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Fibrates for primary prevention of cardiovascular disease events
Open accessAbstract
BACKGROUND: Fibrates are effective for modifying atherogenic dyslipidaemia, and particularly for lowering serum triglycerides. However, evidence that fibrates reduce mortality and morbidity associated with cardiovascular disease (CVD), or overall mortality and morbidity, in the primary prevention of CVD is lacking. OBJECTIVES: This Cochrane Review and meta-analysis aimed to evaluate the clinical benefits and harms of fibrates versus placebo or usual care or fibrates plus other lipid-modifying drugs versus other lipid-modifying drugs alone for the primary prevention of cardiovascular disease (CVD) morbidity and mortality. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and Web of Science (all from inception to 19 May 2016). We searched four clinical trial registers (last searched on 3 August 2016) with the help of an experienced professional librarian. We searched the databases to identify randomised controlled trials (RCTs) evaluating the clinical effects of fibrate therapy in the primary prevention of CVD events. We did not impose any language restrictions. SELECTION CRITERIA: We aimed to include all RCTs comparing the effects of fibrate monotherapy versus placebo or usual care, or fibrates plus other lipid-modifying drugs versus other lipid-modifying drugs alone. Included studies had a follow-up of at least six months for the primary prevention of CVD events. We excluded trials with clofibrate, because it was withdrawn from the market in 2002. DATA COLLECTION AND ANALYSIS: statistic to measure inconsistency of treatment effects across studies. Using the GRADE approach, we assessed the quality of the evidence and used the GRADE profiler software (GRADEpro GDT) to import data from Review Manager 5 to create 'Summary of findings' tables. MAIN RESULTS: = 74%; very low-quality of evidence). Data on quality of life were not available from any trial. Trials that evaluated fibrates in the background of statins (2 studies) showed no benefits in preventing cardiovascular events. AUTHORS' CONCLUSIONS: Moderate-quality evidence suggests that fibrates lower the risk for cardiovascular and coronary events in primary prevention, but the absolute treatment effects in the primary prevention setting are modest (absolute risk reductions < 1%). There is low-quality evidence that fibrates have no effect on overall or non-CVD mortality. Very low-quality evidence suggests that fibrates are not associated with increased risk for adverse effects.
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“Subsequent metaanalyses have also demonstrated similar findings regarding the benefits of fibrates in patients with true dyslipidemia”
From The Forgotten Lipids: Triglycerides, Remnant Cholesterol, and Atherosclerotic Cardiovascular Disease Risk (2019) · cites this paper as [144]
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Metadata
- Authors
- Jakob, T., Nordmann, A. J., Schandelmaier, S., Ferreira-González, I., & Briel, M.
- Affiliations
- University of Basel (CH)
- Vall d'Hebron Hospital; Cardiology Department, Epidemiology Unit; Passeig Vall d'Hebron 119-129 Barcelona Barcelona Spain 08035
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2016-11-16
- Volume
- 2017
- Issue
- 3
- Pages
- CD009753-CD009753
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6464497
- OpenAlex
- W1918267826
- Cited by
- 147
- References
- 129
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 11 · 2023: 25 · 2022: 18 · 2021: 16 · 2020: 16 · 2019: 15 · 2018: 21 · 2017: 8 · 2016: 1
- FWCI
- 2.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- British Heart Foundation
- European Society of Cardiology
- Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- fibrates, primary prevention, cardiovascular disease, cardiovascular events, coronary events, triglycerides, lipid-modifying drugs, statins, atherogenic dyslipidemia, mortality, adverse effects, quality of life
- MeSH terms
- Atorvastatin, Hypolipidemic Agents, Bezafibrate, Cardiovascular Diseases, Clofibric Acid, Humans, Middle Aged, Myocardial Infarction, Primary Prevention, Fenofibrate, Gemfibrozil, Simvastatin, Stroke
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