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Item #2
Gemfibrozil
May Reduce Risk of Cardiac Events in Men With Diabetes Or Insulin
Resistance
Treatment
reduces risk of cardiovascular events in men with diabetes or insulin
resistance.
Treatment
with gemfibrozil appears to reduce the risk of cardiovascular events
in men with coronary heart disease (CHD), low HDL cholesterol levels,
and either diabetes or insulin resistance, according to a report
published in the Archives of Internal Medicine.
Dr.
Hanna Bloomfield Rubins, from the VA Medical Center in Minneapolis,
and colleagues assessed the cardiovascular outcomes of 2517 men with
CHD and a low HDL cholesterol level who were randomized to receive
gemfibrozil 1200 mg or placebo daily.
The
study group included 627 patients with known diabetes, 142 with newly
diagnosed diabetes, 323 with an impaired fasting glucose level, and
1425 with a normal fasting glucose level. The primary outcome was the
composite endpoint of CHD death, stroke, or myocardial infarction. The
average follow-up period was 5.1 years.
Compared
with patients with normal fasting glucose levels, those with known or
newly diagnosed diabetes were 87% and 72% more likely, respectively,
to experience the composite endpoint. In patients without diabetes,
the presence of insulin resistance was associated with a 31% increased
risk of cardiovascular events (p = 0.03).
In
patients with diabetes, gemfibrozil therapy resulted in a 32%
reduction in the risk of the composite endpoint (p = 0.004). When only
CHD death was considered, the risk reduction was 41%. In nondiabetic
subjects with high insulin levels, gemfibrozil was associated with a
risk reduction of 35% for the composite endpoint.
"This
is the first large clinical trial to show that a fibrate significantly
reduces the risk of major cardiovascular events in diabetic men with
established CHD and a low HDL cholesterol level," the
investigators note.
"We
also report the novel observation that gemfibrozil may be particularly
effective in nondiabetic men with high levels of fasting plasma
insulin," the authors state. "To our knowledge, no other
therapeutic interventions have been reported to reduce major
cardiovascular events" in this group, they add.
Arch Intern
Med 2002;162:2597-2604.
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FACT
There
are currently more than 177 million people with diabetes
worldwide. WHO figures estimate that this will rise to 300
million by 2025. International
Diabetes Federation, 2000.
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