Role for fibrate therapy in diabetes: evidence before FIELD.
OBJECTIVE
Diabetic dyslipidaemia, among the main factors contributing to vascular risk in type 2 diabetes, is characterized by hypertriglyceridaemia, low HDL-cholesterol and increased prevalence of small dense LDL particles. Because fibrates have positive effects on triglycerides, HDL-cholesterol and LDL particle size, they may be an appropriate treatment for diabetic dyslipidaemia. Statins have been shown to diminish significantly the risk for coronary disease in patients with type 2 diabetes, and so what are the real effects of fibrates on cardiovascular risk in type 2 diabetes?


RESULTS
Although statins reduce the incidence of coronary disease in type 2 diabetes, data from clinical trials demonstrate 'residual' cardiovascular risk in these patients treated with statins. Clinical trials with fibrates show that they are particularly effective in reducing cardiovascular risk in patients with type 2 diabetes/metabolic syndrome and in those exhibiting the lipid abnormalities typical of diabetic dyslipidaemia (elevated triglycerides, low HDL-cholesterol).


CONCLUSIONS
Data on the effects of fibrates on cardiovascular risk in diabetes were obtained from subgroup analyses. Thus far, the only study performed specifically in patients with type 2 diabetes is the angiographic Diabetes Atherosclerosis Intervention Study which demonstrated a significant reduction in progression of atherosclerosis in patients receiving fenofibrate, but it was not powered to analyse the effects of fibrates on clinical outcomes. This is why the Fenofibrate Intervention and Event Lowering in Diabetes study is needed; it will provide robust data on the ability of fibrates to reduce cardiovascular risk in patients with type 2 diabetes.
Vergès
Bruno
B
Service Endocrinologie, Diabétologie et Maladies Métaboliques, Centre Hospitalier, Universitaire de Dijon, and INSERM U498, Faculté de Médecine, Dijon, France. bruno.verges@chu-dijon.fr
D002995:Clofibric Acid / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D024821:Metabolic Syndrome / Q000097:blood / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic
D000960:Hypolipidemic Agents; D002995:Clofibric Acid