The quality of evidence is downgraded by study llimitations (high loss to follow-up).
A Cochrane review [Abstract] 1 included 6 studies with a total of 16 135 subjects. The mean age of participants varied between 47.3 and 62.3 years. Four studies included subjects with diabetes mellitus type 2 only. The mean treatment duration and follow-up of participants across studies was 4.8 years. Reporting of adverse effects was very limited, and discontinuation of therapy due to adverse effects was used as a proxy for adverse effects.
| Outcome | Relative effect (95% CI) | Assumed risk - Placebo | Corresponding risk - Fibrates (95% CI) | Participants (studies) |
|---|---|---|---|---|
| CVD death, non-fatal MI, or non-fatal stroke | RR 0.84 (0.79 to 0.96) | 62 per 1000 | 52 per 1000(49 to 59) | 16 135(6 studies) |
| CHD death or non-fatal MI | RR 0.79 (0.68 to 0.92) | 46 per 1000 | 36 per 1000(31 to 42) | 16 135(6 studies) |
| Overall mortality | RR 1.01 (0.81 to 1.26) | 36 per 1000 | 36 per 1000(30 to 45) | 8 471(5 studies) |
| Non-CVD mortality | RR 1.01 (0.76 to 1.35) | 22 per 1000 | 22 per 1000(16 to 29) | 8 471(5 studies) |
| Discontinuation of therapy due to adverse effects | RR 1.38 (0.71 to 2.68)* | 261 per 1000 | 360 per 1000(185 to 699) | 4 805(3 studies) |
| CVD = cardiovascular disease; MI = myocardial infarction; CHD = coronary heart disease; *) statistical heterogeneity I2 =74% | ||||
Patients treated with fibrates had a reduced risk for the combined primary outcome of cardiovascular disease (CVD) death, non-fatal myocardial infarction (MI), or non-fatal stroke and for the secondary endpoint of coronary heart disease (CHD) death or non-fatal MI (table T1) compared to patients on placebo. Overall mortality, non-CVD mortality, and discontinuation of therapy due to adverse effects were not different between the groups. Data on quality of life were not available from any study. Two studies that evaluated fibrates in the background of statins showed no benefits in preventing cardiovascular events.
References
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