Representatives from the National Lipid Association (NLA) participated in the development of the 2018 American Heart Association/American College of Cardiology/Multisociety Guideline on the Management of Blood Cholesterol, which reaffirmed that lifestyle changes and statin treatment are therapeutic cornerstones for atherosclerotic cardiovascular disease (ASCVD) risk reduction. It also updated prior recommendations to incorporate newer data demonstrating ASCVD risk reduction with ezetimibe and proprotein convertase subtilisin kexin type 9 inhibitors as adjuncts to statin therapy for patients at high and very-high ASCVD risk. The 2018 Guideline was finalized shortly before full results were available from a randomized, placebo-controlled cardiovascular outcomes trial [Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT)] that examined the effects of icosapent ethyl (IPE) 4 g/d on major adverse cardiovascular events in selected high- or very high-risk, statin-treated patients with elevated triglycerides. The primary outcome variable of first major adverse cardiovascular event (cardiovascular death, myocardial infarction, stroke, coronary revascularization and hospitalization for unstable angina) was reduced by 25% (95% confidence interval 17%–32%, P < .001). REDUCE-IT served as the primary basis for the NLA's review of evidence for the use of IPE for ASCVD risk reduction. Based on this review, the NLA position is that for patients aged ≥45 years with clinical ASCVD, or aged ≥50 years with diabetes mellitus requiring medication plus ≥1 additional risk factor, with fasting triglycerides 135 to 499 mg/dL on high-intensity or maximally tolerated statin therapy (±ezetimibe), treatment with IPE is recommended for ASCVD risk reduction (evidence rating: class I; evidence level: B-R).

美国国家脂质协会（NLA）的代表参加了2018年美国心脏协会/美国心脏病学会/血液胆固醇管理多社会指南的制定工作，该指南重申生活方式的改变和他汀类药物的治疗是动脉粥样硬化性心血管疾病的治疗基石（ ASCVD）降低风险。它还更新了先前的建议，以纳入新数据，证明使用依泽替米贝和前蛋白转化酶枯草杆菌蛋白酶kexin 9型抑制剂降低ASCVD风险可作为他汀类药物用于高和极高ASCVD风险患者的辅助治疗。在随机化，安慰剂对照的心血管结果试验[通过使用二十碳五烯乙基干预试验减少心血管事件（REDUCE-IT）]，该试验研究了4 g / d二十碳五烯酸乙酯（IPE）对选定的高危或高危人群的主要不良心血管事件的影响危险，他汀类药物治疗的甘油三酯升高。首次严重不良心血管事件（心血管死亡，心肌梗塞，中风，冠状动脉血运重建和不稳定型心绞痛的住院治疗）的主要结局变量降低了25％（95％置信区间17％–32％，P  <.001）。REDUCE-IT是NLA审查使用IPE降低ASCVD风险的证据的主要依据。根据此评价，NLA的立场是：≥45岁的临床ASCVD或≥50岁的糖尿病患者需要药物加≥1的其他危险因素，高强度时禁食甘油三酸酯为135至499 mg / dL或最大耐受他汀类药物治疗（±ezetimibe），建议采用IPE治疗以降低ASCVD风险（证据等级：I级；证据等级：BR）。