NEW YORK, Mar 23 (Reuters Health) - The cholesterol-lowering drug fenofibrate slows the progression of coronary artery disease in people with type 2 diabetes, according to an international study. Heart disease is one of the major complications of diabetes.
Based on the findings, the study's authors conclude that even small abnormalities in blood cholesterol should be treated in diabetic patients.
The most common complication of diabetes is atherosclerosis, the build-up of fatty plaques in arteries that can lead to a heart attack. Keeping blood sugar, or glucose, under control can reduce the risk of many diabetes complications, but good glucose control does little to reduce the risk of coronary artery disease, according to a team led by Dr. George Steiner, of the University of Toronto in Canada.
Steiner and his colleagues studied the effects of fenofibrate among diabetics with good glucose control, but mild abnormalities in blood fats, such as mildly elevated levels of LDL ("bad") cholesterol and triglycerides and low levels of HDL ("good") cholesterol. All participants had at least one artery-clogging lesion in a heart artery.
Fenofibrate, sold as Tricor in the US by Illinois-based Abbott Laboratories, is approved in the US for lowering cholesterol and triglycerides, another form of blood fat. Abbott sells the drug under an agreement with Groupe Fournier, the French company that developed the drug.
The study, conducted in Canada and several European countries, included 418 men and women who were randomly assigned to take a daily dose of fenofibrate or an inactive placebo for at least 3 years. At the beginning and end of the study, patients underwent blood vessel imaging to evaluate the extent of their atherosclerosis.
Levels of triglycerides and cholesterol, both good and bad, improved significantly more in patients taking fenofibrate, the researchers report in the March 24th issue of The Lancet.
Moreover, their artery disease progressed 25% to 42% less, compared with those on placebo, according to the report.
Patients taking fenofibrate were also less likely to have a heart attack, to undergo artery-clearing treatment or to die during the study. However, the researchers caution that the study was too small to prove that the drug was responsible for this reduced risk.
Still, based on these findings, Steiner's team calls for the careful monitoring of blood fats in people with diabetes, even when levels are only mildly abnormal.
"Current evidence suggests that if any abnormality is found, even if it is small, it should be corrected to reduce the risk of coronary disease," the researchers conclude.
Laboratoires Fournier in France funded the study.
This study will have an impact on the way physicians treat patients with diabetes, according to Dr. Nicola Abate, director of the lipid clinic at the University of Texas Southwestern Medical Center at Dallas.
It should "push more physicians to look not just at LDL, but at all lipids," he told Reuters Health in an interview.
"It's important to lower LDL, but...raising HDL and lowering triglycerides is important, too," noted Abate, who was not involved in the study. Since most people with diabetes have only mild lipid abnormalities, it is important to pay close attention to these blood fats regardless of whether a patient has evidence of heart disease, he said. |
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