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Hyperlipidaemia and cardiovascular disease: do fibrates have a role?
Curr Opin Lipidol 2011; 22(4):270-6CO

Abstract

PURPOSE OF REVIEW

Fibrates continue to be a viable treatment option for mixed atherogenic dyslipidemia, and recent reports from clinical studies have shed new light on the therapeutic utility of fibrates for the prevention of microvascular and macrovascular disease, especially in combination with statins.

RECENT FINDINGS

Data from randomized placebo-controlled trials have shown that fibrates reduce nonfatal coronary events but do not confer any benefit on mortality or other adverse cardiovascular outcomes. The ACCORD Lipid trial studied the additive effect of fenofibrate therapy along with low-dose simvastatin therapy in 5,518 patients with type 2 diabetes mellitus, and found that fenofibrate did not affect any of the adverse cardiovascular outcomes, either individually or as part of a composite outcome, after 4.7 years of follow-up. An a priori subgroup analysis showed a significant benefit from fenofibrate-simvastatin combination therapy over simvastatin alone in participants with moderate hypertriglyceridemia and low HDL-cholesterol on major cardiovascular events, consistent with post-hoc analyses of previous fibrate trials. The ACCORD-Eye study adds to the sparse clinical data on the effect of fenofibrate on diabetic retinopathy, and showed that fenofibrate may be used to reduce the risk of progression of diabetic retinopathy even in patients with established disease. The combination of statin and fibrate was well tolerated.

SUMMARY

Fibrate therapy does not reduce mortality but may reduce nonfatal coronary events in patients at risk for cardiovascular disease, including those with type 2 diabetes. The ACCORD Lipid study shows that the combination of low-dose simvastatin and fenofibrate is well tolerated, and is potentially cardioprotective in patients with atherogenic 'mixed' dyslipidemia.

Authors+Show Affiliations

Providence Sacred Heart Medical Center, Spokane, WA 99220-2555, USA. sahas@uw.eduNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21519250

Citation

Saha, Sandeep A., and Rohit R. Arora. "Hyperlipidaemia and Cardiovascular Disease: Do Fibrates Have a Role?" Current Opinion in Lipidology, vol. 22, no. 4, 2011, pp. 270-6.
Saha SA, Arora RR. Hyperlipidaemia and cardiovascular disease: do fibrates have a role? Curr Opin Lipidol. 2011;22(4):270-6.
Saha, S. A., & Arora, R. R. (2011). Hyperlipidaemia and cardiovascular disease: do fibrates have a role? Current Opinion in Lipidology, 22(4), pp. 270-6. doi:10.1097/MOL.0b013e32834701c3.
Saha SA, Arora RR. Hyperlipidaemia and Cardiovascular Disease: Do Fibrates Have a Role. Curr Opin Lipidol. 2011;22(4):270-6. PubMed PMID: 21519250.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperlipidaemia and cardiovascular disease: do fibrates have a role? AU - Saha,Sandeep A, AU - Arora,Rohit R, PY - 2011/4/27/entrez PY - 2011/4/27/pubmed PY - 2011/10/25/medline SP - 270 EP - 6 JF - Current opinion in lipidology JO - Curr. Opin. Lipidol. VL - 22 IS - 4 N2 - PURPOSE OF REVIEW: Fibrates continue to be a viable treatment option for mixed atherogenic dyslipidemia, and recent reports from clinical studies have shed new light on the therapeutic utility of fibrates for the prevention of microvascular and macrovascular disease, especially in combination with statins. RECENT FINDINGS: Data from randomized placebo-controlled trials have shown that fibrates reduce nonfatal coronary events but do not confer any benefit on mortality or other adverse cardiovascular outcomes. The ACCORD Lipid trial studied the additive effect of fenofibrate therapy along with low-dose simvastatin therapy in 5,518 patients with type 2 diabetes mellitus, and found that fenofibrate did not affect any of the adverse cardiovascular outcomes, either individually or as part of a composite outcome, after 4.7 years of follow-up. An a priori subgroup analysis showed a significant benefit from fenofibrate-simvastatin combination therapy over simvastatin alone in participants with moderate hypertriglyceridemia and low HDL-cholesterol on major cardiovascular events, consistent with post-hoc analyses of previous fibrate trials. The ACCORD-Eye study adds to the sparse clinical data on the effect of fenofibrate on diabetic retinopathy, and showed that fenofibrate may be used to reduce the risk of progression of diabetic retinopathy even in patients with established disease. The combination of statin and fibrate was well tolerated. SUMMARY: Fibrate therapy does not reduce mortality but may reduce nonfatal coronary events in patients at risk for cardiovascular disease, including those with type 2 diabetes. The ACCORD Lipid study shows that the combination of low-dose simvastatin and fenofibrate is well tolerated, and is potentially cardioprotective in patients with atherogenic 'mixed' dyslipidemia. SN - 1473-6535 UR - https://www.unboundmedicine.com/medline/citation/21519250/Hyperlipidaemia_and_cardiovascular_disease:_do_fibrates_have_a_role L2 - http://Insights.ovid.com/pubmed?pmid=21519250 DB - PRIME DP - Unbound Medicine ER -