Issue 136 Item 2 Gemfibrozil May Reduce Risk of Cardiac Events in Men With Diabe

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.