Abstract
Objective
Fibrates might represent a viable treatment option for patients who do not meet their
target low-density lipoprotein levels on statins or who are resistant or intolerant
to statins. New data from fibrate trials can be synthesized with the existing literature
to better estimate their effects.
Methods
We systematically searched the literature to identify randomized, double-blind, placebo-controlled
trials examining the effect of fibrates on lipid profiles or cardiovascular outcomes.
We estimated the effect of fibrates on the incidence of nonfatal myocardial infarction
and all-cause mortality using random effects models.
Results
Compared with placebo, fibrates were associated with greater reductions in total cholesterol
(range: −101.3 mg/dL to −5.0 mg/dL) and triglycerides (range: −321.3 mg/dL to −20.8
mg/dL), and a greater increase in high-density lipoprotein (range: +1.1 mg/dL to +17.9
mg/dL) in all trials. Fibrates tended to be associated with a greater reduction in
low-density lipoprotein (range: −76.3 mg/dL to +38.7 mg/dL) than placebo, although
these results were not consistent across all trials. Fibrates were more efficacious
than placebo at preventing nonfatal myocardial infarction (odds ratio=0.78; 95% confidence interval, 0.69-0.89), but not all-cause mortality (odds ratio=1.05; 95% confidence interval, 0.95-1.15).
Conclusion
In addition to improving lipid profiles, fibrates are associated with an important
decrease in nonfatal myocardial infarction, but do not substantially affect all-cause
mortality. Potential applications include treatment for patients with statin resistance
or isolated hypertriglyceridemia, or as an adjunct to other lipid-lowering therapies.
Keywords
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Article Info
Publication History
Published online: August 20, 2009
Footnotes
Funding: This work is supported by the Canadian Institutes of Health Research (MOP: 82918). Samuel Abourbih is supported by a McGill Faculty of Medicine Summer Research Bursary. Kristian Filion is supported, in part, by a bursary from the Fonds de la Recherche en Santé du Québec (FRSQ). Dr Joseph is a Scientist of the FRSQ. Dr Schiffrin holds a Canada Research Chair in Vascular and Hypertension Research. Drs Poirier and Rinfret are Junior Physician-Scientists of the FRSQ. Dr Pilote is a Physician-Scientist of the Canadian Institutes for Health Research. Dr Genest holds the McGill University/Novartis Chair in Medicine. Dr Eisenberg is a Chercheur-National of the FRSQ.
Conflict of Interest: Jacques Genest has been on an advisory board for Sanofi-Aventis for the past 3 years and has received honoraria from Sanofi-Aventis. He does not own stock in the company. No other authors have declared any conflicts of interest.
Authorship: All authors had access to the data and played a role in writing this manuscript.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
