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Systematic review
Fibrates reduce the risk of major cardiovascular and coronary events compared with placebo, but do not affect risk of cardiovascular or all-cause mortality
  1. Sandeep A Saha
  1. Providence Sacred Heart Medical Center, Spokane, Washington, USA
  2. University of Washington School of Medicine, Seattle, Washington, USA
  1. Correspondence to Sandeep A Saha
    101 West 8th Avenue, Spokane, WA 99220-2555, USA; sahas{at}uw.edu

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Context

Fibrates are selective activators of the peroxisome proliferator-activating receptor-α (PPARα) group of nuclear receptors and are currently an important treatment option for ‘mixed’ dyslipidemia characterised by low HDL-cholesterol levels, high triglycerides and a predominance of small, dense LDL-cholesterol particles. These lipid abnormalities are often seen in high-risk patient populations such as those with type 2 diabetes mellitus, metabolic syndrome and chronic kidney disease. Statins are considered first-line antidyslipidemic agents for prevention of adverse cardiovascular outcomes in most high-risk patients. However, a significant number of patients continue to develop cardiovascular events despite aggressive lowering of LDL-cholesterol using high-dose statin therapy, indicative of a substantial residual cardiovascular risk in these patients.1 Clinical trials using fibrates for prevention of cardiovascular events have yielded disparate results, leading to uncertainty about their role in cardiovascular risk modification, especially in patients with mixed dyslipidemia and high residual risk.

Methods

The paper by Jun and colleagues is an updated review and meta-analysis of published randomised controlled trials to study the effect of fibrates on various cardiovascular outcomes, prompted by publication of the results of the lipid-lowering arm of the ACCORD trial (ACCORD-Lipid) earlier this year.2 Using the PRISMA statement guidelines, the authors systematically searched the literature using Index Medicus/Medline, EMBASE, the Cochrane library …

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