Board Certified in Internal Medicine
Prescribing of Fibrates
Comment: In large trials published in 2005 and 2010, fenofibrate did not improve cardiovascular outcomes significantly in patients with type 2 diabetes (JW Cardiol Jan 5 2006 and Mar 14 2010). Although gemfibrozil lowered rates of cardiovascular endpoints in older trials involving high-risk nondiabetic patients conducted largely before the statin era — for example, the Helsinki Heart Study (JW Gen Med Nov 17 1987) and VA-HIT Trial (JAMA 2001; 285:1585) — most such patients would now receive statins as first-line therapy. Thus, the recent rapid expansion of fenofibrate prescribing is unwarranted. One reason for this phenomenon is aggressive marketing of fibrates; another is confusion among clinicians about the lack of hard evidence to support add-on triglyceride-lowering therapies in patients receiving statins.