TY - JOUR
T1 - Effects of fibrates on cardiovascular outcomes
T2 - a systematic review and meta-analysis
AU - Jun, Min
AU - Foote, Celine
AU - Lv, Jicheng
AU - Neal, Bruce
AU - Patel, Anushka
AU - Nicholls, Stephen J.
AU - Grobbee, Diederick E.
AU - Cass, Alan
AU - Chalmers, John
AU - Perkovic, Vlado
N1 - MJ was supported by an Australian Postgraduate Award and the Australasian Kidney Trials Network (AKTN). CF and JL were supported
by an Amgen Renal Research Fellowship. AC and AP were supported by NHMRC Senior Research Fellowships. VP was supported by the Heart
Foundation/Offi ce of Science and Medical Research (NSW) Career Development Award. This study was supported by a programme grant
from the National Health and Medical Research Council of Australia (grant number 571281).
PY - 2010
Y1 - 2010
N2 - Background: Several clinical trials have reported inconsistent findings for the effect of fibrates on cardiovascular risk. We undertook a systematic review and meta-analysis to investigate the effects of fibrates on major clinical outcomes. Methods: We systematically searched Medline, Embase, and the Cochrane Library for trials published between 1950 and March, 2010. We included prospective randomised controlled trials assessing the effects of fibrates on cardiovascular outcomes compared with placebo. Summary estimates of relative risk (RR) reductions were calculated with a random effects model. Outcomes analysed were major cardiovascular events, coronary events, stroke, heart failure, coronary revascularisation, all-cause mortality, cardiovascular death, non-vascular death, sudden death, new onset albuminuria, and drug-related adverse events. Findings: We identified 18 trials providing data for 45 058 participants, including 2870 major cardiovascular events, 4552 coronary events, and 3880 deaths. Fibrate therapy produced a 10% RR reduction (95% CI 0-18) for major cardiovascular events (p=0·048) and a 13% RR reduction (7-19) for coronary events (p<0·0001), but had no benefit on stroke (-3%, -16 to 9; p=0·69). We noted no effect of fibrate therapy on the risk of all-cause mortality (0%, -8 to 7; p=0·92), cardiovascular mortality (3%, -7 to 12; p=0·59), sudden death (11%, -6 to 26; p=0·19), or non-vascular mortality (-10%, -21 to 0·5; p=0·063). Fibrates reduced the risk of albuminuria progression by 14% (2-25; p=0·028). Serious drug-related adverse events were not significantly increased by fibrates (17 413 participants, 225 events; RR 1·21, 0·91-1·61; p=0·19), although increases in serum creatinine concentrations were common (1·99, 1·46-2·70; p<0·0001). Interpretation: Fibrates can reduce the risk of major cardiovascular events predominantly by prevention of coronary events, and might have a role in individuals at high risk of cardiovascular events and in those with combined dyslipidaemia. Funding: National Health and Medical Research Council of Australia.
AB - Background: Several clinical trials have reported inconsistent findings for the effect of fibrates on cardiovascular risk. We undertook a systematic review and meta-analysis to investigate the effects of fibrates on major clinical outcomes. Methods: We systematically searched Medline, Embase, and the Cochrane Library for trials published between 1950 and March, 2010. We included prospective randomised controlled trials assessing the effects of fibrates on cardiovascular outcomes compared with placebo. Summary estimates of relative risk (RR) reductions were calculated with a random effects model. Outcomes analysed were major cardiovascular events, coronary events, stroke, heart failure, coronary revascularisation, all-cause mortality, cardiovascular death, non-vascular death, sudden death, new onset albuminuria, and drug-related adverse events. Findings: We identified 18 trials providing data for 45 058 participants, including 2870 major cardiovascular events, 4552 coronary events, and 3880 deaths. Fibrate therapy produced a 10% RR reduction (95% CI 0-18) for major cardiovascular events (p=0·048) and a 13% RR reduction (7-19) for coronary events (p<0·0001), but had no benefit on stroke (-3%, -16 to 9; p=0·69). We noted no effect of fibrate therapy on the risk of all-cause mortality (0%, -8 to 7; p=0·92), cardiovascular mortality (3%, -7 to 12; p=0·59), sudden death (11%, -6 to 26; p=0·19), or non-vascular mortality (-10%, -21 to 0·5; p=0·063). Fibrates reduced the risk of albuminuria progression by 14% (2-25; p=0·028). Serious drug-related adverse events were not significantly increased by fibrates (17 413 participants, 225 events; RR 1·21, 0·91-1·61; p=0·19), although increases in serum creatinine concentrations were common (1·99, 1·46-2·70; p<0·0001). Interpretation: Fibrates can reduce the risk of major cardiovascular events predominantly by prevention of coronary events, and might have a role in individuals at high risk of cardiovascular events and in those with combined dyslipidaemia. Funding: National Health and Medical Research Council of Australia.
UR - http://www.scopus.com/inward/record.url?scp=77952708442&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(10)60656-3
DO - 10.1016/S0140-6736(10)60656-3
M3 - Article
C2 - 20462635
AN - SCOPUS:77952708442
VL - 375
SP - 1875
EP - 1884
JO - Lancet
JF - Lancet
SN - 0140-6736
IS - 9729
ER -