NEW YORK (Reuters Health) - Bezafibrate can reduce long-term risk of myocardial infarction in patients with metabolic syndrome and a history of MI, Israeli researchers report.
While statins and fibrates have not been directly compared in any clinical trials, Dr. Alexander Tenenbaum of the Neufield Cardiac Research Institute at Chaim Sheba Medical Center in Tel-Hashomer and colleagues note, fibrates seem to target therapeutic goals in patients with metabolic syndrome more selectively.
To investigate the effect of bezafibrate, a fibric acid derivative, on secondary prevention in this group of patients, Dr. Tenenbaum’s team performed a post-hoc analysis of a clinical trial in which patients with at least three of five metabolic syndrome risk factors had been randomized to 400 mg of bezafibrate or placebo daily. The current study analyzed results for 1470 patients. The results are reported in the May 23rd issue of the Archives of Internal Medicine.
Over a mean 6.2-year follow-up period, 11.1% of the patients on bezafibrate had a new MI, compared with 15.2% of patients on placebo (p = 0.02). The drug cut risk of MI by 29% and non-fatal MI by 33%.
In the bezafibrate patients, there was a 26% reduction in cardiac mortality, which was not statistically significant. But when the 575 patients with four or five metabolic syndrome risk factors were analyzed separately, the reduction in cardiac mortality was larger and statistically significant, at 56%.
Patients showed a significant increase in HDL cholesterol levels (33.0 to 38.3 mg/dL) after the first year on the drug, and a drop in triglycerides from 170 to 120 mg/dL.
Fasting glucose levels also fell in patients on bezafibrate, from 107 to 105 mg/dL, but rose from107 to 112 mg/dL among those on placebo. No differences were seen in BMI over time between the two groups.
“Whereas statins remain the drug of choice for patients who need to achieve the LDL-C level goal, fibrate therapy may represent the alternative intervention for patients with atherogenic dyslipidemia typical of metabolic syndrome and an LDL-C level already close to the goal,” the researchers conclude.
“In addition, the concomitant use of fibrates seems to be attractive in patients whose LDL-C level is controlled by statin therapy but HDL-C and/or triglyceride levels are still inappropriate.”
Source: Arch Intern Med 2005;165:1154-1160. [ Google search on this article ]
MeSH Headings:Acids, Acyclic: Bezafibrate: Butyrates: Butyric Acids: Carbohydrate Metabolism, Inborn Errors: Clofibric Acid: Glucose Intolerance: Butyric AcidCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
