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. 2019 Sep 27;366:l5125.
doi: 10.1136/bmj.l5125.

Use of Fenofibrate on Cardiovascular Outcomes in Statin Users With Metabolic Syndrome: Propensity Matched Cohort Study

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Free PMC article

Use of Fenofibrate on Cardiovascular Outcomes in Statin Users With Metabolic Syndrome: Propensity Matched Cohort Study

Nam Hoon Kim et al. BMJ. .
Free PMC article

Abstract

Objective: To investigate whether fenofibrate as add-on to statin treatment reduce persistent cardiovascular risk in adults with metabolic syndrome in a real world setting.

Design: Propensity matched cohort study.

Setting: Population based cohort in Korea.

Participants: 29 771 adults with metabolic syndrome (≥40 years) receiving statin treatment. 2156 participants receiving combined treatment (statin plus fenofibrate) were weighted based on propensity score in a 1:5 ratio with 8549 participants using statin only treatment.

Main outcome measure: Primary outcome was composite cardiovascular events including incident coronary heart disease, ischaemic stroke, and death from cardiovascular causes.

Results: The incidence rate per 1000 person years of composite cardiovascular events was 17.7 (95% confidence interval 14.4 to 21.8) in the combined treatment group and 22.0 (20.1 to 24.1) in the statin group. The risk of composite cardiovascular events was significantly reduced in the combined treatment group compared with statin group (adjusted hazard ratio 0.74, 95% confidence interval 0.58 to 0.93; P=0.01). The significance was maintained in the on-treatment analysis (hazard ratio 0.63, 95% confidence interval 0.44 to 0.92; P=0.02). The risk of incident coronary heart disease, ischaemic stroke, and cardiovascular death was lower in the combined treatment group than statin group but was not significant. Participant characteristics did not appear to be associated with the low risk of composite cardiovascular events with combined treatment.

Conclusion: In this propensity weighted cohort study of adults with metabolic syndrome, the risk of major cardiovascular events was significantly lower with fenofibrate as add-on to statin treatment than with statin treatment alone.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from Abbott Laboratories Korea; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Flow diagram of participant selection
Fig 2
Fig 2
Kaplan-Meier survival curves for composite cardiovascular outcomes between treatment groups in all participants (top), participants with high triglyceride or low high density lipoprotein cholesterol concentrations (middle), and participants with low triglyceride and high high density lipoprotein cholesterol concentrations (bottom)
Fig 3
Fig 3
Hazard ratio of composite cardiovascular events by subgroups. CVD=cardiovascular disease; LDL=low density lipoprotein; HDL=high density lipoprotein

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