NEW YORK (Reuters Health) - Addition of fenofibrate to statin therapy may reduce cardiovascular disease in type 2 diabetics with hypertriglyceridemia and low high-density lipoprotein cholesterol, according to a new study.
As Dr. Marshall B. Elam told Reuters Health by email, the study "presents the findings of extended follow-up of patients with type 2 diabetes who were treated with fenofibrate, a member of a group of triglyceride-lowering medications known as fibrates or PPAR alpha agonists, as part of the Action to Control Cardiovascular Risk in T2DM (ACCORD) study."
"In ACCORD," continued Dr. Elam, "addition of fenofibrate to statin therapy did not further reduce cardiovascular risk in the overall study cohort, however we observed that a subgroup of study participants with the combination of elevated triglyceride and low 'good' cholesterol (HDL) appeared to benefit from fenofibrate therapy."
The findings were published online December 28 in JAMA Cardiology.
ACCORD was designed to test the effect of intensive treatment of cardiovascular risk factors including blood glucose, blood pressure and lipids on risk of heart attack, stroke and cardiac death in patients with type 2 diabetes.
Dr. Elam of the University of Tennessee Health Sciences Center in Memphis and colleagues analyzed data on more than 4,600 ACCORD participants who were followed for a median of 9.7 years. However, only 144 (4.3%) continued or started treatment with fenofibrate following completion of ACCORD as part of the posttrial, nontreatment, observation-only ACCORDION study.
The primary study outcome was a composite of fatal and non-fatal myocardial infarction and stroke. The hazard ratio for reaching this endpoint among participants originally randomized to fenofibrate rather than placebo was 0.92 (p=0.32) versus 0.93 (p=0.47) in the follow-up study.
However in patients with dyslipidemia, defined as triglyceride levels greater than 204 mg/dL and HDL cholesterol levels less than 34 mg/dL, the hazard was significantly reduced (HR, 0.73).
"Although the results of these subgroup analyses cannot be considered conclusive," added Dr. Elam, "they suggest that patients with T2DM who have elevated triglycerides and low HDL-C may benefit from 'add-on' fenofibrate therapy."
He concluded, "Randomized trials testing the cardiovascular efficacy of fibrates and other triglyceride-lowering treatments in this specific patient population are needed."
JAMA Cardiol 2016.
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