Fibrates in the prevention of cardiovascular disease in patients with type 2 diabetes mellitus--a pooled meta-analysis of randomized placebo-controlled clinical trials.
OBJECTIVE
Fibrates are thought to be useful anti-dyslipidemic agents particularly in patients with diabetes mellitus and dyslipidemia characterized by high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) levels. We conducted a systematic review and meta-analysis of long-term randomized controlled trials to evaluate the role of fibrates in the prevention of cardiovascular events in patients with type 2 diabetes mellitus.


METHODS
English-language journals indexed in Index Medicus/MEDLINE and the Cochrane Collaboration databases (through December 2007), unpublished data from selected clinical trials.


METHODS
A total of 11,590 patients from 6 published randomized placebo-controlled trials were analyzed using pooled meta-analysis techniques. Relative risks were computed for various cardiovascular outcomes and mortality, and statistical significance was tested using the z-test statistic (two-sided alpha error <0.05).


RESULTS
The use of fibrates did not significantly affect the risk of all-cause mortality or cardiac mortality, and also did not affect the risk of stroke, unstable angina, or invasive coronary revascularization. However, the relative risk of non-fatal myocardial infarction was significantly reduced by about 21% (pooled relative risk 0.79, p=0.006) with the use of fibrates.


CONCLUSIONS
Long-term use of fibrates in patients with type 2 diabetes mellitus significantly reduces the risk of non-fatal myocardial infarction, but has no significant effect on mortality or on other adverse cardiovascular outcomes.
Saha
Sandeep A
SA
Department of Internal Medicine, Sacred Heart Medical Center, Spokane, Washington 99220-2555, USA. sahas@u.washington.edu
Arora
Rohit R
RR
D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002995:Clofibric Acid / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention
D000960:Hypolipidemic Agents; D008055:Lipids; D002995:Clofibric Acid