it accounts for 3.9 million deaths in Europe2 and has an economic burden in the European Union of €210 billion.1
With research showing a clear link between COVID-19 and CVD, Europe’s silent pandemic is being further amplified.
In Ireland, chronic heart disease is one of the top three conditions associated with an increased risk of COVID-19 related ICU admissions, while CVD is also amongst the top three most common underlying health conditions of fatal COVID-19 cases.3 This is supported by analysis from the British Medical Journal and the British Heart Foundation, who found CVD patients are more likely to die as a result of COVID-194 or suffer serious complications.5
Adding to this, the reprioritisation of clinical resources during the current pandemic has led CVD patients to delay much needed medical help or diagnosis, worsening their cardiac conditions.6
The growing scale of the crisis has resulted in increasing calls among industry experts to tackle CVD differently. The ESC and European Heart Network have recently called for urgent Government action across the EU to improve the care of CVD patients to prevent an even greater future crisis.7
The reprioritisation of clinical resources during the current pandemic has led CVD patients to delay much needed medical help or diagnosis, worsening their cardiac conditions.6
The hidden risk
As part of the ongoing debate over Government intervention and therapy options, it is important to acknowledge that the current treatment options do not fully address cardiovascular risk.
Lowering low-density lipoprotein (LDL) levels has been the major focus of treatment for the past 30 years and statins have been the first line of treatment to achieve this.8,9 While statins have an important role to play, they are not the panacea many people seem to think.
LDL-cholesterol is not the whole story; patients are still dying of heart attacks and strokes and the residual risk remains unresolved. Various primary and secondary prevention trials have shown a significant reduction of 25% to 35% in the risk of cardiovascular events with statin therapy, leaving a residual risk beyond LDL-cholesterol control of 65% to 75%.9-12
To tackle this growing crisis, preventative care, alongside LDL-cholesterol management, must be prioritised for at-risk CVD patients.13 There is a clear need for pragmatic new options, proven to treat high-risk patients on statins. We need to think beyond LDL reduction to tackle the problem and take a closer look at elevated triglycerides as a marker of residual cardiovascular risk.
Rethinking cardiovascular risk
Recent breakthroughs in clinical research have shown that there are new treatment solutions available. The landmark REDUCE-IT study showed icosapent ethyl could significantly reduce the incidence of cardiovascular death, strokes and heart attacks for statin-treated patients with untreated residual CV risk, identified by elevated triglycerides.14 High triglyceride levels are a common warning sign of cardiovascular risk, despite statin therapy and controlled LDL-cholesterol.15,16
The REDUCE-IT study found that icosapent ethyl achieved a 25% relative risk reduction for serious cardiovascular events for high-risk statin-treated patients with elevated triglycerides, corresponding to an absolute risk reduction of 4.8%.14
Two major European medical societies, the ESC and European Atherosclerosis Society (EAS) recommend the usage of icosapent ethyl in appropriate patients, in addition to 15 other medical societies across the globe.13,17
This new treatment has the potential to benefit patients across Europe and Ireland who are at high risk of a potentially fatal cardiovascular event. As the COVID-19 vaccine programme continues to rollout and something resembling normality starts to emerge, now is the time to rethink cardiovascular care in Europe, using new scientifically proven insights and treatment strategies, to ultimately save patients’ lives and provide a sense of relief from the burden of living with CVD.
 European Society of Cardiology. ESC Cardiovascular Realities 2020. https://www.flipsnack.com/Escardio/esc-cardiovascular-realities-2020/full-view.html Accessed May 2021
 European Heart Network. European Cardiovascular Disease Statistics 2017. https://ehnheart.org/cvd-statistics/cvd-statistics-2017.html Accessed May 2021
 The Irish Times. Covid-19 carries higher risk for morbidly obese men with heart disease – study. https://www.irishtimes.com/news/health/covid-19-carries-higher-risk-for-morbidly-obese-men-with-heart-disease-study-1.4548050 Accessed May 2021
 Bae S, Kim SR, Kim M et al. Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis. Heart. 2021;107:373-380 5. British Heart Foundation. Coronavirus: what it means for you if you have heart or circulatory disease. https://www.bhf.org.uk/informationsupport/heart-matters-
 British Heart Foundation. Coronavirus: what it means for you if you have heart or circulatory disease. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health#Heading1 Accessed May 2021
 Fersia O, Bryant S, Nicholson R, et al. The impact of the COVID-19 pandemic on cardiology services. Heart. 2020;7:e001359
 European Society of Cardiology. Fighting cardiovascular disease – a blueprint for EU action. https://www.escardio.org/The-ESC/Advocacy/fighting-cardiovascular-disease-a-blueprint-for-eu-action Accessed May 2021
 Ballantyne CM, Bays HE, Kastelein JJ, et al. Efficacy and safety of eicosapentaenoic acid ethyl ester (AMR101) therapy in statin-treated patients with persistent high triglycerides (from the ANCHOR study). Am J Cardiol. 2012;110:984-92
 Ganda OP, Bhatt DL, Mason RP. Unmet Need for Adjunctive Dyslipidemia Therapy in Hypertriglyceridemia Management. J Am Coll Cardiol. 2018;72(3):330-343
 Hong KN, Fuster V, Rosenson RS, Rosendorff C, Bhatt DL. How low to go with glucose, cholesterol, and blood pressure in primary prevention of CVD. J Am Coll Cardiol. 2017 Oct 24;70(17):2171-85
 Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy Lancet. 2016 Nov