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Do persons with diabetes benefit from combination statin and fibrate therapy?
Curr Cardiol Rep. 2012 Feb; 14(1):112-24.CC

Abstract

Combination fibrate-statin therapy favorably modifies the atherogenic, triglyceride-rich lipoprotein environment, common to insulin resistance, diabetes, and higher cardiovascular disease (CVD) risk. Five major fibrate randomized clinical trial (RCT) results (HHS, VA-HIT, BIP, FIELD, and ACCORD-Lipid) demonstrated four consistent features: 1) the highest CVD event rates occurred in the placebo subgroups possessing atherogenic "moderate" dyslipidemia (triglycerides, > 200 mg/dL, and low high-density lipoprotein cholesterol [HDL-C], < 35-40 mg/dL); 2) with this subgroup having the greatest "hypothesis-generating" fibrate benefit (27% to 65% relative risk reduction, variable significance [P values ranging 0.057-0.005]); 3) those subgroups without moderate dyslipidemia had relatively lower CVD event rates; and 4) little or no benefit from fibrates. The ACCORD-Lipid results, specifically, demonstrated benefits against the background of statin therapy. Three independent meta-analyses combining the five RCTs, which provided a large sample of moderate dyslipidemia participants (i.e., 2401 on fibrates; 2270 on placebo), demonstrated a fibrate benefit with significant heterogeneity of effect across lipid subgroups (P = 0.0002). The fibrate benefit was observed in "low HDL-C only" patients, reducing CVD events by 17% (P < 0.001) or "hypertriglyceridemia-only" patients, reducing CVD events by 28% (P < 0.001), or "atherogenic (moderate) dyslipidemia" phenotype, reducing CVD events by 30% (P < 0.0001), compared with a nonsignificant 6% reduction (P = 0.13) in nonatherogenic dyslipidemia patients. Fibrate RCTs in patients with diabetes (FIELD and ACCORD-Lipid) also demonstrated significant microvascular (ie, retinopathy and nephropathy) outcome benefit possibly independent of lipid levels.

Authors+Show Affiliations

Diabetes/Lipid Management & Research Center, 18821 Delaware Street, Suite 202, Huntington Beach, CA 92648, USA. rosenblitpd@pol.net

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22213157

Citation

Rosenblit, Paul D.. "Do Persons With Diabetes Benefit From Combination Statin and Fibrate Therapy?" Current Cardiology Reports, vol. 14, no. 1, 2012, pp. 112-24.
Rosenblit PD. Do persons with diabetes benefit from combination statin and fibrate therapy? Curr Cardiol Rep. 2012;14(1):112-24.
Rosenblit, P. D. (2012). Do persons with diabetes benefit from combination statin and fibrate therapy? Current Cardiology Reports, 14(1), 112-24. https://doi.org/10.1007/s11886-011-0237-7
Rosenblit PD. Do Persons With Diabetes Benefit From Combination Statin and Fibrate Therapy. Curr Cardiol Rep. 2012;14(1):112-24. PubMed PMID: 22213157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do persons with diabetes benefit from combination statin and fibrate therapy? A1 - Rosenblit,Paul D, PY - 2012/1/4/entrez PY - 2012/1/4/pubmed PY - 2012/3/16/medline SP - 112 EP - 24 JF - Current cardiology reports JO - Curr Cardiol Rep VL - 14 IS - 1 N2 - Combination fibrate-statin therapy favorably modifies the atherogenic, triglyceride-rich lipoprotein environment, common to insulin resistance, diabetes, and higher cardiovascular disease (CVD) risk. Five major fibrate randomized clinical trial (RCT) results (HHS, VA-HIT, BIP, FIELD, and ACCORD-Lipid) demonstrated four consistent features: 1) the highest CVD event rates occurred in the placebo subgroups possessing atherogenic "moderate" dyslipidemia (triglycerides, > 200 mg/dL, and low high-density lipoprotein cholesterol [HDL-C], < 35-40 mg/dL); 2) with this subgroup having the greatest "hypothesis-generating" fibrate benefit (27% to 65% relative risk reduction, variable significance [P values ranging 0.057-0.005]); 3) those subgroups without moderate dyslipidemia had relatively lower CVD event rates; and 4) little or no benefit from fibrates. The ACCORD-Lipid results, specifically, demonstrated benefits against the background of statin therapy. Three independent meta-analyses combining the five RCTs, which provided a large sample of moderate dyslipidemia participants (i.e., 2401 on fibrates; 2270 on placebo), demonstrated a fibrate benefit with significant heterogeneity of effect across lipid subgroups (P = 0.0002). The fibrate benefit was observed in "low HDL-C only" patients, reducing CVD events by 17% (P < 0.001) or "hypertriglyceridemia-only" patients, reducing CVD events by 28% (P < 0.001), or "atherogenic (moderate) dyslipidemia" phenotype, reducing CVD events by 30% (P < 0.0001), compared with a nonsignificant 6% reduction (P = 0.13) in nonatherogenic dyslipidemia patients. Fibrate RCTs in patients with diabetes (FIELD and ACCORD-Lipid) also demonstrated significant microvascular (ie, retinopathy and nephropathy) outcome benefit possibly independent of lipid levels. SN - 1534-3170 UR - https://www.unboundmedicine.com/medline/citation/22213157/Do_persons_with_diabetes_benefit_from_combination_statin_and_fibrate_therapy L2 - https://dx.doi.org/10.1007/s11886-011-0237-7 DB - PRIME DP - Unbound Medicine ER -