More clinical lessons from the FIELD study.
BACKGROUND
The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study investigated the effect of fenofibrate treatment in 9,795 patients with type 2 diabetes.


CONCLUSIONS
Reduction in major coronary events (the primary endpoint) and total cardiovascular disease (CVD) events (the secondary endpoint) was similar (relative risk reduction 11%), but only significant for total CVD events (p = 0.035). The benefit of fenofibrate treatment was greater in patients with mixed dyslipidaemia, especially in those with triglycerides >2.3 mmol/L and low plasma levels of high-density lipoprotein cholesterol (relative risk reduction 27%, p = 0.005). There were also microvascular benefits associated with fenofibrate treatment, specifically reduction in the rate of laser therapy for retinopathy (by 30%, p < 0.001), non-traumatic amputation (by 38%, p = 0.011) and progression of albuminuria (p < 0.002). Fenofibrate was generally well tolerated alone or in combination with a statin.


CONCLUSIONS
Overall, the FIELD study data support the use of fenofibrate for CVD prevention in diabetes, ideally in patients without prior macrovascular or microvascular complications. Fenofibrate may also have a role as a preventive treatment for diabetic retinopathy. Addition of fenofibrate to statin therapy may a logical progression from the FIELD study data, although the efficacy and tolerability of this approach needs to be evaluated in prospective outcome studies.
Fazio
Sergio
S
Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-6300, USA. sergio.fazio@vanderbilt.edu
D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy*; D011345:Fenofibrate / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*
D000960:Hypolipidemic Agents; D002784:Cholesterol; D011345:Fenofibrate