Date Published: October 4, 2018
Publisher: Public Library of Science
Author(s): Yeongmin Woo, Jeong-soo Shin, Chi-Young Shim, Jung-Sun Kim, Byeong-Keuk Kim, Sungha Park, Hyuk-Jae Chang, Geu-Ru Hong, Young-Guk Ko, Seok-Min Kang, Donghoon Choi, Jong-Won Ha, Myeong-Ki Hong, Yangsoo Jang, Sang-Hak Lee, Laura Calabresi.
Fibrates are used in patients with dyslipidemia and high cardiovascular risk. However, information regarding drug response to fibrate has been highly limited. We investigated treatment results and factors associated with triglyceride reduction after fenofibrate therapy using large-scale real-world data. Patients with one or more cardiovascular risk factors, at low-density lipoprotein-cholesterol goal but with triglyceride level ≥150 mg/dL, and undergoing treatment with fenofibrate 135–160 mg for the first time were included in this retrospective observational study. The outcome variable was the percentage changes of TG levels. The achievement rate of triglyceride <150 mg/dL was additionally analyzed. Factors associated with treatment results were also analyzed. Among 2546 patients who were initially screened, 1113 patients were enrolled (median age: 61 years; male: 71%). After median follow-up of 4 months, the median change in triglyceride was -60%, and 49% of the patients reached triglyceride <150 mg/dL. After adjusting for confounding variables, female sex, non-diabetic status, coronary artery disease, lower baseline triglyceride, and no statin use were identified to be independently associated with achievement of triglyceride <150 mg/dL. Among them, female sex, non-diabetic status, and coronary artery disease were also related to median or greater percentage reduction of triglyceride. In conclusion, only half of the study patients reached triglyceride levels <150 mg/dL after real-world fenofibrate therapy. This study indicates that more attention is needed on some subgroups to obtain optimal triglyceride levels when treating with fenofibrate.
Fibrate is frequently used in patients with dyslipidemia and cardiovascular risk [1–3]. Its clinical benefit has been shown in specific conditions such as atherogenic dyslipidemia [4–7] or diabetes for retardation of microangiopathy [8, 9]. However, universal control of triglyceride (TG) is not strongly recommended for cardiovascular prevention [3, 10] and real-world data regarding drug response to fibrate has been highly limited.
In the current study, the median reduction of TG by usual dose of fenofibrate was -60%, whereas 49% of patients achieved TG <150 mg/dL. The percentage of TG reduction was greater in women, patients without DM, non-smokers, and those with higher pre-treatment TG, with atherogenic dyslipidemia, or without statin use. After adjusting confounding variables, older age, female sex, non-diabetic status, history of CAD, and higherpre-treatment TG level were identified to be associated with optimal level achievement. Taken together, in real-world practice, only half of patients receiving fenofibrate therapy reached the optimal TG levels and more attention may be needed to subgroups such as males or diabetic patients. Source: http://doi.org/10.1371/journal.pone.0205006