She responded well to dietary modification and a fibrate
, but was prone to develop hypertriglyceridaemia and pancreatitis after dietary indiscretion.
"We believe that the data actually suggest possible benefit for ESKD [end-stage kidney disease] with intensive glucose control, and remain inconclusive for intensive blood pressure control and fibrate
use given the wide confidence intervals for the more reliable ESKD outcomes," they wrote.
Most of these 30 patients were male (73%), had diabetes (90%), were taking a fibrate
(93%), and/or were taking a statin (80%), with 23% of the whole cohort on maximum statin therapy (atorvastatin 40 or 80 mg daily, or rosuvastatin 40 mg daily).
There is clinical equipoise, as demonstrated by the approval of several ongoing double-blind placebo-controlled cardiovascular outcomes studies that are evaluating the addition of omega-3 fatty acids (two studies) or a novel fibrate
(one study) to statin-treated patients with residual hypertriglyceridaemia and low HDL cholesterol.
Following this, the patient was started on a fibrate
and daily triglyceride trend was monitored.
Six studies accepted the stable use of hypolipemiants for a minimum period (prior to the beginning of the study) of 8 weeks (18); 3 months (15,29); 6 months (25); one of them accepted the use of statin, but excluded who were on fibrates
for 6 weeks before the beginning of the study (28); and on another, the use of fibrate
or niacin was allowed, but the use of niacin for less or equal to 3 months prior to the beginning of the study was exclusion criteria (26).
Old age, male sex, hypertension, diabetic retinopathy and neuropathy, high HbA1c SD, high mean HbA1c, high triglyceride, low HDL-cholesterol, low eGFR, ACEI and/or ARB use, aspirin use, statin and/or fibrate
use, and insulin use were associated with significantly higher risk of cardiovascular events.
(5) People with triglycerides over 500 mg/dL are an exception; they may need to start a fibrate
to control the high triglycerides before addressing other lipid abnormalities (Table 3).
Editor's Note: As possible protective mechanisms for DHEA, the authors note that the hormone is a peroxisome proliferator-activated receptor (PPAR) alpha agonist, as are fibrate
drugs currently used to treat high triglyceride levels.
However, the association no longer recommends niacin or fibrate
drugs to raise good cholesterol, due to sparse data establishing their effectiveness at reducing secondary stroke risk.
PPAR[alpha] is mainly expressed in the liver and heart, where it is activated by endogenous activators such as fatty acid derivatives (i.e., eicosanoids, palmitic, oleic, and linoleic acids) or exogenous ligands, such as the Wy14,643 compounds or fibrate
drugs (i.e., gemfibrozil, clofibrate, ciprofibrate, and fenofibrate) .
Case in point: in the ACCORD study (2010) both lipid and hypertension components were at variance, respectively, with expectations for intensive blood pressure targets in diabetes patients and additional benefit in protection from cardiovascular events by adding a fibrate
to a statin regimen.