Effects of fenofibrate on cardiovascular events in patients with diabetes, with and without prior cardiovascular disease: The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

Andrew Tonkin, David Hunt, Merryn Voysey, Antero Kesaniemi, Andrew Hamer, Jonathon Waites, Leo Mahar, Stewart Mann, Paul Glasziou, Peta Forder, John Simes, Anthony Keech

    Research output: Contribution to journalArticle

    21 Citations (Scopus)

    Abstract

    Background: In the FIELD study, comparison of the effect of fenofibrate on cardiovascular disease (CVD) between those with prior CVD and without was a prespecified subgroup analysis. Methods: The effects of fenofibrate on total CVD events and its components in patients who did (n = 2,131) and did not (n = 7,664) have a history of CVD were computed by Cox proportional hazards modeling and compared by testing for treatment-by-subgroup interaction. The analyses were adjusted for commencement of statins, use of other CVD medications, and baseline covariates. Effects on other CVD end points were explored. Results: Patients with prior CVD were more likely than those without to be male, to be older (by 3.3 years), to have had a history of diabetes for 2 years longer at baseline, and to have diabetic complications, hypertension, and higher rates of use of insulin and CVD medications. Discontinuation of fenofibrate was similar between the subgroups, but more patients with prior CVD than without, and also more placebo than fenofibrate-assigned patients, commenced statin therapy. The borderline difference in the effects of fenofibrate between those who did (hazard ratio [HR] 1.02, 95% CI 0.86-1.20) and did not have prior CVD (HR 0.81, 95% CI 0.70-0.94; heterogeneity P =.045) became nonsignificant after adjustment for baseline covariates and other CVD medications (HR 0.96, 95% CI 0.81-1.14 vs HR 0.78, 95% CI 0.67-0.90) (heterogeneity P =.06). Conclusions: Our findings do not support treating patients with fenofibrate differently based on any history of CVD, in line with evidence from other trials.

    Original languageEnglish
    Pages (from-to)508-514
    Number of pages7
    JournalAmerican Heart Journal
    Volume163
    Issue number3
    DOIs
    Publication statusPublished - 2012

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