Effects of long-term fenofibrate therapy on cardiovascular events in people with type 2 diabetes mellitus

Conclusions The authors of the FIELD study conclude that the result of this large and scientifically rigorous study provides information to help guide clinicians on the future use of fenofibrate in patients with type 2 diabetes. They state the “results are likely to be of particular importance among patients without previous cardiovascular disease where both the prevention of non-fatal macrovascular events and microvascular complications are judged important.” I do not believe the results of the FIELD trial support an expanded role of fenofibrate therapy for patients with diabetes. To suggest we use fenofibrate as primary prevention in diabetic patients because a post hoc analysis of the FIELD study demonstrated no benefit in patients with known heart disease and modest benefit in patients without known heart disease is scientifically invalid and biologically implausible. To suggest we use fenofibrate to reduce microvascular disease will require a clinical trial designed to look at those specific endpoints. At present, there is no evidence to suggest that therapy with fenofibrate is superior to generic gemfibrozil. The clinical utility of fenofibrate in patients with more severe hypertriglyceridemia or in combination with statin therapy will remain to be demonstrated in a well-designed clinical trial.