Fibrates: Statin’s Trusty Sidekick or Lackluster Fallback?
Fibrates: Statin’s Trusty Sidekick or Lackluster Fallback?
This weeks Tools for Practice examines the evidence for Fibrates.
Clinical Question: Do fibrates reduce cardiovascular (CV) events?
Bottom-line
When used alone, fibrates reduce non-fatal coronary events, but have no effect on mortality or other CV events, including stroke. Current evidence suggests fibrates provide no advantage when added to statin therapy.
Meta-analysis of 18 trials (45,058 patients) of fibrates versus placebo over one to six years:
- 10% (confidence interval 0-18%) relative risk reduction (RRR) in CV events.
- No significant effect on all-cause mortality, vascular mortality or stroke.
- Coronary benefits seen in both primary and secondary prevention trials.
Before initiating a fibrate, consider optimizing other CV interventions that provide better value.
In a primary prevention patient with 10% risk of CV disease over 10 years:
- Fibrates reduce CV risk to 9%
- Statins reduce CV risk to 7.5%
- Thiazides reduce CV risk to 7%
Whereas fibrate benefits are limited to non-fatal coronary events, statins and thiazides also reduce stroke and mortality risk.
References are at the Tools for Practice site.