Statin alone or plus fibrate for patients with DM2

January 01, 0001

Statin alone or plus fibrate for patients with DM2

These US authors investigated whether combination therapy with a statin plus a fibrate, as compared with statin monotherapy, would reduce the risk of cardiovascular disease in patients with type 2 diabetes mellitus who were at high risk for cardiovascular disease. They randomly assigned 5518 patients with type 2 diabetes who were being treated with open-label simvastatin to receive either masked fenofibrate or placebo. The primary outcome was the first occurrence of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years.

They found: "The annual rate of the primary outcome was 2.2% in the fenofibrate group and 2.4% in the placebo group (hazard ratio in the fenofibrate group, 0.92, NS). There were also no significant differences between the two study groups with respect to any secondary outcome. Annual rates of death were 1.5% in the fenofibrate group and 1.6% in the placebo group. Prespecified subgroup analyses suggested heterogeneity in treatment effect according to sex, with a benefit for men and possible harm for women, and a possible interaction according to lipid subgroup, with a possible benefit for patients with both a high baseline triglyceride level and a low baseline level of high-density lipoprotein cholesterol."

The authors concluded: "The combination of fenofibrate and simvastatin did not reduce the rate of fatal cardiovascular events, nonfatal myocardial infarction, or nonfatal stroke, as compared with simvastatin alone. These results do not support the routine use of combination therapy with fenofibrate and simvastatin to reduce cardiovascular risk in the majority of high-risk patients with type 2 diabetes."

The evidence does not support routine use of fenofibrate for patients with DM2.

For the full abstract, click here.

N Engl J Med 362(17):1563-1574, 29 April 2010
© 2010 to the Massachusetts Medical Society
Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus-The ACCORD Study Group. Henry N. Ginsberg, Marshall B. Elam, Laura C. Lovato, et al. Correspondence to Dr. Ginsberg:

Category: T. Endocrine/Metabolic/Nutritional, K. Circulatory. Keywords: type 2 diabetes, simvastatin, fenofibrate, triglycerides, cholesterol, myocardial infarction, stroke, death, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 18 May don't fill in 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.