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

M. Jun; C. Foote; F Lv; B. Neal; A. Patel; S.J. Nicholls; D.E. Grobbee; A. Cass; J. Chalmers; V. Perkovic

doi:10.1016/S0140-6736(10)60656-3

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

M. Jun, C. Foote, F Lv, B. Neal, A. Patel, S.J. Nicholls, D.E. Grobbee, A. Cass, J. Chalmers, V. Perkovic

Research output: Contribution to journal › Review article › peer-review

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.

FUNDING: National Health and Medical Research Council of Australia.

Original language	English
Pages (from-to)	1875-1884
Number of pages	10
Journal	The Lancet
Volume	375
Issue number	9729
DOIs	https://doi.org/10.1016/S0140-6736(10)60656-3
Publication status	Published - 2010

Keywords

Cardiovascular Diseases
Clofibric Acid
Humans
Hypolipidemic Agents
Randomized Controlled Trials as Topic
Treatment Outcome
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

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10.1016/S0140-6736(10)60656-3

http://www.ncbi.nlm.nih.gov/pubmed/20462635

Cite this

@article{ba553b8627ec42d180c801235377beec,

title = "Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis",

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.FUNDING: National Health and Medical Research Council of Australia.",

keywords = "Cardiovascular Diseases, Clofibric Acid, Humans, Hypolipidemic Agents, Randomized Controlled Trials as Topic, Treatment Outcome, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review",

author = "M. Jun and C. Foote and F Lv and B. Neal and A. Patel and S.J. Nicholls and D.E. Grobbee and A. Cass and J. Chalmers and V. Perkovic",

year = "2010",

doi = "10.1016/S0140-6736(10)60656-3",

language = "English",

volume = "375",

pages = "1875--1884",

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issn = "0140-6736",

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TY - JOUR

T1 - Effects of fibrates on cardiovascular outcomes

T2 - a systematic review and meta-analysis

AU - Jun, M.

AU - Foote, C.

AU - Lv, F

AU - Neal, B.

AU - Patel, A.

AU - Nicholls, S.J.

AU - Grobbee, D.E.

AU - Cass, A.

AU - Chalmers, J.

AU - Perkovic, V.

PY - 2010

Y1 - 2010

N2 - 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.FUNDING: National Health and Medical Research Council of Australia.

AB - 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.FUNDING: National Health and Medical Research Council of Australia.

KW - Cardiovascular Diseases

KW - Clofibric Acid

KW - Humans

KW - Hypolipidemic Agents

KW - Randomized Controlled Trials as Topic

KW - Treatment Outcome

KW - Journal Article

KW - Meta-Analysis

KW - Research Support, Non-U.S. Gov't

KW - Review

U2 - 10.1016/S0140-6736(10)60656-3

DO - 10.1016/S0140-6736(10)60656-3

M3 - Review article

C2 - 20462635

SN - 0140-6736

VL - 375

SP - 1875

EP - 1884

JO - The Lancet

JF - The Lancet

IS - 9729

ER -

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

Abstract

Keywords

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