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Fibrates reduce nonfatal events, no effect on fatal events

Clinical Question:
Do fibrates reduce the rate of cardiovascular events?

Bottom Line:
In this meta-analysis, patients who took fibrates were less likely to experience cardiovascular events and coronary events, but they gained no mortality benefit. (LOE = 1a)

Jun M, Foote C, Lv J, et al. Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. Lancet 2010;375(9729):1875-1884.  [PMID:20462635]

Study Design:
Meta-analysis (randomized controlled trials)


Outpatient (any)

This team of researchers systematically searched several databases for clinical trials comparing fibrates (eg,, gemfibrozil, clofibrate, and so forth) with placebo. The trials had to include at least 100 patient-years of follow-up. The authors supplemented their search with a review of the bibliographies of included studies, and they searched a clinical trials registry to identify unpublished studies. Two members of the team independently extracted the data and assessed study quality (using the Jadad score). A third member of the team adjudicated disagreements. Ultimately, they included 15 trials of 4 different fibrates with approximately 45,000 patients (range = 81 to 10,627). Although the duration of follow-up ranged from 1 year to 8.75 years, the researchers don't report annualized rates of events. In 5 studies that reported data on major cardiovascular outcomes (fatal and nonfatal events), 13.6% of patients who took fibrates experienced an event compared with 15.2% of control patients (number needed to treat [NNT] to benefit one patient = 62; 95% CI, 39 - 157). Excluding the sole study in which placebo was better than fibrates had a negligible effect on the overall results. In the 16 studies that assessed coronary events, 8.7% of patients taking fibrates had a coronary event compared with 11.6% of control patients (NNT = 35; 30 - 44). Although the total rate of events was lower in patients taking fibrates, there was no difference in all-cause mortality, cardiac death, or cardiovascular death. Only 4 of the trials reported adverse events, and those reported adverse events were similar to those of placebo. In addition to their search for unpublished studies, the authors statistically assessed the potential for publication bias and found that only studies of coronary events showed evidence of publication bias. Finally, this report did not provide enough data to estimate annualized event rates, and therefore not enough data to be able to report a time frame for the estimates of numbers needed to treat to benefit 1 patient.


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