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Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis

Jun, Min, Foote, Celine, Lv, Jicheng, Neal, Bruce, Patel, Anushka, Nicholls, Stephen J., Grobbee, Diederick E., Cass, Alan, Chalmers, John and Perkovic, Vlado (2010). Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. The Lancet,375(9729):1875-1884.

Document type: Journal Article

IRMA ID 84473293xPUB47
Title Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis
Author Jun, Min
Foote, Celine
Lv, Jicheng
Neal, Bruce
Patel, Anushka
Nicholls, Stephen J.
Grobbee, Diederick E.
Cass, Alan
Chalmers, John
Perkovic, Vlado
Journal Name The Lancet
Publication Date 2010
Volume Number 375
Issue Number 9729
ISSN 0140-6736   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-77952708442
Start Page 1875
End Page 1884
Total Pages 9
Place of Publication United Kingdom
Publisher The Lancet Publishing Group
HERDC Category C1 - Journal Article (DIISR)
Abstract 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.
DOI http://dx.doi.org/10.1016/S0140-6736(10)60656-3   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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