Effects of High Density Lipoprotein Raising Therapies on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus, with or without Renal Impairment

The Action to Control Cardiovascular Risk in Diabetes Study

Vasilios Papademetriou, Laura Lovato, Costas Tsioufis, William Cushman, William B. Applegate, Amy Mottle, Zubin Punthakee, Eric Nylen, Michael Doumas

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The role of high density lipoprotein-raising interventions in addition to statin therapy in patients with diabetes remains controversial. Chronic kidney disease (CKD) is a strong modifier of cardiovascular (CV) outcomes. We therefore investigated the impact of CKD status at baseline on outcomes in patients with diabetes randomized to standard statin or statin plus fenofibrate treatment in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial. Methods: Among 5,464 participants in the ACCORD lipid trial, 3,554 (65%) were free of CKD at baseline, while 1,910 (35%) had mild to moderate CKD. Differences in CV outcomes during follow-up between CKD and non-CKD subgroups were examined. In addition, the effect of fenofibrate as compared to placebo on CV outcomes was examined for both subgroups. Results: All CV outcomes were 1.4-3 times higher among patients with CKD as compared to non-CKD patients. In patients with CKD, the addition of fenofibrate had no effect on any of the primary or secondary outcomes. In patients without CKD, however, the addition of fenofibrate was associated with a significant 36% reduction of CV mortality (hazards ratio [HR] 0.64; 95% CI 0.42-0.97; p value for treatment interaction <0.05) and 44% lower rate of fatal or non-fatal congestive heart failure (CHF; HR 0.56; 95% CI 0.37-0.84; p value treatment interaction <0.03). Conclusions: For patients with type 2 diabetes at high CV risk but no CKD, fenofibrate therapy added to statin reduced the CV mortality and the rate of fatal and non-fatal CHF.

Original languageEnglish (US)
Pages (from-to)136-145
Number of pages10
JournalAmerican Journal of Nephrology
Volume45
Issue number2
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

Fingerprint

HDL Lipoproteins
Chronic Renal Insufficiency
Type 2 Diabetes Mellitus
Fenofibrate
Kidney
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Therapeutics
Kidney Diseases
Lipids
Mortality
Heart Failure
Placebos

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Effects of High Density Lipoprotein Raising Therapies on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus, with or without Renal Impairment : The Action to Control Cardiovascular Risk in Diabetes Study. / Papademetriou, Vasilios; Lovato, Laura; Tsioufis, Costas; Cushman, William; Applegate, William B.; Mottle, Amy; Punthakee, Zubin; Nylen, Eric; Doumas, Michael.

In: American Journal of Nephrology, Vol. 45, No. 2, 01.02.2017, p. 136-145.

Research output: Contribution to journalArticle

Papademetriou, Vasilios ; Lovato, Laura ; Tsioufis, Costas ; Cushman, William ; Applegate, William B. ; Mottle, Amy ; Punthakee, Zubin ; Nylen, Eric ; Doumas, Michael. / Effects of High Density Lipoprotein Raising Therapies on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus, with or without Renal Impairment : The Action to Control Cardiovascular Risk in Diabetes Study. In: American Journal of Nephrology. 2017 ; Vol. 45, No. 2. pp. 136-145.
@article{76dd64113ceb49c2807e5129878c6247,
title = "Effects of High Density Lipoprotein Raising Therapies on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus, with or without Renal Impairment: The Action to Control Cardiovascular Risk in Diabetes Study",
abstract = "Background: The role of high density lipoprotein-raising interventions in addition to statin therapy in patients with diabetes remains controversial. Chronic kidney disease (CKD) is a strong modifier of cardiovascular (CV) outcomes. We therefore investigated the impact of CKD status at baseline on outcomes in patients with diabetes randomized to standard statin or statin plus fenofibrate treatment in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial. Methods: Among 5,464 participants in the ACCORD lipid trial, 3,554 (65{\%}) were free of CKD at baseline, while 1,910 (35{\%}) had mild to moderate CKD. Differences in CV outcomes during follow-up between CKD and non-CKD subgroups were examined. In addition, the effect of fenofibrate as compared to placebo on CV outcomes was examined for both subgroups. Results: All CV outcomes were 1.4-3 times higher among patients with CKD as compared to non-CKD patients. In patients with CKD, the addition of fenofibrate had no effect on any of the primary or secondary outcomes. In patients without CKD, however, the addition of fenofibrate was associated with a significant 36{\%} reduction of CV mortality (hazards ratio [HR] 0.64; 95{\%} CI 0.42-0.97; p value for treatment interaction <0.05) and 44{\%} lower rate of fatal or non-fatal congestive heart failure (CHF; HR 0.56; 95{\%} CI 0.37-0.84; p value treatment interaction <0.03). Conclusions: For patients with type 2 diabetes at high CV risk but no CKD, fenofibrate therapy added to statin reduced the CV mortality and the rate of fatal and non-fatal CHF.",
author = "Vasilios Papademetriou and Laura Lovato and Costas Tsioufis and William Cushman and Applegate, {William B.} and Amy Mottle and Zubin Punthakee and Eric Nylen and Michael Doumas",
year = "2017",
month = "2",
day = "1",
doi = "10.1159/000453626",
language = "English (US)",
volume = "45",
pages = "136--145",
journal = "American Journal of Nephrology",
issn = "0250-8095",
publisher = "S. Karger AG",
number = "2",

}

TY - JOUR

T1 - Effects of High Density Lipoprotein Raising Therapies on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus, with or without Renal Impairment

T2 - The Action to Control Cardiovascular Risk in Diabetes Study

AU - Papademetriou, Vasilios

AU - Lovato, Laura

AU - Tsioufis, Costas

AU - Cushman, William

AU - Applegate, William B.

AU - Mottle, Amy

AU - Punthakee, Zubin

AU - Nylen, Eric

AU - Doumas, Michael

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background: The role of high density lipoprotein-raising interventions in addition to statin therapy in patients with diabetes remains controversial. Chronic kidney disease (CKD) is a strong modifier of cardiovascular (CV) outcomes. We therefore investigated the impact of CKD status at baseline on outcomes in patients with diabetes randomized to standard statin or statin plus fenofibrate treatment in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial. Methods: Among 5,464 participants in the ACCORD lipid trial, 3,554 (65%) were free of CKD at baseline, while 1,910 (35%) had mild to moderate CKD. Differences in CV outcomes during follow-up between CKD and non-CKD subgroups were examined. In addition, the effect of fenofibrate as compared to placebo on CV outcomes was examined for both subgroups. Results: All CV outcomes were 1.4-3 times higher among patients with CKD as compared to non-CKD patients. In patients with CKD, the addition of fenofibrate had no effect on any of the primary or secondary outcomes. In patients without CKD, however, the addition of fenofibrate was associated with a significant 36% reduction of CV mortality (hazards ratio [HR] 0.64; 95% CI 0.42-0.97; p value for treatment interaction <0.05) and 44% lower rate of fatal or non-fatal congestive heart failure (CHF; HR 0.56; 95% CI 0.37-0.84; p value treatment interaction <0.03). Conclusions: For patients with type 2 diabetes at high CV risk but no CKD, fenofibrate therapy added to statin reduced the CV mortality and the rate of fatal and non-fatal CHF.

AB - Background: The role of high density lipoprotein-raising interventions in addition to statin therapy in patients with diabetes remains controversial. Chronic kidney disease (CKD) is a strong modifier of cardiovascular (CV) outcomes. We therefore investigated the impact of CKD status at baseline on outcomes in patients with diabetes randomized to standard statin or statin plus fenofibrate treatment in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial. Methods: Among 5,464 participants in the ACCORD lipid trial, 3,554 (65%) were free of CKD at baseline, while 1,910 (35%) had mild to moderate CKD. Differences in CV outcomes during follow-up between CKD and non-CKD subgroups were examined. In addition, the effect of fenofibrate as compared to placebo on CV outcomes was examined for both subgroups. Results: All CV outcomes were 1.4-3 times higher among patients with CKD as compared to non-CKD patients. In patients with CKD, the addition of fenofibrate had no effect on any of the primary or secondary outcomes. In patients without CKD, however, the addition of fenofibrate was associated with a significant 36% reduction of CV mortality (hazards ratio [HR] 0.64; 95% CI 0.42-0.97; p value for treatment interaction <0.05) and 44% lower rate of fatal or non-fatal congestive heart failure (CHF; HR 0.56; 95% CI 0.37-0.84; p value treatment interaction <0.03). Conclusions: For patients with type 2 diabetes at high CV risk but no CKD, fenofibrate therapy added to statin reduced the CV mortality and the rate of fatal and non-fatal CHF.

UR - http://www.scopus.com/inward/record.url?scp=85008312409&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85008312409&partnerID=8YFLogxK

U2 - 10.1159/000453626

DO - 10.1159/000453626

M3 - Article

VL - 45

SP - 136

EP - 145

JO - American Journal of Nephrology

JF - American Journal of Nephrology

SN - 0250-8095

IS - 2

ER -