title: Hyperlipidaemia and cardiovascular disease: do fibrates have a role?
abstract: OBJECTIVE
  Fibrates continue to be a viable treatment option for mixed atherogenic dyslipidemia, and recent reports from clinical studies have shed new light on the therapeutic utility of fibrates for the prevention of microvascular and macrovascular disease, especially in combination with statins.
  
  
  RESULTS
  Data from randomized placebo-controlled trials have shown that fibrates reduce nonfatal coronary events but do not confer any benefit on mortality or other adverse cardiovascular outcomes. The ACCORD Lipid trial studied the additive effect of fenofibrate therapy along with low-dose simvastatin therapy in 5,518 patients with type 2 diabetes mellitus, and found that fenofibrate did not affect any of the adverse cardiovascular outcomes, either individually or as part of a composite outcome, after 4.7 years of follow-up. An a priori subgroup analysis showed a significant benefit from fenofibrate-simvastatin combination therapy over simvastatin alone in participants with moderate hypertriglyceridemia and low HDL-cholesterol on major cardiovascular events, consistent with post-hoc analyses of previous fibrate trials. The ACCORD-Eye study adds to the sparse clinical data on the effect of fenofibrate on diabetic retinopathy, and showed that fenofibrate may be used to reduce the risk of progression of diabetic retinopathy even in patients with established disease. The combination of statin and fibrate was well tolerated.
  
  
  CONCLUSIONS
  Fibrate therapy does not reduce mortality but may reduce nonfatal coronary events in patients at risk for cardiovascular disease, including those with type 2 diabetes. The ACCORD Lipid study shows that the combination of low-dose simvastatin and fenofibrate is well tolerated, and is potentially cardioprotective in patients with atherogenic 'mixed' dyslipidemia.
authors.affiliation: Providence Sacred Heart Medical Center, Spokane, WA 99220-2555, USA. sahas@uw.edu
authors.forename: Sandeep A
authors.initials: SA
authors.lastname: Saha
authors.forename: Rohit R
authors.initials: RR
authors.lastname: Arora
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D003930:Diabetic Retinopathy / Q000188:drug therapy; D004359:Drug Therapy, Combination; D058607:Fibric Acids / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000188:drug therapy; D015201:Meta-Analysis as Topic; D055806:Microvessels / Q000187:drug effects / Q000473:pathology; D016032:Randomized Controlled Trials as Topic
chemical_list: D058607:Fibric Acids