Fenofibrate improves heart failure outcomes in patients with type 2 diabetes: ACCORD Lipid trial
Porto, Portugal: Recent data from the ACCORD Lipid trial showed that fenofibrate reduces the composite of HF hospitalizations or cardiovascular mortality in type 2 diabetes (T2D) patients treated with simvastatin. The effect was observed primarily in patients with standard background glucose-lowering therapy. The study was published in the journal Diabetes Care on March 23, 2022.
Type 2 diabetes patients are known to be at high risk for heart failure development, which is associated with a poor prognosis. Fenofibrate may reduce HF events through multiple mechanisms. João Pedro Ferreira, University of Porto, Porto, Portugal, and colleagues, therefore, aimed to study the effect of fenofibrate (vs. placebo) in HF outcomes among T2D patients receiving simvastatin enrolled in the Action to Control Cardiovascular Risk in Diabetes lipid trial (ACCORD Lipid).
The researchers used Cox regression analysis with background glucose-lowering strategy as the stratification variable. The median follow-up was 4.7 years. The study included a total of 5,518 patients. The median age was 62 years, and 31% were women. Prior HF history was present in 5% of the patients.
Salient findings of the study include:
- The composite outcome of HF hospitalization or cardiovascular death occurred in 190 (6.9%) patients in the fenofibrate group vs. 228 (8.3%) in the placebo group: HR 0.82.
- The beneficial effect of fenofibrate to reduce HF hospitalizations or cardiovascular death was present among patients receiving standard glucose-lowering strategy, HR 0.64, and not among patients receiving intensive glucose-lowering strategy, HR 1.02.
- A similar pattern was observed for HF hospitalizations alone.
- The effect of fenofibrate on blood lipids was not influenced by background glucose-lowering therapy in a clinically important manner.
- Fenofibrate caused more transient worsening estimated glomerular filtration rate (eGFR) events but slowed long-term eGFR decline.
"In T2D patients treated with simvastatin, fenofibrate reduced the composite of HF hospitalizations or cardiovascular mortality, an effect that was seen predominantly in patients with standard background glucose-lowering therapy," the researchers conclude.
Reference:
João Pedro Ferreira, Francisco Vasques-Nóvoa, Diana Ferrão, Francisca Saraiva, Inês Falcão-Pires, João Sérgio Neves, Abhinav Sharma, Patrick Rossignol, Faiez Zannad, Adelino Leite-Moreira; Fenofibrate and Heart Failure Outcomes in Patients With Type 2 Diabetes: Analysis From ACCORD. Diabetes Care 2022; dc211977. https://doi.org/10.2337/dc21-1977
KEYWORDS: fenofibrate, type 2 diabetes, heart failure, HF hospitalization, cardiovascular mortality, simvastatin, glucose-lowering therapy, João Pedro Ferreira, diabetes, hospitalization, ACCORD Lipid trial, Diabetes Care
