1. The risk of major cardiovascular events may be further reduced with the addition of fenofibrate therapy to statin treatment in adults with metabolic syndrome.
Evidence Rating Level: 2 (Good)
Metabolic syndrome is associated with an increased risk of atherosclerotic cardiovascular disease; this risk is partly attributable to accompanying atherogenic dyslipidemia. While statin therapy significantly reduces low density lipoprotein (LDL) cholesterol concentrations and therefore reduces the risk of cardiovascular disease, many patients continue to have significant cardiovascular risk. Fenofibrate has been suggested as a treatment option or adjunct in the management of dyslipidemia. Although previous large randomized clinical trials failed to demonstrate a reduction in major cardiovascular populations with diabetes, risk reduction was observed in subgroups with atherogenic dyslipidemia. In this population-based cohort study, adults in Korea age 40 years or older with metabolic syndrome receiving statin treatment (2007-2014) were followed up to evaluate the effects of fenofibrate treatment on major cardiovascular events (MACE) in adults with metabolic syndrome on statin therapy. Of the 29,771 individuals forming the initial cohort, 2156 participants were receiving combined treatment, and were thus weighted based on propensity scoring in a 1:5 ratio with 8549 patients using statin only treatment. Researchers found that the incidence per 1000 person-years of composite cardiovascular events was 17.7 (95% CI 14.4 to 21.8) in the combined treatment group, as compared to 22.0 (95% CI 20.1 to 24.1) in the statin-only group. This translated to a significantly reduced risk of cardiovascular events (HR 0.74, 95% CI 0.58 to 0.93). The risk of incident coronary heart disease, stroke, and cardiovascular death were also lower in the combined treatment group, however, these findings were not significant. This study therefore shows that the risk of major cardiovascular events may be further reduced with the addition of fenofibrate therapy to statin treatment in adults with metabolic syndrome.
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