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 .
Gemfibrozil for secondary prevention of cardiovascular events in mild to moderate chronic renal insufficiency.
BACKGROUND Although cardiovascular disease and low high-density lipoprotein ( HDL ) cholesterol are common in people with renal insufficiency , data addressing the cardiovascular benefits of fibric acid derivatives in this population are sparse . We conducted a post hoc subgroup analysis of a r and omized double-blind , placebo-controlled trial to determine whether gemfibrozil is effective and safe for secondary prevention of cardiovascular events in individuals with chronic renal insufficiency ( CRI ) . METHODS Using an analysis plan that was developed a priori , we analyzed data from the Veterans ' Affairs High-Density Lipoprotein Intervention Trial ( VA-HIT ) study ; a r and omized trial of gemfibrozil versus placebo in 2531 men with established coronary disease , an HDL cholesterol level of 40 mg/dL ( 1.0 mmol/L ) or less , and a low-density lipoprotein ( LDL ) cholesterol level of 140 mg/dL ( 3.6 mmol/L ) or less . Of these , 1046 men had CRI as defined by creatinine clearance < /=75 mL/min using the Cockcroft-Gault equation , 99.8 % of whom had either mild or moderate renal impairment ( creatinine clearance 60 - 75 or 30 - 59.9 mL/min , respectively ) . RESULTS The incidence of the primary outcome ( coronary death or nonfatal myocardial infa rct ion ) was lower in participants with CRI who received gemfibrozil compared to placebo [ hazard ratio ( HR ) 0.73 ; 95 % CI 0.56 - 0.96 , P= 0.02 ) . The cumulative incidence of the primary end point was reduced from 24.3 % to 18.2 % . In subjects with CRI , gemfibrozil also significantly reduced the risk of the combined outcome of coronary death , nonfatal myocardial infa rct ion , or stroke ( HR 0.74 , 95 % CI 0.58 - 0.95 , P= 0.02 ) , but not the need for coronary revascularization ( HR 0.85 , 95 % CI 0.66 - 1.10 , P= 0.21 ) or total mortality ( HR 1.03 , 95 % CI 0.78 - 1.35 , P= 0.85 ) . The overall incidence of adverse effects was similar in individuals receiving gemfibrozil and placebo . However , the risk of sustained increases in serum creatinine was increased in gemfibrozil recipients compared with placebo ( 5.9 vs. 2.8 % , P= 0.02 ) . CONCLUSION Gemfibrozil appears effective for secondary prevention of cardiovascular events in individuals with mild to moderate chronic renal insufficiency and HDL cholesterol of 40 mg/dL or less . However , the benefit and safety of gemfibrozil in people with more severe impairment of kidney function requires further study
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 .