Lancet: Fibrates could have preventive role for coronary events

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Fibrate drugs have shown that they reduce the risk of major cardiovascular events, mainly through prevention of coronary artery disease and the need for revascularisation events such as angioplasty or PCI, according to a meta-analysis published online May 11 in the Lancet.

Fibrates are clearly effective at raising HDL cholesterol, lowering triglyceride concentrations and could also reduce LDL cholesterol and chylomicron remnants, according to the authors. However, their effects on vascular events remain uncertain.

The authors noted that several clinical trials have reported inconsistent findings for the effect of fibrates on cardiovascular risk, including the ACCORD study, which reported no overall benefit for fenofibrate, raising further questions about the usefulness of these agents.

In that regard, Min Jun, Msc, from the George Institute for International Health at the University of Sydney in Australia, and colleagues aimed to synthesize the available clinical trial evidence and to improve definition of the likely effects of fibrate therapy on major clinical outcomes.

Jun and colleagues searched through trials published between 1950 and March, 2010. They included prospective randomized controlled trials assessing the effects of fibrates on cardiovascular outcomes compared with placebo.

The final analysis included 18 trials and 45,058 participants, including 2,870 major cardiovascular events, 4,552 coronary events and 3,880 deaths.

Fibrate therapy produced a 10 percent relative risk reduction for major cardiovascular events and a 13 percent relative risk reduction for coronary events. However, fibrate treatment had no statistically significant effect on stroke, all-cause mortality, cardiovascular mortality or sudden death.

Fibrates reduced the risk of albuminuria progression, an early marker of kidney disease, by 14 percent. Serious adverse events were not significantly increased by fibrates.

The authors noted that the benefit of fibrate treatment on cardiovascular disease occurs mainly through prevention of coronary artery disease and the need for revascularization events such as angioplasty or stenting.

"The magnitude of effect is moderate compared with other vascular preventive therapies targeting lipids, blood pressure and coagulation, but in high-risk individuals and in those with combined dyslipidemia, clinically meaningful reductions in risk could be achieved. With modern fibrates being safe and well tolerated, these agents seem to have a role in cardiac protection," they concluded.

Researchers noted that it will be a challenge to define the group of patients that will best benefit from fibrate therapy in the clinical setting.