The Work Group also considered the potential harm of adverse events. Patient values and preferences could not be estimated. Finally, the drug will likely be expensive and patient/provider acceptability may be low if the adverse event rate continues to be high. Thus, the Work Group decided upon a Neither for nor against recommendation. There is a need for a larger secondary prevention study of bempedoic acid as an add-on to statins. The study should have longer follow-up and be appropriately powered for adverse events and important clinical outcomes (e.g., fatal and non-fatal stroke, MI, and mortality). Recommendation 18. For primary prevention, there is insufficient evidence to recommend for or against icosapent ethyl in patients on statin therapy with persistently elevated fasting triglycerides. (Neither for nor against | Reviewed, New-added) 19. For secondary prevention, we suggest offering icosapent ethyl in patients on statin therapy with persistently elevated fasting triglycerides >150 mg/dL to reduce cardiovascular morbidity and mortality. (Weak for | Reviewed, New-added) Discussion Icosapent ethyl is a purified ethyl ester of the omega-3 fatty acid eicosapentaenoic acid (EPA). At the time of our systematic evidence review, the body of evidence examining the potential effects of icosapent ethyl on critical CV outcomes was limited to a single randomized trial. In this double-blinded, placebo-controlled trial by Bhatt et al. (2019), Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial (REDUCE-IT), treatment with 4 grams of icosapent ethyl resulted in a 25% reduction in the primary endpoint defined as a combination of vascular death, non-fatal MI, non-fatal stroke, coronary revascularization, or unstable angina over 4.9 years (NNT=21).[99] The results from REDUCE-IT may not be generalizable to all patients represented in the spectrum of CV risk. 