CVD history should not influence fenofibrate treatment decisions
MedWire News: Patients with Type 2 diabetes who are receiving fenofibrates should not be treated differently based on their cardiovascular disease (CVD) history, shows an analysis of the FIELD study.
"Our detailed analyses showed no evidence of heterogeneity in the effect of fenofibrate given as well as statins between patients who had a history of CVD at baseline and those who did not," write Antony Keech (NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia) and colleagues in the American Heart Journal.
"Patients already taking fenofibrate who have a CVD event may still benefit from continuing fenofibrate, particularly if they have elevated triglycerides and low HDL [high-density lipoprotein] levels or are at risk of microvascular complications," they say.
The FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study followed up 9795 patients with Type 2 diabetes who were randomly assigned to receive daily fenofibrate 200 mg or placebo for a median of 5 years. The study found that fenofibrate treatment significantly reduced the risk for total CVD events (coronary events, stroke, and coronary and carotid revascularization) by 11%.
In the present analysis, Keech et al compared the effects of fenofibrate on total CVD events and associated components among FIELD participants who did (n=2131) and did not (n=7664) have a history of CVD.
They report that patients with prior CVD were more likely to be male, older (by 3.3 years), have had diabetes for 2 years longer at baseline, and to have diabetic complications, hypertension, and higher rates of use of insulin and CVD medications.
There was a significant reduction in the risk for a CVD event associated with fenofibrate treatment in the group without prior CVD (hazard ratio=0.81), whereas in the prior-CVD group there was no significant effect of treatment.
However, the difference between the patient groups was only marginally significant after adjustment for uptake of statins and other CVD medications, and was no longer significant after adjustment for baseline covariates.
Therefore, "our findings do not support treating patients with fenofibrate differently based on any history of CVD," conclude Keech et al.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Nikki Withers