Add-on fenofibrate to statins and cardiovascular outcomes in metabolic syndrome

  • Kim NH & al.
  • BMJ
  • 27 Sep 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In adults with metabolic syndrome, the addition of fenofibrate to statin therapy was associated with a reduction in the risk for major cardiovascular (CV) events compared with statin treatment alone.

Why this matters

  • With the adoption of statin treatment to manage dyslipidaemia and CV risk, strategies to reduce residual CV risk after statin treatment have remained important.
  • Limited evidence is available on the advantage of lipid-modifying agents over statins for residual CV risk reduction in people with a broad range of CV risk, such as those with metabolic syndrome.

Study design

  • This study included 29,771 adults with metabolic syndrome (age, ≥40 years) who received statin treatment.
  • 2156 who received statin plus fenofibrate (combined treatment group) were matched with 8549 participants who received statin treatment (statin group) based on propensity score matching at a ratio of 1:5.
  • Primary outcome: composite of CV events (coronary heart disease, ischaemic stroke, and death from CV causes).
  • Funding: Abbott Laboratories Korea.

Key results

  • After adjustment for confounders, the incidence of composite CV events was significantly reduced in combined treatment vs statin group (17.7 vs 22.0 per 1000 person-years; HR, 0.74; 95% CI, 0.58-0.93; P=.01).
  • The significance was maintained in the on-treatment analysis (HR, 0.63; 95% CI, 0.44-0.92; P=.02).
  • Combined treatment and statin group did not significantly differ in the risk for:
    • incident coronary heart disease (HR, 0.82; 95% CI, 0.62-1.09; P=.2),
    • ischaemic stroke (HR, 0.74; 95% CI, 0.49-1.12; P=.2), and
    • CV death (HR, 0.48; 95% CI, 0.18-1.23; P=.1).

Limitations

  • Risk of possible bias.

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