The ink was barely dry on the 2018 American Heart Association (AHA) and American College of Cardiology (ACC) cholesterol management guidelines1 when new evidence from the REDUCE-IT trial supported a possible role for icosapent ethyl in reducing cardiovascular risk in patients with persistent hypertriglyceridaemia despite the use of statins.2 As a result, the ACC has produced further guidance on the management of patients with persistent hypertriglyceridemia,3 as Dr Michael Miller, Professor of Cardiovascular Medicine at the University of Maryland, Baltimore, USA, and co-author of the publication explains.