Studies find greater risk reduction following treatment of patients with dyslipidemia.
Patients who have type 2 diabetes are at high risk for cardiovascular disease. Although medications such as statins can help reduce this cardiovascular complication, it is still important to consider other treatment options that can further reduce this risk. One such class of medication is fibrates, which helps reduce plasma triglycerides and also helps increase HDL cholesterol. The American Diabetes Association guideline recommends statin and fibrate combination therapy in type 2 diabetes patients with triglycerides > 2.3 mmol/L and HDL less than 0.9 mmol/L. The goal of this study was to estimate the individual treatment effect of fenofibrate on major cardiovascular events in patients with type 2 diabetes. They analyzed the results from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD), the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trials, and the Second Manifestations of ARTerial disease (SMART) study.
In FIELD study, the effect of fenofibrate was evaluated in a total of 9,795 patients with type 2 diabetes who were not taking the statin therapy. The primary outcome for this study was coronary events, including myocardial infarction, and results showed that this occurred in 544 patients. FIELD also showed 11% reduction in coronary events in patients who were using fenofibrate compared to placebo. The ACCORD trial enrolled 5,518 patients with type 2 diabetes and studied the effect of combination therapy of fenofibrate with atorvastatin. According to the results, there was a 8% reduction in major cardiovascular events, including stroke, cardiovascular death, and myocardial infarction when patients used combination therapy. In the SMART study, a total of 1,829 patients with type 2 diabetes were studied and major cardiovascular events were observed in 334 patients.