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More Clinical Lessons from the FIELD Study

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Abstract

Introduction

The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study investigated the effect of fenofibrate treatment in 9,795 patients with type 2 diabetes.

Results and discussion

Reduction in major coronary events (the primary endpoint) and total cardiovascular disease (CVD) events (the secondary endpoint) was similar (relative risk reduction 11%), but only significant for total CVD events (p = 0.035). The benefit of fenofibrate treatment was greater in patients with mixed dyslipidaemia, especially in those with triglycerides >2.3 mmol/L and low plasma levels of high-density lipoprotein cholesterol (relative risk reduction 27%, p = 0.005). There were also microvascular benefits associated with fenofibrate treatment, specifically reduction in the rate of laser therapy for retinopathy (by 30%, p < 0.001), non-traumatic amputation (by 38%, p = 0.011) and progression of albuminuria (p < 0.002). Fenofibrate was generally well tolerated alone or in combination with a statin.

Conclusions

Overall, the FIELD study data support the use of fenofibrate for CVD prevention in diabetes, ideally in patients without prior macrovascular or microvascular complications. Fenofibrate may also have a role as a preventive treatment for diabetic retinopathy. Addition of fenofibrate to statin therapy may a logical progression from the FIELD study data, although the efficacy and tolerability of this approach needs to be evaluated in prospective outcome studies.

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Acknowledgements

The preparation of this manuscript was assisted by an unrestricted educational grant from ABBOTT Laboratories. The author acknowledges editorial assistance provided by Jane Stock PhD.

Disclosures

The author has received funding for clinical trials from Merck, Pfizer, Astra-Zeneca, and Takeda. He is a lecturer or advisor for Merck, Schering-Plough, Astra-Zeneca, Glaxo-SmithKline, and Abbott.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    Sergio Fazio

  2. Vanderbilt University School of Medicine, 383 PRB, 2220 Pierce Avenue, Nashville, TN, 37232-6300, USA

    Sergio Fazio

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  1. Sergio Fazio
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Correspondence to Sergio Fazio.

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Fazio, S. More Clinical Lessons from the FIELD Study. Cardiovasc Drugs Ther 23, 235–241 (2009). https://doi.org/10.1007/s10557-008-6160-5

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