Cardioprotective Properties of Fibrates

Abstract

Several large intervention trials have investigated the potential of fibrates to reduce cardiovascular events. The results have varied widely: positive, with gemfibrozil in the primary prevention Helsinki Heart Study (HHS)1 and the secondary prevention Veterans Administration High Density Lipoprotein Intervention Trial (VA-HIT)2; positive, with reservations related to an increase in noncardiovascular mortality in the primary prevention World Health Organization trial (clofibrate)3; and mixed, with bezafibrate in the secondary prevention Bezafibrate Infarction Prevention (BIP) study4 and with fenofibrate in the combined primary and secondary prevention FIELD study,5 in which positive outcomes were observed only in certain subgroups. Reasons for the differences between the outcomes of these studies are not immediately apparent. Article p 1556 It emerged in post hoc subgroup analyses of the HHS,6 VA-HIT,7 and BIP8 data that fibrate-induced reductions in cardiovascular events were especially great (of the order of 30% to 50%) in subjects with evidence of insulin resistance or other features of the metabolic syndrome, such as dyslipidemia and increased body weight. However, this finding was not replicated with fenofibrate in the FIELD study.5 In another post hoc analysis of VA-HIT, it was found that diabetics with preexisting cardiovascular disease derived a major reduction in future events when treated with gemfibrozil,7 but again, this was not confirmed with fenofibrate in FIELD.5 The observation that the cardioprotective effects of gemfibrozil in the HHS and VA-HIT studies were substantially greater than those found with other fibrates in the World Health Organization, BIP, and FIELD studies may reflect no more than the play of chance. It may also reflect differences in the populations studied in the trials. However, it is possible that gemfibrozil has protective properties that are lacking in other fibrates or that other fibrates have adverse …