Fenofibrate may lower heart failure hospitalization, CV mortality in type 2 diabetes
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In a cohort of patients with type 2 diabetes treated with simvastatin, fenofibrate decreased the composite of heart failure hospitalizations or cardiovascular mortality, according to an analysis of the ACCORD Lipid trial.
This effect was predominantly observed in patients with standard background glucose-lowering therapy.
João Pedro Ferreira, MD, PhD, a researcher at the Université de Lorraine in Nancy, France, and colleagues conducted the secondary analysis to assess the effect of fenofibrate compared with placebo in heart failure (HF) outcomes among patients with type 2 diabetes who received simvastatin.
The study included data from 5,518 adults who participated in the ACCORD Lipid trial (median age, 62 years; 31% women), of whom 5% had a prior history of HF. In all, 2,765 patients were randomly assigned to fenofibrate and 2,753 to placebo, and both groups received simvastatin. The two groups were well balanced in baseline characteristics, according to the researchers.
During follow-up (median, 4.7 years), the composite outcome — defined as HF hospitalization or CV death — occurred in 6.9% of patients in the fenofibrate group compared with 8.3% in the placebo group (HR = 0.82; 95% CI, 0.68-1; P = .048).
Among patients receiving standard glucose-lowering therapy, fenofibrate lowered HF hospitalizations or CV death (HR = 0.64; 95% CI, 0.48-0.85); however, this beneficial effect was not observed in patients receiving an intensive glucose-lowering strategy (HR = 1.02; 95% CI, 0.79-1.33; P for interaction = .017). Researchers reported a similar pattern for HF hospitalizations alone.
Background diabetes therapy did not influence the clinical effect of fenofibrate on lipid levels, whereas the drug was associated with slower long-term decline in estimated glomerular filtration rate, according to the researchers.
“Our study shows that fenofibrate reduced the composite of HF hospitalizations or cardiovascular death, an effect that was mainly due to a reduction in HF hospitalizations among patients on a standard glucose-lowering strategy treatment,” the researchers wrote. “Adequately powered prospective randomized controlled trials are needed to confirm these findings.”
Perspective
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This is a secondary analysis from the ACCORD study, which in the overall trial failed to show benefit of fenofibrate added to statin therapy. In addition, the sample size is very small, so this should only be seen as a hypothesis-generating study.
The recent announcement that the trial with pemafibrate (Kowa) has been stopped should lead to further concern by clinicians as to whether there is any benefit of adding fibrate therapy to statins in patients with existing cardiovascular disease. Thus, at the current time, I do not believe that the results of this study should impact clinical practice. We will need to closely examine the results of the PROMINENT study, which will be presented in the near future.
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