Reducing vascular risk in the diabetic patient: implications from the FIELD study

Abstract

The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, involving 9, 795 patients with type 2 diabetes, is the largest study to date investigating the role of a lipid-modifying therapy in reducing cardiovascular risk in type 2 diabetes. Although the reduction in the primary end point (non-fatal myocar-dial infarction [MI] and coronary heart disease [CHD] death) did not reach statistical significance, fenofibrate treatment was associated with a significant reduction in total cardiovascular events, largely driven by reductions in non-fatal MI and revascularisation procedures. Subgroup analyses demonstrated greater treatment effect in patients without prior cardiovascular disease than in those with established cardiovascular disease (relative risk reduction for CHD events of 25%, p=0.014 vs. a non-significant 8% increase, respectively; and for total cardiovascular events of 19%, p=0.004 vs. no effect). Differences in the magnitude of the reduction in cardiovascular risk between studies emphasise the importance of considering patient characteristics, such as duration of diabetes, concomitant lipid-modifying therapy, glycaemic control and prior cardiovascular disease, which may all influence treatment response. Taking these factors into account, as well as the promising effects on microangiopathy observed in FIELD, suggests that fenofibrate may have a role as a well-tolerated treatment (most likely in combination with a statin) in patients with early stage type 2 diabetes without evidence of macrovascular disease.