Effects of fenofibrate treatment on cardiovascular disease risk in 9,795 individuals with type 2 diabetes and various components of the metabolic syndrome: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.
Effects of fenofibrate treatment on cardiovascular disease risk in 9,795 individuals with type 2 diabetes and various components of the metabolic syndrome: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.
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DOI：
10.2337/dc08-1543
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发表时间：
2009-03
期刊：
影响因子：
16.2
通讯作者：
Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study Investigators
中科院分区：
文献类型：
--
作者：
Scott R;O'Brien R;Fulcher G;Pardy C;D'Emden M;Tse D;Taskinen MR;Ehnholm C;Keech A;Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study Investigators
目的：在非诺贝特干预和糖尿病事件降低研究中，根据成人治疗小组III(ATPIII)对2型糖尿病患者定义的代谢综合征的不同特征，我们探讨了非诺贝特在有无代谢综合征的受试者中心血管疾病(CVD)风险和非诺贝特的作用是否不同。研究设计和方法-计算代谢综合征的患病率及其特征。根据年龄、性别、心血管疾病状况和基线A1C水平调整后的COX比例模型用于确定代谢综合征特征对总心血管事件发生率的独立贡献以及非诺贝特的影响。结果：超过80%的现场参与者符合ATPIII代谢综合征标准。代谢综合征的每一种ATPIII特征，除了腰围增加外，在5年内发生心血管事件的绝对风险增加至少3%。有明显血脂异常(甘油三酯升高、高密度脂蛋白胆固醇(≥)2.3mmo1/L、低密度脂蛋白胆固醇)的人群患心血管疾病的风险最高(5年内为17.8%)。非诺贝特显著减少低高密度脂蛋白胆固醇或高血压患者的心血管事件。非诺贝特对降低心血管风险的作用最大的是有明显血脂异常的患者，他们的相对风险降低了27%(95%可信区间9-42，P=0.005；需要治疗的人数=23)。既往没有心血管疾病的受试者比整个组的风险降低更大。结论--代谢综合征成分在2型糖尿病患者中识别出更高的心血管风险，因此当存在代谢综合征特征时，非诺贝特的绝对益处可能更大。非诺贝特的风险最高，受益最大的是那些有明显高甘油三酯血症的人。
OBJECTIVE—We explored whether cardiovascular disease (CVD) risk and the effects of fenofibrate differed in subjects with and without metabolic syndrome and according to various features of metabolic syndrome defined by the Adult Treatment Panel III (ATP III) in subjects with type 2 diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. RESEARCH DESIGN AND METHODS—The prevalence of metabolic syndrome and its features was calculated. Cox proportional models adjusted for age, sex, CVD status, and baseline A1C levels were used to determine the independent contributions of metabolic syndrome features to total CVD event rates and the effects of fenofibrate. RESULTS—More than 80% of FIELD participants met the ATP III criteria for metabolic syndrome. Each ATP III feature of metabolic syndrome, apart from increased waist circumference, increased the absolute risk of CVD events over 5 years by at least 3%. Those with marked dyslipidemia (elevated triglycerides ≥2.3 mmol/l and low HDL cholesterol) were at the highest risk of CVD (17.8% over 5 years). Fenofibrate significantly reduced CVD events in those with low HDL cholesterol or hypertension. The largest effect of fenofibrate to reduce CVD risk was observed in subjects with marked dyslipidemia in whom a 27% relative risk reduction (95% CI 9–42, P = 0.005; number needed to treat = 23) was observed. Subjects with no prior CVD had greater risk reductions than the entire group. CONCLUSIONS—Metabolic syndrome components identify higher CVD risk in individuals with type 2 diabetes, so the absolute benefits of fenofibrate are likely to be greater when metabolic syndrome features are present. The highest risk and greatest benefits of fenofibrate are seen among those with marked hypertriglyceridemia.
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