Subgroup analyses showed the benefit of fibrates on the primary composite outcome to be consistent irrespective of age , gender , and diabetes mellitus .
Moderate evidence showed that the fibrate class can be effective in the secondary prevention of composite outcome of non-fatal stroke , non-fatal MI , and vascular death .
However , this beneficial effect relies on the inclusion of clofibrate data , a drug that was discontinued in 2002 due to its unacceptably large adverse effects .
BACKGROUND Fibrates are a class of drugs characterised by mainly lowering high triglyceride , raising high-density lipoprotein ( HDL ) cholesterol , and lowering the small dense fraction of low-density lipoprotein ( LDL ) cholesterol .
Their efficacy for secondary prevention of serious vascular events is unclear , and to date no systematic review focusing on secondary prevention has been undertaken .
OBJECTIVES To assess the efficacy and safety of fibrates for the prevention of serious vascular events in people with previous cardiovascular disease ( CVD ) , including coronary heart disease and stroke .
Angiographic assessment of effects of bezafibrate on progression of coronary artery disease in young male postinfarction patients
BACKGROUND Bezafibrate has effects on lipid metabolism and haemostatic function . We undertook a double-blind , placebo-controlled intervention trial , the Bezafibrate Coronary Atherosclerosis Intervention Trial ( BECAIT ) , to establish whether bezafibrate ( 200 mg three times daily ) could retard or prevent the progression of atherosclerotic lesions in dyslipidaemic male survivors of myocardial infa rct ion who were younger than 45 years at the time of the event . METHODS 92 patients completed an initial 3-month period of dietary intervention  and were r and omly assigned to treatment with bezafibrate or placebo . Dietary intervention continued throughout the trial . Coronary angiography was done at baseline and after 2 and 5 years . 81 patients ( 42 bezafibrate treated and 39 placebo treated ) who underwent baseline angiography and at least one post-treatment angiogram were included in the efficacy analysis . The primary endpoint was change in mean minimum lumen diameter . FINDINGS The mean minimum lumen diameter decreased from baseline to the last angiographic assessment ( 2 or 5 years ) by 0.06 mm ( 95 % CI 0.15 reduction to 0.01 increase ) in the bezafibrate group and by 0.17 mm ( 0.33 reduction to 0.09 increase ) in the placebo group . The treatment effect was therefore 0.13 mm ( 95 % CI 0.10 to 0.15 ; p=0.049 ) . Parallel treatment effects , although not statistically significant , were observed for the secondary angiographic endpoints ( mean segment diameter 0.02 mm [ 0.01 - 0.04 ] and percentage stenosis -3.41 % [ -4.00 to -2.98 ] ) . The cumulative coronary event rate was significantly lower among bezafibrate-treated than among placebo-treated patients ( three vs 11 patients ; p=0.02 ) . There were significant treatment effects of bezafibrate for serum concentrations of cholesterol ( -9 % ; p<0.001 ) , very-low-density-lipoprotein ( VLDL ) cholesterol ( -35 % ; p<0.001 ) , serum triglycerides ( -31 % ; p<0.001 ) , VLDL triglycerides ( -37 % ; p<0.001 ) , and plasma fibrinogen ( -12 % ; p=0.001 ) , whereas low-density ( LDL ) cholesterol concentrations did not change . High density lipoprotein ( HDL ) cholesterol increased significantly with bezafibrate ( 9 % ; p=0.02 ) . INTERPRETATION The results show that bezfibrate improves dyslipidaemia , lowers plasma fibrinogen , slows the progression of focal coronary atherosclerosis , and reduces coronary events in young survivors of myocardial infa rct ion
Subgroup analyses showed the benefit of fibrates on the primary composite outcome to be consistent irrespective of age , gender , and diabetes mellitus .
Moderate evidence showed that the fibrate class can be effective in the secondary prevention of composite outcome of non-fatal stroke , non-fatal MI , and vascular death .
However , this beneficial effect relies on the inclusion of clofibrate data , a drug that was discontinued in 2002 due to its unacceptably large adverse effects .
BACKGROUND Fibrates are a class of drugs characterised by mainly lowering high triglyceride , raising high-density lipoprotein ( HDL ) cholesterol , and lowering the small dense fraction of low-density lipoprotein ( LDL ) cholesterol .
Their efficacy for secondary prevention of serious vascular events is unclear , and to date no systematic review focusing on secondary prevention has been undertaken .
OBJECTIVES To assess the efficacy and safety of fibrates for the prevention of serious vascular events in people with previous cardiovascular disease ( CVD ) , including coronary heart disease and stroke .