This significant effect was derived by the use of fibrates ( RR 0.80 , 95 % CI 0.73–0.87 , P < 0.001 , I2 = 22 % ) and meta-regression analysis showed that this benefit was consistent with an absolute reduction in low-density lipoprotein cholesterol .
Meta-regression analyses failed to demonstrate a significant association of pharmacologically increased high-density lipoprotein cholesterol with key endpoints .
Conclusion The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality , stroke or all-cause mortality .
The beneficial effect on myocardial infa rct ion was lost when drugs were used with statin therapy
Background The effects of increasing high-density lipoprotein cholesterol on cardiovascular outcomes remain uncertain .
Design We conducted a meta- analysis to investigate the effects of high-density lipoprotein cholesterol modifiers ( niacin , fibrates and cholesteryl ester transfer protein inhibitors ) on cardiovascular outcomes .
Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomised study
BACKGROUND Atherosclerosis is the most common complication of diabetes . Correction of hyperglycaemia helps to prevent microvascular complications but has little effect on macrovascular disease . Post-hoc analyses of diabetic sub population s in lipid intervention trials suggest that correction of lipoprotein abnormalities will lead to a decrease in coronary-artery disease . The Diabetes Atherosclerosis Intervention Study ( DAIS ) was specifically design ed to assess the effects of correcting lipoprotein abnormalities on coronary atherosclerosis in type 2 diabetes . METHODS 731 men and women with type 2 diabetes were screened by metabolic and angiographic criteria . 418 were r and omly assigned micronised fenofibrate ( 200 mg/day ) or placebo for at least 3 years . They were in good glycaemic control ( mean haemoglobin A1c 7.5 % ) , had mild lipoprotein abnormalities , typical of type 2 diabetes , and at least one visible coronary lesion . Half had no previous clinical coronary disease . Initial and final angiograms followed a st and ard protocol and were analysed by a computer-assisted quantitative approach . Missing data for the primary endpoints ( minimum lumen diameter , mean segment diameter , and mean percentage stenosis ) were imputed . Analyses were by intention to treat . FINDINGS Total plasma cholesterol , HDL-cholesterol , LDL-cholesterol , and triglyceride concentrations all changed significantly more from baseline in the fenofibrate group ( n=207 ) than in the placebo group ( n=211 ) . The fenofibrate group showed a significantly smaller increase in percentage diameter stenosis than the placebo group ( mean 2.11 [ SE 0.594 ] vs 3.65 [0.608]% , p=0.02 ) , a significantly smaller decrease in minimum lumen diameter ( -0.06 [ 0.016 ] vs -0.10 [ 0.016 ] mm , p=0.029 ) , and a non-significantly smaller decrease in mean segment diameter ( -0.06 [ 0.017 ] vs -0.08 [ 0.018 ] mm , p=0.171 ) . The trial was not powered to examine clinical endpoints , but there were fewer in the fenofibrate group than the placebo group ( 38 vs 50 ) . INTERPRETATION DAIS suggests that treatment with fenofibrate reduces the angiographic progression of coronary-artery disease in type 2 diabetes . This effect is related , at least partly , to the correction of lipoprotein abnormalities , even those previously judged not to need treatment
This significant effect was derived by the use of fibrates ( RR 0.80 , 95 % CI 0.73–0.87 , P < 0.001 , I2 = 22 % ) and meta-regression analysis showed that this benefit was consistent with an absolute reduction in low-density lipoprotein cholesterol .
Meta-regression analyses failed to demonstrate a significant association of pharmacologically increased high-density lipoprotein cholesterol with key endpoints .
Conclusion The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality , stroke or all-cause mortality .
The beneficial effect on myocardial infa rct ion was lost when drugs were used with statin therapy
Background The effects of increasing high-density lipoprotein cholesterol on cardiovascular outcomes remain uncertain .
Design We conducted a meta- analysis to investigate the effects of high-density lipoprotein cholesterol modifiers ( niacin , fibrates and cholesteryl ester transfer protein inhibitors ) on cardiovascular outcomes .