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July 13, 2011

Fibrate Use in the United States and Canada

JAMA. 2011;306(2):157-159. doi:10.1001/jama.2011.946

To the Editor: Dr Jackevicius and colleagues reported an interesting trend of increasing fenofibrate prescriptions in the United States in the face of data questioning its value in reducing cardiovascular events in patients with diabetes.1

Could the increasing use of fenofibrate be partly motivated by efforts to prevent diabetic retinopathy (DR) and microvascular outcomes in patients with type 2 diabetes? It has long been known that dyslipidemia is a risk factor for DR, although previous clinical trials have not consistently shown a benefit of lipid-lowering therapy (eg, statins) in preventing DR.2 However, both the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and ACCORD trials demonstrated a clear benefit for fenofibrate on DR outcomes. The FIELD study reported that over 5 years, patients treated with fenofibrate were 30% less likely to need laser treatment for DR and were also less likely to demonstrate progression of pre-existing retinopathy or to develop macular edema.3 More recently, the ACCORD Eye study4 comparing fenofibrate with placebo in patients already using statins demonstrated the superiority of fenofibrate in preventing DR progression with an effect size similar to FIELD (risk reduction of 30%-40%).

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