Cardiovascular disease is the principal cause of illness and disability in patients with diabetes, and is also the most common cause of death worldwide in adults.
Fenofibrate, a member of the
fibrate class of
lipid-modifying drugs, is a potent
triglyceride-lowering and
high-density lipoprotein cholesterol-raising agent and has a variable effect on
low-density lipoprotein cholesterol.
Fenofibrate administration also leads to a modified, less atherogenic
low-density lipoprotein profile, with a consistent effect toward increased
low-density lipoprotein particle size and a reduction in the
low-density lipoprotein particle density. Maximal clinical efficacy in
fibrates has been demonstrated in subjects with
dyslipidemia, particularly in populations with features of the
metabolic syndrome and in patients with
Type 2 diabetes. Angiographic data from the Diabetes
Atherosclerosis Intervention Study (DAIS) support a similar effect of
fenofibrate. However, in the recent
Fenofibrate Intervention and Event Lowering in Diabetes trial (FIELD; 9795 patients with
Type 2 diabetes), the rate of nonfatal macrovascular events, after adjustment for the use of other
lipid-lowering agents and significant reductions in microvascular complications, was lower for the
fenofibrate treatment group. These results and those from a current large trial, ACtion to COntrol cardiovascular Risk in Diabetes (ACCORD), will provide valuable evidence for the likely future use of this drug in combination with
statins for reducing
cardiovascular disease risk in the
metabolic syndrome and in
Type 2 diabetes.