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Ginsberg, MD
College of Physicians & Surgeons , Columbia University, New York For The ACCORD Study Group
Lipids
60 < LDL-C < 180 mg/dl HDL-C < 55 mg/dl for women/Blacks; < 50 mg/dl otherwise Triglycerides < 750 mg/dl if on no therapy; < 400 mg/dl otherwise
All participants on open-labeled simvastatin, 20 to 40 mg/day Simvastatin dose complied with lipid guidelines
Patients randomized to double-blind placebo or fenofibrate, 54 to 160mg/day Dosing based upon eGFR level Only blinded ACCORD trial
Mean or % 62 31
68 15
Hispanic %
Secondary prevent % DM duration (yrs)* A1c (%) * BMI (kg/m2)
7
37 9 8.3 32
0.9
15 60 8 33
Median values
Mean LDL-C
120
110 100
mg/dl
Feno Placebo
mg/dl
170 160
90
80 70
Feno
Placebo
150
140
Years PostRandomization
60
0
N = 5483
0
N = 5483
1
5180
2
4988
3
4783
4
5250
5
3377
6
1668
7
491
1
5180
2
4988
3
4783
4
5250
5
3377
6
1668
7
491
Years PostRandomization
Mean HDL-C
42 41
mg/dl
170 160 150
Median Triglycerides
mg/dl
40 39
Feno
Placebo
140
Feno Placebo
130
38 37
0
N = 5483 Years PostRandomization
120
110
0
N = 5432
1
5180
2
4988
3
4783
4
5250
5
3377
6
1668
7
491
1
5180
2
4988
3
4783
4
5250
5
3377
6
1668
7
491
Years PostRandomization
P value
0.21 0.03 0.43 0.83
P value
0.21 0.03 0.43 0.83
0.01
289 (10.5%)
337 (12.3%)
0.03
Primary Outcome
Placebo (N=2753) Rate N of (%/yr) Events Primary Outcome: Major Fatal or Nonfatal Cardiovascular Event
310
2.41
Primary Outcome
Fenofibrate (N=2765) Rate N of (%/yr) Events Primary Outcome: Major Fatal or Nonfatal Cardiovascular Event Placebo (N=2753) Rate N of (%/yr) Events
291
2.24
310
2.41
Primary Outcome
Fenofibrate (N=2765) Rate N of (%/yr) Events Primary Outcome: Major Fatal or Nonfatal Cardiovascular Event Placebo (N=2753) Rate N of (%/yr) Events
HR (95% CI)
P Value
291
2.24
310
2.41
Trial (Drug)
HHS
(Gemfibrozil)
-34% (0.02)
-71%
BIP
(Bezafibrate)
-7.3% (0.24) TG > 204 mg/dl HDL-C < 42 mg/dl TG > 204 mg/dl HDL-C < 34 mg/dl
-39.5%
FIELD
(Fenofibrate)
-11%
(0.16)
-27%
ACCORD
(Fenofibrate)
-8%
(0.32)
-31%
Conclusion (1)
ACCORD Lipid does not support use of the combination of fenofibrate and simvastatin compared to simvastatin alone to reduce CVD events in the majority of patients with T2DM who have HDL-
Conclusion (2)
Subgroup analyses suggesting heterogeneity in