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FIELD. Fenofibrate Intervention and Event Lowering in Diabetes. Presented at The American Heart Association Scientific Sessions, November 2005 Presented by Dr. Anthony Keech. FIELD: Background.
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FIELD Fenofibrate Intervention and Event Lowering in Diabetes Presented at The American Heart Association Scientific Sessions, November 2005 Presented by Dr. Anthony Keech
FIELD: Background • Statins, whose main action is to lower LDL, have been shown to have significant beneficial effects in diabetics • Fibrates affect different components of the lipid profile by preferentially increasing HDL, lowering triglycerides, and increasing the size of LDL particles • Fibrates could be beneficial for diabetics in whom low HDL, high triglycerides, and small LDL particles are more common than in the general population • The goal of the study is to evaluate treatment with fenofibrate compared with placebo in patients with diabetes who are at risk for coronary heart disease ● AHA 2005
FIELD: Design 9795 patients, Age 50-75 years, type 2 diabetes diagnosed after age 35 years, no clear indication for cholesterol-lowering therapy at baseline (total cholesterol 116-251 mg/dL, plus either total cholesterol to HDL ratio ≥4.0 or triglyceride >88.6 mg/dL Fenofibrate (200 mg daily) n=4895 Placebo N=4900 • Endpoints: • Primary – Composite of CHD death or non-fatal MI at 5 year follow-up • Secondary – Composite of total CV events, CV mortality, total mortality, stroke, coronary revascularization and all revascularization at 5 year follow-up ESC 2005
FIELD: Primary Endpoint Composite CHD death or nonfatal MI at 5 Years (% of treatment arm) • The primary composite endpoint of CHD death or non-fatal MI was not significantly lower in the fenofibrate group compared to the placebo group. p=0.16 AHA 2005
FIELD: Primary Endpoint CHD death or nonfatal MI at 5 year follow-up (% of treatment arm) P=0.01 • CHD death was not significantly different between treatment groups • Nonfatal MI was significantly lower in the fenofibrate group compared with the placebo group. P=0.22 AHA 2005
FIELD: Secondary Endpoint Secondary Composite Endpoint of Total CV events at 5 year Follow-up • The secondary composite endpoint of total CV events was significantly lower in the fenofibrate group compared to the placebo group (% of treatment arm) p=0.035 AHA 2005
FIELD: Secondary Endpoint Individual Components of Secondary Endpoint p=0.18 • CV Mortality, Total Mortality, and Stroke were not significantly different between the fenofibrate and placebo groups p=0.36 p=0.41 AHA 2005
FIELD: Secondary Endpoint Individual Components of Secondary Endpoint P=0.001 P=0.003 • Percentage of coronary revascularization and all revascularization were significantly lower in the fenofibrate group compared to placebo AHA 2005
FIELD: Limitations • The results of this study may have been confounded by uneven use of statins between the two groups as 17% of the placebo group was prescribed a statin during the trial compared with 7% in the fenofibrate group • Although adjusting for statin use yields a statistically significant reduction in the primary endpoint (19%, p=0.01) this may slightly overestimate the effect for the fenofibrate group since the use of statins was not randomized • In terms of adverse effects, the fenofibrate group showed small increases in pancreatitis (0.5% vs 0.8%, p=0.031) and pulmonary embolism (0.7% vs 1.1%, p=0.022) • Although fenofibrate reduced triglycerides and LDL, there was virtually no increase shown in HDL AHA 2005
FIELD: Summary • Among patients with diabetes at risk of coronary heart disease, there was no statistically significant difference in the primary composite endpoint of CHD death or nonfatal MI. There was, however, a significant reduction in nonfatal MI in the fenofibrate group compared with placebo. • The secondary composite endpoint of total cardiovascular events was significantly lower in the fenofibrate group primarily due to reductions in nonfatal MI and revascularizations. • The results may have been confounded by a difference in statin use between the two groups as 17% of the placebo group were prescribed statins during the trial compared to 7% in the fenofibrate group. This may have attenuated treatment effect differences. • The ACCORD trial, which will randomize diabetics to either fenofibrate or placebo with all patients taking simvastatin, will provide a more definitive answer regarding the benefit of fenofibrates in diabetics. AHA 2005