Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis

Fibrat dapat mengurangi risiko kardiovaskuler terutama koroner.

Fibrat juga dapat mengurangi progresi albuminuria.

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The Lancet, Volume 375, Issue 9729, Pages 1875 - 1884, 29 May 2010

Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis

Min Jun MSc a, Celine Foote MBBS a, Jicheng Lv MD a b, Prof Bruce Neal MBChB a, Anushka Patel MD a, Stephen J Nicholls MBBS c,Prof Diederick E Grobbee MD d, Prof Alan Cass MBBS a, Prof John Chalmers MBBS a, Dr Vlado Perkovic MBBS a

Summary

Background
Several clinical trials have reported inconsistent findings for the effect of fibrates on cardiovascular risk. We undertook a systematic review and meta-analysis to investigate the effects of fibrates on major clinical outcomes.
Methods
We systematically searched Medline, Embase, and the Cochrane Library for trials published between 1950 and March, 2010. We included prospective randomised controlled trials assessing the effects of fibrates on cardiovascular outcomes compared with placebo. Summary estimates of relative risk (RR) reductions were calculated with a random effects model. Outcomes analysed were major cardiovascular events, coronary events, stroke, heart failure, coronary revascularisation, all-cause mortality, cardiovascular death, non-vascular death, sudden death, new onset albuminuria, and drug-related adverse events.
Findings
We identified 18 trials providing data for 45 058 participants, including 2870 major cardiovascular events, 4552 coronary events, and 3880 deaths. Fibrate therapy produced a 10% RR reduction (95% CI 0—18) for major cardiovascular events (p=0·048) and a 13% RR reduction (7—19) for coronary events (p<0·0001), but had no benefit on stroke (−3%, −16 to 9; p=0·69). We noted no effect of fibrate therapy on the risk of all-cause mortality (0%, −8 to 7; p=0·92), cardiovascular mortality (3%, −7 to 12; p=0·59), sudden death (11%, −6 to 26; p=0·19), or non-vascular mortality (−10%, −21 to 0·5; p=0·063). Fibrates reduced the risk of albuminuria progression by 14% (2—25; p=0·028). Serious drug-related adverse events were not significantly increased by fibrates (17 413 participants, 225 events; RR 1·21, 0·91—1·61; p=0·19), although increases in serum creatinine concentrations were common (1·99, 1·46—2·70; p<0·0001).
Interpretation
Fibrates can reduce the risk of major cardiovascular events predominantly by prevention of coronary events, and might have a role in individuals at high risk of cardiovascular events and in those with combined dyslipidaemia.

Konsumsi kacang memperbaiki profil lipid

Konsumsi kacang2an 67 g per hari dapat memperbaiki profil lipid (menurunkan kolesterol total, LDL dan trigliserid)

 

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Nut Consumption and Blood Lipid Levels
A Pooled Analysis of 25 Intervention Trials
Joan Sabaté, MD, DrPH; Keiji Oda, MA, MPH; Emilio Ros, MD, PhD

Arch Intern Med. 2010;170(9):821-827.

Background  Epidemiological studies have consistently associated nut consumption with reduced risk for coronary heart disease. Subsequently, many dietary intervention trials investigated the effects of nut consumption on blood lipid levels. The objectives of this study were to estimate the effects of nut consumption on blood lipid levels and to examine whether different factors modify the effects.

Methods  We pooled individual primary data from 25 nut consumption trials conducted in 7 countries among 583 men and women with normolipidemia and hypercholesterolemia who were not taking lipid-lowering medications. In a pooled analysis, we used mixed linear models to assess the effects of nut consumption and the potential interactions.

Results  With a mean daily consumption of 67 g of nuts, the following estimated mean reductions were achieved: total cholesterol concentration (10.9 mg/dL [5.1% change]), low-density lipoprotein cholesterol concentration (LDL-C) (10.2 mg/dL [7.4% change]), ratio of LDL-C to high-density lipoprotein cholesterol concentration (HDL-C) (0.22 [8.3% change]), and ratio of total cholesterol concentration to HDL-C (0.24 [5.6% change]) (P < .001 for all) (to convert all cholesterol concentrations to millimoles per liter, multiply by 0.0259). Triglyceride levels were reduced by 20.6 mg/dL (10.2%) in subjects with blood triglyceride levels of at least 150 mg/dL (P < .05) but not in those with lower levels (to convert triglyceride level to millimoles per liter, multiply by 0.0113). The effects of nut consumption were dose related, and different types of nuts had similar effects on blood lipid levels. The effects of nut consumption were significantly modified by LDL-C, body mass index, and diet type: the lipid-lowering effects of nut consumption were greatest among subjects with high baseline LDL-C and with low body mass index and among those consuming Western diets.

Conclusion  Nut consumption improves blood lipid levels in a dose-related manner, particularly among subjects with higher LDL-C or with lower BMI.

Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy

Penderita nefropati diabetik sering disertai dengan hiperhomosisteinemia, sehingga diberikan terapi vitamin B untuk menurunkan kadar homosistein.

Tapi ternyata pemberian terapi vitamin B menyebabkan penurunan GFR lebih besar, dan meningkatkan risiko vascular events (myocardial infarction, stroke, revascularization, and all-cause mortality)

 

Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy

A Randomized Controlled Trial

Andrew A. House, MD; Misha Eliasziw, PhD; Daniel C. Cattran, MD; David N. Churchill, MD; Matthew J. Oliver, MD;Adrian Fine, MD; George K. Dresser, MD; J. David Spence, MD

JAMA. 2010;303(16):1603-1609.

Context  Hyperhomocysteinemia is frequently observed in patients with diabetic nephropathy. B-vitamin therapy (folicacid, vitamin B6, and vitamin B12) has been shown to lower the plasma concentration of homocysteine.
Objective  To determine whether B-vitamin therapy can slow progression of diabetic nephropathy and prevent vascular complications.
Design, Setting, and Participants  A multicenter, randomized, double-blind, placebo-controlled trial (Diabetic Intervention with Vitamins to Improve Nephropathy [DIVINe]) at 5 university medical centers in Canada conducted between May 2001 and July 2007 of 238 participants who had type 1 or 2 diabetes and a clinical diagnosis of diabetic nephropathy.
Intervention  Single tablet of B vitamins containing folic acid (2.5 mg/d), vitamin B6 (25 mg/d), and vitamin B12 (1 mg/d), or matching placebo.
Main Outcome Measures  Change in radionuclide glomerular filtration rate (GFR) between baseline and 36 months. Secondary outcomes were dialysis and a composite of myocardial infarction, stroke, revascularization, and all-cause mortality. Plasma total homocysteine was also measured.
Results  The mean (SD) follow-up during the trial was 31.9 (14.4) months. At 36 months, radionuclide GFR decreased by a mean (SE) of 16.5 (1.7) mL/min/1.73 m2 in the B-vitamin group compared with 10.7 (1.7) mL/min/1.73 m2 in the placebo group (mean difference, –5.8; 95% confidence interval [CI], –10.6 to –1.1; P = .02). There was no difference in requirement of dialysis (hazard ratio [HR], 1.1; 95% CI, 0.4-2.6; P = .88). The composite outcome occurred more often in the B-vitamin group (HR, 2.0; 95% CI, 1.0-4.0; P = .04). Plasma total homocysteine decreased by a mean (SE) of 2.2 (0.4) µmol/L at 36 months in the B-vitamin group compared with a mean (SE) increase of 2.6 (0.4) µmol/L in the placebo group (mean difference, –4.8; 95% CI, –6.1 to –3.7; P < .001, in favor of B vitamins).
Conclusion  Among patients with diabetic nephropathy, high doses of B vitamins compared with placebo resulted in a greater decrease in GFR and an increase in vascular events.