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Anti-atherogenic effects of fibrates in type 2 diabetes
1Royal Adelaide Hospital, Adelaide, South Australia, Australia. philip.barter@adelaide.edu.au
Abstract:
Type 2 diabetes is an increasing cause of premature coronary heart disease. Several trials with lipid-modifying therapy have included sufficient numbers of diabetics to indicate that treatment of diabetic dyslipidaemia with either fibrates or statins reduces the risk of future coronary events in such patients. However, until recently no reported study had been designed specifically to investigate the effects of intervening in patients with type 2 diabetes. The Diabetes Atherosclerosis Intervention Study (DAIS) is an angiographic study in which 418 diabetic subjects were randomized to micronised fenofibrate or placebo groups. After 3 years of treatment, the fenofibrate group had a significantly reduced rate of progression of coronary atherosclerosis. This study, when considered with the results of other studies that have included diabetics, has important implications for the treatment of diabetic dyslipidaemia. The evidence that is currently available supports a place for both fibrates and statins, either as monotherapy or in combination, in the treatment of diabetic dyslipidaemia.
Insights
Micronised fenofibrate significantly slowed coronary atherosclerosis progression in type 2 diabetes patients. This finding supports lipid-modifying therapies, like fibrates and statins, for managing diabetic dyslipidaemia and reducing heart disease risk.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Type 2 diabetes is a major risk factor for premature coronary heart disease.
- Diabetic dyslipidaemia contributes significantly to cardiovascular complications.
- Previous trials suggested lipid-modifying therapy benefits in diabetic patients, but lacked specific design.
Purpose of the Study:
- To investigate the specific effect of lipid-modifying therapy on coronary atherosclerosis progression in type 2 diabetes patients.
- To evaluate the efficacy of micronised fenofibrate in this population.
Main Methods:
- The Diabetes Atherosclerosis Intervention Study (DAIS) was an angiographic study.
- 418 diabetic subjects were randomized to receive micronised fenofibrate or a placebo.
- Coronary atherosclerosis progression was assessed over a 3-year treatment period.
Main Results:
- The group treated with micronised fenofibrate demonstrated a significantly reduced rate of coronary atherosclerosis progression.
- Fenofibrate therapy showed a positive impact on lipid profiles relevant to diabetic dyslipidaemia.
Conclusions:
- Micronised fenofibrate is effective in slowing the progression of coronary atherosclerosis in patients with type 2 diabetes.
- Current evidence supports the use of fibrates and statins, alone or in combination, for treating diabetic dyslipidaemia.