Fenofibrate for Diabetes?

Heart disease and stroke are the biggest causes of death and disability in people who have type 2 diabetes, so minimizing risks for these cardiovascular events is extremely important.

An analysis of data from a large study suggests that one cholesterol-lowering drug may play a role in preventing these serious conditions in some patients...

Diabetes and Heart Disease

High blood sugar levels can lead to deposits of fatty substances on blood vessel walls, which can cause clogging or hardening of the vessels and interrupt the flow of blood. This puts diabetes patients at increased risk for heart disease and stroke.

Diabetes patients tend to have heart attacks or strokes at earlier ages and they are usually more serious. But patients who successfully keep their blood glucose under control often still have other heart disease risk factors, such as high blood pressure, high cholesterol, or obesity. In fact, even patients who don’t have these risk factors have higher rates of heart disease, according to Amber Taylor, MD, who treats patients with diabetes at Mercy Medical Center in Baltimore.

Because of the high risk of heart disease, physicians may prescribe drugs that treat high cholesterol to help reduce the risks of heart attack or stroke. There are several types of cholesterol lowering medications; statins, which help prevent the formation of cholesterol, are some of the most popular. Fenofibrate belongs to a class of cholesterol-lowering medications called fibrates; fibrates are best at lowering levels of triglycerides, a type of blood fat.

Diabetes and Fenofibrate

A large study of nearly 10,000 participants (Fenofibrate Intervention and Event Lowering in Diabetes, or FIELD) demonstrated that fenofibrate reduces the incidence of serious cardiovascular events in both men and women with type 2 diabetes, though it did not significantly reduce the prevalence of first-time, non-fatal heart attacks or coronary death. A different study (ACCORD) had questioned the safety and effectiveness of fenofibrate in women with diabetes who were also taking the statin simvastatin. FIELD, which included a larger percent of women participants than ACCORD, found fenofibrate was safe for women.

FIELD also showed that women had significant improvements in their total and LDL ("bad") cholesterol levels when they took fenofibrate, though the reason for this was not clear.

The researchers suggest that diabetes patients who take statins but still have high triglyceride and low HDL ("good") cholesterol levels might benefit from adding 200 mg per day of fenofibrate to their medication regimen.

"The FIELD trial showed there is no harm in using fenofibrate," says Taylor. "However, it does not change my prescribing patterns. This is about using evidence-based medicine to guide treatment decisions. Since physicians treat real, actual people, and not laboratory numbers, we want to be sure we are offering patients a good risk-to-benefit ratio. There are definitely people with diabetes who would benefit from the use of fibrate therapy, but we’ll offer the most effective risk-reducing therapy first, which is typically a statin."

Preventing Heart Disease

Even if you have diabetes, you can take steps to prevent heart disease by controlling your weight, eating a healthy diet, getting regular physical activity, and not smoking, which doubles the risk of heart disease.

Amber Taylor, MD, Mercy Medical Center, reviewed this article.

Sources

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