Fenofibrate therapy and cardiovascular protection in diabetes: recommendations after FIELD.

Abstract:

PURPOSE OF REVIEW:The aim of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study was to provide valuable information on the ability of fibrates to reduce cardiovascular risk in type 2 diabetes. The purpose of this review is to analyse results from FIELD and to see whether they may lead to modify the recommendations for treatment of diabetic dyslipidemia. RECENT FINDINGS:In FIELD, fenofibrate therapy was associated with a nonsignificant 11% reduction in the primary endpoint (coronary heart disease death, nonfatal myocardial infarction), corresponding to a significant 24% reduction in nonfatal myocardial infarction (P = 0.010) and a nonsignificant 19% increase in CHD mortality. Fenofibrate reduced CHD events only in patients in primary prevention, but not in secondary prevention. Fenofibrate treatment was associated with less albuminuria progression and less retinopathy needing laser treatment. SUMMARY:FIELD's results are somewhat disappointing. The relatively low cardiovascular risk population from FIELD and the 'pollution' by statin therapy may not totally explain the weak results of fenofibrate in the reduction in CHD events. The significant increase in plasma homocysteine observed with fenofibrate could partly explain not only the higher number of venous thrombotic events, but also the poor effect of fenofibrate in reducing clinical outcomes, more particularly in patients with previous cardiovascular disease.

journal_name

Curr Opin Lipidol

authors

Vergès B

doi

10.1097/01.mol.0000252612.21602.e3

subject

Has Abstract

pub_date

2006-12-01 00:00:00

pages

653-8

issue

6

eissn

0957-9672

issn

1473-6535

pii

00041433-200612000-00008

journal_volume

17

pub_type

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