Abstract Background and aims Patients with prior cerebrovascular accident (CVA) or transient ischaemic attack (TIA) remain at substantial residual atherosclerotic cardiovascular disease risk despite standard secondary lipid prevention. National Health Service (NHS) priorities and NICE/European stroke guidance emphasise comprehensive, patient-centred risk reduction in primary care, including optimisation of lipid pathways beyond low-density lipoprotein cholesterol (LDL-C). This review explored patients' understanding, confidence, and support needs regarding icosapent ethyl as part of secondary residual risk reduction associated with raised triglycerides in rural England. Methods An anonymised electronic survey was distributed to patients prescribed icosapent ethyl in primary care. The survey captured quantitative responses on knowledge, confidence and concerns, alongside free-text qualitative comments. Ethical approval was obtained, and consent recorded. Descriptive statistics were used for quantitative items, and thematic analysis was applied to qualitative responses. Results 167 patients responded (98.2% consent). Most had been taking icosapent ethyl for 6 months (86%) and were prescribed the therapy in general practice (94%). While 50% felt confident taking the medication, 55.6% reported limited understanding of its mechanism of action, and 25% correctly identified raised TGs as its indication. The most common concerns were related to effectiveness and polypharmacy. Qualitative themes highlighted a desire for a more precise explanation of personal residual risk, reassurance about the benefits, and accessible information on monitoring/safety. Conclusions In rural primary care stroke/TIA populations, a confidence–comprehension gap exists around residual risk management. Aligning NHS priorities with NICE/European guidance requires improved patient-centred education, written resources and structured reviews to support sustained, informed residual risk reduction. Conflict of interest Dr C Deaney has received honoraria/grants from Amarin, Amenarini, AZ, Chiesi, Daiichi Sankyo, Ferring, GSK, Idorsia, Novartis, and Novo Nordisk.
Carl Deaney (Fri,) studied this question.