Fenofibrate and Heart Failure Outcomes in Patients With Type 2 Diabetes: Analysis From ACCORD
Research design and Methods: Cox regression analysis with background glucose-lowering strategy as stratification variable. The median follow-up was 4.7 years.
Results: A total of 5518 patients were included. The median age was 62 years and 31% were women. A prior HF history was present in 5% of the patients. The composite outcome of HF hospitalization or cardiovascular death occurred in 190 (6.9%) patients in the fenofibrate group vs. 228 (8.3%) in the placebo group: HR 0.82, 95%CI 0.68-1.00, P =0.048. The beneficial effect of fenofibrate to reduce HF hospitalizations or cardiovascular death was present among patients receiving standard glucose-lowering strategy: HR 0.64, 95%CI 0.48-0.85, and not among patients receiving intensive glucose-lowering strategy: HR 1.02, 95%CI 0.79-1.33, interaction P =0.017. A similar pattern was observed for HF hospitalizations alone. The effect of fenofibrate on blood lipids was not influenced by background glucose-lowering therapy in a clinically important manner. Fenofibrate caused more transient worsening eGFR events but slowed the long-term eGFR decline.
Conclusion: In patients with T2D treated with simvastatin, fenofibrate reduced the composite of HF hospitalizations or cardiovascular mortality, an effect that was seen predominantly in patients with standard background glucose-lowering therapy.