The effect of fibrate-statin combination therapy on cardiovascular events: a retrospective cohort analysis.
OBJECTIVE
To investigate the long-term efficacy of fibrate-statin combination therapy on cardiovascular events as opposed to lipid levels.


METHODS
A retrospective analysis was performed of patients attending metabolic clinics. Cardiovascular risk factor, baseline and final lipid data and details of concomitant drug therapies were gathered on all subjects.


METHODS
The occurrence of major adverse cardiovascular events (MACE) was recorded and major prognostic factors associated with outcome determined.


RESULTS
A total of 318 patients with mixed dyslipidaemia were identified on fibrate-statin therapy. Follow-up comprised an average of 7.5 years totalling 2400 patient-years. Patients were 78% male aged 62 years and 68% had evidence of previous cardiovascular disease (CVD). Smoking was present in 17%, hypertension in 41% and 32% had established diabetes. Baseline lipid parameters were total cholesterol (TC) 6.84 mmol/L, triglycerides (TG) 6.09 mmol/L and HDL-C 1.09 mmol/L. Fibrate-statin combination reduced TC by 27% to 4.64 mmol/L, TG by a median 42% to 2.33 mmol/L and increased HDL-C by 21% to 1.22 mmol/L. Non-HDL-C was reduced by 35% and apolipoprotein B by 17%. MACE occurred in 25%. Logistic regression analysis showed that patients with MACE had higher initial TC (7.02 vs. 6.80 mmol/L; p = 0.002), established CVD (65 vs. 57%; p = 0.05) and a lesser atherogenic index response (31 vs. 38%; p = 0.008). Cox regression analysis showed that age (p = 0.002), and previous CVD (p < 0.001) were determinants of outcome allied either to reduction in TG (p = 0.009), TC (p = 0.04) and increase in HDL-C (p = 0.05) or change in TG (p = 0.002) and non-HDL-C (p = 0.01).


CONCLUSIONS
Fibrate-statin therapy in a population with mixed dyslipidaemia resulted in an improved lipid profile with few side-effects. Consistent with its effects, decreases in TG allied with modest decrease in cholesterol and an increase in HDL-C, were associated with better prognosis.
Wierzbicki
Anthony S
AS
Department of Cardiology, Conquest (East Sussex) Hospital, Hastings, UK. Anthony.Wierzbicki@kcl.ac.uk
Morrell
Jonathan
J
Hemsley
Deborah
D
McMahon
Zofia
Z
Crook
Martin A
MA
Wray
Richard
R
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D004338:Drug Combinations; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D058607:Fibric Acids / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
D004338:Drug Combinations; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents