title: Cardiovascular events in patients received combined fibrate/statin treatment versus statin monotherapy: Acute Coronary Syndrome Israeli Surveys data.
abstract: BACKGROUND
  The effect of combination of fibrate with statin on major adverse cardiovascular events (MACE) following acute coronary syndrome (ACS) hospitalization is unclear. The main aim of this study was to investigate the 30-day rate of MACE in patients who participated in the nationwide ACS Israeli Surveys (ACSIS) and were treated on discharge with a fibrate (mainly bezafibrate) and statin combination vs. statin alone.
  
  
  METHODS
  The study population comprised 8,982 patients from the ACSIS 2000, 2002, 2004, 2006, 2008 and 2010 enrollment waves who were alive on discharge and received statin. Of these, 8,545 (95%) received statin alone and 437 (5%) received fibrate/statin combination. MACE was defined as a composite measure of death, recurrent MI, recurrent ischemia, stent thrombosis, ischemic stroke and urgent revascularization.
  
  
  RESULTS
  Patients from the combination group were younger (58.1±11.9 vs. 62.9±12.6 years). However, they had significantly more co-morbidities (hypertension, diabetes), current smokers and unfavorable cardio-metabolic profiles (with respect to glucose, total cholesterol, triglyceride and HDL-cholesterol). Development of MACE was recorded in 513 (6.0%) patients from the statin monotherapy group vs. 13 (3.2%) from the combination group, p = 0.01. 30-day re-hospitalization rate was significantly lower in the combination group: 68 (15.6%) vs. 1691 (19.8%) of patients, respectively; p = 0.03. Multivariable analysis identified the fibrate/statin combination as an independent predictor of reduced risk of MACE with odds ratio of 0.54, 95% confidence interval 0.32-0.94.
  
  
  CONCLUSIONS
  A significantly lower risk of 30-day MACE rate was observed in patients receiving combined fibrate/statin treatment following ACS compared with statin monotherapy. However, caution should be exercised in interpreting these findings taking into consideration baseline differences between our observational study groups.
authors.affiliation: Cardiac Rehabilitation Institute, The Chaim Sheba Medical Center, Tel-Hashomer, Israel. altenen@yahoo.com
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
authors.forename: Diego
authors.initials: D
authors.lastname: Medvedofsky
authors.forename: Enrique Z
authors.initials: EZ
authors.lastname: Fisman
authors.forename: Liudmila
authors.initials: L
authors.lastname: Bubyr
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.forename: David
authors.initials: D
authors.lastname: Tanne
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
authors.forename: Joseph
authors.initials: J
authors.lastname: Shemesh
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D015897:Comorbidity; D058607:Fibric Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D010359:Patient Readmission; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors