Role of fibrates in cardiovascular disease prevention, the ACCORD-Lipid perspective

Purpose of review To examine the results of the Action to Control Cardiovascular Risk in Diabetes (ACCORD)-Lipid trial, particularly the subgroup analyses. It is important, when a study fails to meet its overall primary endpoint, to ensure that interpretation of the results include analyses of subgroups that might benefit from the treatment tested. The goal of this review, therefore, is to provide insight and advice to physicians and healthcare workers treating patients similar to those enrolled in ACCORD. Recent findings The recently published results of ACCORD-Lipid trial will be presented upon the background of previous trials that have tested the ability of fibrates to lower cardiovascular risk. Summary Although ACCORD-Lipid trial did not provide support for the general addition of fenofibrate to statin-treated patients with type 2 diabetes mellitus (T2DM), it added significantly to the results from fibrate monotherapy trials indicative of benefit from such treatment in subgroups of patients who present with significant dyslipidemia. In particular, ACCORD-Lipid trial, in our view, supports the addition of fenofibrate to statin therapy in patients with T2DM and optimal low-density lipoprotein cholesterol levels but persistent, significant hypertriglyceridemia (>200 mg/dl) and low high-density lipoprotein cholesterol levels (<35-40 mg/dl).