Abstract 3691: Features Of Metabolic Syndrome Identify Individuals With Type 2 Diabetes Mellitus At High Risk For Cardiovascular Events And Greater Absolute Benefits Of Fenofibrate
Objective: The FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) trial examined the effects of long-term treatment over five years with fenofibrate compared with placebo on cardiovascular disease (CVD) events. Examining the effects of fenofibrate on total CVD events (myocardial infarction, stroke, CVD death, coronary and carotid revascularization) according to features of the metabolic syndrome (MS) were pre-specified analyses.
Methods: Among the 9795 individuals with type 2 diabetes mellitus randomized into the FIELD trial, subjects were categorized according to their other features of MS based on the Adult Treatment Panel (ATP) III criteria. Low HDL cholesterol was defined as < 40mg/dL for males and < 50mg/dL for females, high triglycerides ≥ 150mg/dL, increased waist circumference as ≥ 102 cm for males and ≥ 88 cm for females and elevated blood pressure as SBP/DBP ≥ 130/85 mm Hg or treated hypertension. For comparison with other fibrate trials, marked dyslipidemia was also defined, as low HDL cholesterol plus triglyceride levels ≥ 200mg/dL.
Results: Among placebo-allocated patients, the risk of CVD over an average of five years was higher for those with each feature of MS than those without, except for waist circumference. Hypertension and marked dyslipidemia provided the strongest risk discrimination. The highest risk for CVD was in patients with low HDL cholesterol and triglyceride levels ≥ 200mg/dL. This group also demonstrated the largest absolute reduction in CVD rate with fenofibrate use.
Conclusions: Marked dyslipidemia and elevated blood pressure were the best discriminators of CVD risk among placebo-allocated patients. Marked dyslipidemia also identified individuals with greater absolute CVD risk and greater event reduction due to fenofibrate.