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Can Concurrent Fibrate Use Reduce Cardiovascular Risks among Moderate Chronic Kidney Disease Patients Undergoing
Li-Yi Ma1, Pei-Chun Fan1,2, Chao-Yu Chen1,2
1Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333423, Taiwan.
Insights
Adding fibrates to statin therapy in chronic kidney disease (CKD) patients did not significantly reduce major adverse cardiovascular events or all-cause mortality. Fibrates may not provide additional cardiovascular protection beyond statins alone in moderate CKD.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hypertriglyceridemia in chronic kidney disease (CKD) increases cardiovascular disease (CVD) risk.
- Statins are first-line for dyslipidemia in CKD, but fibrate's role is unclear.
- Investigating combined statin-fibrate therapy for CVD prevention in CKD patients.
Purpose of the Study:
- To evaluate the efficacy of concurrent fibrate and statin therapy in moderate CKD patients.
- To assess the impact on cardiovascular events and mortality.
- To determine if fibrates offer additional CVD protection when combined with statins.
Main Methods:
- Retrospective cohort study of CKD3 patients from Chang Gung Research Database.
- Patients on statin therapy, without prior ezetimibe or niacin.
- Comparison between a fibrate group (n=954) and a non-fibrate group (n=2358) with triglycerides >200 mg/dL.
Main Results:
- The fibrate group showed a significantly lower incidence of acute myocardial infarction (AMI).
- No significant differences were observed in major adverse cardiovascular and cerebrovascular events between groups.
- All-cause mortality did not significantly differ between the fibrate and non-fibrate groups.
Conclusions:
- Concurrent fibrate and statin therapy in moderate CKD patients did not significantly reduce major adverse cardiovascular events or all-cause mortality.
- Fibrates may not provide additional cardiovascular protection compared to statin therapy alone in this population.
- Further research is needed to clarify the role of fibrates in managing cardiovascular risk in CKD.
Abstract:
The role of fibrates in treating hypertriglyceridemia in chronic kidney disease (CKD) patients to prevent cardiovascular disease (CVD) has been insufficiently investigated. Since statin is considered the first-line treatment for dyslipidemia in CKD patients, this study aims to evaluate the role of concurrent fibrate therapy with statins among moderate CKD patients. We recruited CKD3 patients from the Chang Gung Research Database who were receiving statin treatment but had not previously been administered ezetimibe or niacin. The participants were divided into two groups based on their use of fibrates (fibrate group) or those with triglyceride levels >200 mg/dL without fibrate treatment (non-fibrate group). The fibrate group (n = 954) only exhibited a significantly lower incidence of AMI (4.4% vs. 5.4%, HR: 0.77, 95% CI: 0.61 to 0.98). The risk of major adverse cardiovascular and cerebrovascular events (14.7% vs. 15.6%, HR: 0.91, 95% CI: 0.72 to 1.15) and all-cause mortality (5.7% vs. 6.1%, HR: 0.91, 95% CI: 0.63 to 1.30) did not significantly differ between the fibrate group and the non-fibrate group (n = 2358). In moderate CKD patients, combining fibrate therapy with statins may not offer additional cardiovascular protection compared to statin alone.
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