A major meta-analysis of fibrate drugs has shown that they reduce the risk of major cardiovascular events, mainly through prevention of coronary artery disease and the need for revascularisation events such as angioplasty or stenting. The findings are reported in an Article Online First and in an upcoming Lancet, written by Dr Vlado Perkovic, The George Institute for International Health, University of Sydney, NSW, Australia, and colleagues.
Several clinical trials have reported inconsistent findings for the effect of fibrates on cardiovascular risk. To resolve this uncertainty, the authors undertook a systematic review and meta-analysis to investigate the effects of fibrates on major clinical outcomes. The authors searched through trials published between 1950 and March, 2010. They included prospective randomised controlled trials assessing the effects of fibrates on cardiovascular outcomes compared with placebo. Relative risk (RR) reductions were calculated using standard meta-analytic techniques. The outcomes included were major cardiovascular events, coronary events, stroke, heart failure, coronary revascularisation, all-cause mortality, cardiovascular death, non-cardiovascular death, sudden death, new onset albuminuria (excessive protein excretion in urine), and adverse events.
The final analysis included 18 trials and 45 058 participants, including 2870 major cardiovascular events, 4552 coronary events, and 3880 deaths. Fibrate therapy produced a 10% RR reduction for major cardiovascular events and a 13% RR reduction for coronary events. However fibrate treatment had no statistically significant effect on stroke, all-cause mortality, cardiovascular mortality, or sudden death. Fibrates reduced the risk of albuminuria progression by 14% (albuminuria is an early marker of kidney disease commonly seen in patients with cardiovascular disease). Serious adverse events were not significantly increased by fibrates.
The authors point out that the benefit of fibrate treatment on cardiovascular disease occurs mainly through prevention of coronary artery disease and the need for revascularisation events such as angioplasty or stenting.
They conclude: "The magnitude of the proportional risk reduction is more modest than that achieved with other vascular preventive therapies targeting lipids, blood pressure, and coagulation, and the clinical relevance of the effect reported here will be debated. As for other drug classes, the real clinical value will depend on both the size of the proportional risk reduction and the absolute extent of risk of the population treated. For high-risk populations, a proportional risk reduction of 10% would translate into a worthwhile absolute risk reduction and a plausible number needed to treat. The challenge will be to define this group in the clinical setting."
For Dr Vlado Perkovic, The George Institute for International Health, media enquiries: Emma Orpilla PR Manager T) +61 410 411 983 / +61 28238 2424 E) eorpilla@george.org.au / vperkovic@george.org.au
For full Article, see: http://press.thelancet.com/fibrates.pdf
Please note: An accompanying Comment is not available at this time but will be available when the Article appears in an upcoming issue of The Lancet, date to be confirmed
Journal
The Lancet