Cardiovascular Diseases; dyslipidaemia; fenobifrate; retinopathy; type 2 diabetes
Abstract :
[en] Fenofibrate has been evaluated in the ACCORD trial, in combination with a statin, to prevent vascular complications in patients with type 2 diabetes. In ACCORD-Lipid, the addition of fenofibrate was not able to significantly reduce the incidence of a composite cardiovascular endpoint (no positive effect was also observed with the intensification of blood glucose or blood pressure control in this population). However, an interaction effect was observed according to basal lipid profile, suggesting a better protection by fenofibrate in patients with hypertriglyceridaemia and low HDL cholesterol (so-called atherogenic dyslipidaemia). In ACCORD-Eye, the addition of fenofibrate to a basal statin therapy resulted in a significant reduction of the progression of diabetic retinopathy, in a similar manner as that observed with intensifying blood glucose control (but with a good safety profile and without increasing the risk of hypoglycaemia). These observations, confirming earlier results from FIELD also with this fibrate, open new perspectives for a useful prescription of fenofibrate in patients with type 2 diabetes. [fr] Le fénofibrate a été testé dans l’étude ACCO RD, en association avec une statine, pour prévenir les complications vasculaires chez le patient diabétique de type 2. Dans l’étude ACCO RD-Lipid, l’ajout de fénofibrate n’a pas permis de réduire significativement la survenue d’un critère composite cardio-vasculaire primaire (tout comme, d’ailleurs, l’intensification du contrôle strict de la glycémie ou de la pression artérielle dans cette population). Cependant, un effet d’interaction a été mis en évidence en fonction du profil lipidique de départ, orientant vers une protection plus marquée avec le fénofibrate chez les patients caractérisés par une hypertriglycéridémie et un taux de cholestérol HDL abaissé (dyslipidémie dite athérogène). Dans l’étude ACCO RD-Eye, l’ajout de fénofibrate à une statine a permis de réduire significativement la progression de la rétinopathie diabétique, de façon comparable à l’intensification du contrôle glycémique (mais avec un bon profil de sécurité et sans risque d’hypoglycémie). Ces observations, confirmant les résultats de l’étude FIE LD également avec ce fibrate, ouvrent de nouvelles perspectives pour une utilisation judicieuse du fénofibrate chez les patients diabétiques de type 2.
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Van Gaal, L. F.
Language :
French
Title :
L'etude clinique du mois. ACCORD-LIPID et ACCORD-EYE: vers un nouveau positionnement du fenofibrate chez le patient diabetique de type 2.
Alternative titles :
[en] Accord-lipid and accord-eye: towards a new positioning of fenofibrate in the management of type 2 diabetes
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