[The PROMINENT trial: swan song of the fibrates]

Ned Tijdschr Geneeskd. 2023 Apr 5:167:D7528.
[Article in Dutch]

Abstract

Post hoc analyses of previous fibrate trials have suggested that individuals with type 2 diabetes mellitus with high triglyceride levels and low HDL-cholesterol levels benefit from fibrate therapy even when the overall trial results were neutral. However the PROMINENT (Pemafibrate to Reduce Cardiovascular Outcomes by Reducing Triglycerides in Patients with Diabetes) trial seems to close the door for fibrates. The trial found that fibrates do not reduce the risk of cardiovascular disease among individuals with type 2 diabetes and high triglyceride levels and low HDL cholesterol levels, despite triglyceride lowering. The results of PROMINENT suggest that triglyceride lowering without decreases in the plasma concentration of atherogenic lipoproteins are unlikely to decrease the risk of cardiovascular disease. These results also highlight the importance of rigorously confirmation of post hoc findings before implementation in clinical practice.

Publication types

  • English Abstract

MeSH terms

  • Cardiovascular Diseases*
  • Diabetes Mellitus, Type 2* / drug therapy
  • Fibric Acids / therapeutic use
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
  • Hypolipidemic Agents / therapeutic use
  • Triglycerides

Substances

  • Hypolipidemic Agents
  • Fibric Acids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Triglycerides