Abstract 1498: Do Fibrates Reduce Cardiovascular Mortality? A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Background: The evidence for fibrates use in patients with established or presumed coronary artery disease (CAD) has been conflicting. We thought to systematically review the literature and perform a meta-analysis of the efficacy of fibrates in this patient population. We tested the hypothesis that fibrates reduce cardiovascular (CV) mortality in patients with established or presumed CAD.
Methods: MEDLINE, EMBASE, BIOSIS from 01/90 till 03/06, abstract of major cardiology meetings were searched for eligible studies. Included studies were randomized, placebo-controlled trials of fibrates use in patients with CAD, diabetes or vascular disease. We performed a random-effect model meta-analysis and quantified between-studies heterogeneity with I2. (I2<50% suggest no heterogeneity)
Results: Of 435 potentially relevant articles screened, seven trials met the inclusion criteria. There were 8937 patients randomized to fibrates and 8934 patients randomized to placebo. Fibrates use did not reduce the risk of CV mortality (RR 0.99, 95% CI 0.86–1.14, p=0.85, I2=8%), all cause mortality (RR 1.03, 95% CI 0.94–1.12, p=0.57, I2=0) or stroke (RR 0.92, 95% CI 0.79–1.08, p=0.3, I2=13). There was a significant reduction in non fatal MI (RR 0.79, 95% CI 0.65–0.81, p=<.00001, I2=0). There was no significant heterogeneity between studies for all outcomes.
Conclusion: The cumulative evidence provided by this meta-analysis suggests that benefit of fibrates in patients with confirmed or suspected CAD is limited to reduction in non-fatal myocardial infarction with no mortality benefit. Other therapies with survival benefit like statins should be the first line of therapy in patient with CAD.