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Fibrates Can Reduce Cardiovascular Risk in Type 2’s

This study showed that fenofibrate was very effective in lowering total, LDL, non-HDL cholesterol significantly in female diabetic patients compared to male patients…. 

Patients with type 2 diabetes are at increased risk of cardiovascular disease. Fibrate may help decrease the risk of cardiovascular disease in women and could be an option for patients who cannot tolerate statins.

This was a double-blind placebo-controlled study, which looked at 9,795 patients with diabetes, and was a secondary analysis where data were collected from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. 3,657 women and 6,138 men were given 200mg/day of fenofibrate or placebo for 5 years. Total cardiovascular events were assessed by sex.

According to data, fenofibrate improved triglyceride levels in both men and women by reducing LDL, non-HDL, and apolipoprotein B to a greater extent in women compared to men. Moreover, fibrate showed 30% reduction in overall cardiovascular outcomes in women (95% CI 8%-46%, P = 0.008) compared to 13% reduction in men (95% CI −1%, 24%; P = 0.07).

"Our results indicate that fenofibrate is generally safe for women with type 2 diabetes," authors wrote. "Although in the FIELD study, the primary endpoint of nonfatal (myocardial infarction) plus coronary death was not significantly reduced, the secondary endpoint of total cardiovascular events was reduced."

Overall, fibrates were cardioprotective in both men and women with type 2 diabetes. A reduction in cardiovascular disease risk in patients with low HDL cholesterol and high triglyceride levels was also seen, but there was more reduction in women compared to men. In conclusion, fenofibrate therapy should be considered for both sexes with type 2 diabetes.

Practice Pearls:
  • Women with type 2 diabetes are at high risk for future cardiovascular disease.
  • This study looks at long-term effect of fibrates on reducing cardiovascular effects in patients with type 2 diabetes
  • Fenofibrate showed reduction in CVD risk in both men and women, but more significantly in women.
  • Fibrates can be an option for patients who cannot tolerate statins.

d’Emden MC, et al "Favorable effects of fenofibrate on lipids and cardiovascular disease in women with type 2 diabetes: results from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study" Diabetologia 2014; DOI: 10.1007/s00125-014-3344-3.