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 .
Reduction in Stroke With Gemfibrozil in Men With Coronary Heart Disease and Low HDL Cholesterol: The Veterans Affairs HDL Intervention Trial (VA-HIT)
Background —A low level of HDL cholesterol has been identified as a risk factor for stroke in observational studies . Methods and Results —Our objective was to determine whether treatment aim ed at raising HDL cholesterol and lowering triglycerides reduces stroke in men with coronary heart disease and low levels of both HDL and LDL cholesterol . The study was a placebo-controlled , r and omized trial conducted in 20 Veterans Affairs medical centers . A total of 2531 men with coronary heart disease , with mean HDL cholesterol 0.82 mmol/L ( 31.5 mg/dL ) and mean LDL cholesterol 2.9 mmol/L ( 111 mg/dL ) , were r and omized to gemfibrozil 1200 mg/d or placebo  and were followed up for 5 years . Strokes were confirmed by a blinded adjudication committee . Relative risks were derived from Cox proportional hazards models . There were 134 confirmed strokes , 90 % of which were ischemic . Seventy-six occurred in the placebo group ( 9 fatal ) and 58 in the gemfibrozil group ( 3 fatal ) , for a relative risk reduction , adjusted for baseline variables , of 31 % ( 95 % CI , 2 % to 52 % , P = 0.036 ) . The reduction in risk was evident after 6 to 12 months . Patients with baseline HDL cholesterol below the median may have been more likely to benefit from treatment than those with higher HDL cholesterol . Conclusions —In men with coronary heart disease , low HDL cholesterol , and low LDL cholesterol , gemfibrozil reduces stroke incidence
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 .