Effect of Fenofibrate Varies Widely in Type 2 Diabetes
Median 5-year major cardiovascular events risk in all 3 studies combined was 6.7% in patients without and 9.4% in patients with dyslipidemia.
HealthDay News — For patients with type 2 diabetes (T2D), the effect of fenofibrate treatment varies and is greater in patients with dyslipidemia, according to a study published in Diabetes Care.
Charlotte Koopal, MD, from the University Medical Center Utrecht in the Netherlands, and colleagues estimated the expected treatment effect of fenofibrate for 17,142 patients with T2D. Results from the FIELD risk model were externally validated in patients from the ACCORD and SMART observational cohorts.
The individual treatment effect was the difference between treated and untreated major cardiovascular event (MCVE) risk, expressed as the absolute risk reduction (ARR).
The researchers observed good calibration and moderate discrimination in ACCORD and SMART (c-statistic, 0.67 and 0.66, respectively) on external validation of the FIELD risk model. In all 3 studies combined, the median 5-year MCVE risk was 9.4% and 6.7% for patients with and without dyslipidemia, respectively.
The median ARR was 2.15% and 0.22% for patients with and without dyslipidemia, respectively, corresponding to a number needed to treat of 47 and 455, respectively.
"In individual patients with T2D, there is a wide range of absolute treatment effect of fenofibrate, and overall the fenofibrate treatment effect was larger in patients with dyslipidemia," the authors write. "The method of individualized treatment effect prediction of fenofibrate on MCVE risk reduction in T2D can be used to guide clinical decision-making."
Koopal C, Visseren FLJ, Westerink J, van der Graaf Y, Ginsberg HN, Keech AC. Predicting the effect of fenofibrate on cardiovascular risk for individual patients with type 2 diabetes mellitus [published online February 22, 2018]. Diabetes Care. doi: 10.2337/dc17-0968