- Email: [email protected]
Abstract: 1446 USE OF PPAR AGONISTS IN THE MANAGEMENT AND PREVENTION OF VASCULAR DISEASE IN DIABETES.
Plenary Session IV - Other Lipid Modifying Treatments for Atherosclerosis Abstract: 1446 Citation: Atherosclerosis Supplement 2009, Vol. 10, Issue 2
USE OF PPAR AGONISTS IN THE MANAGEMENT AND PREVENTION OF VASCULAR DISEASE IN DIABETES. A Keech Sydney, Australia Background: Type 2 diabetes (T2DM) increases CVD events by 3-4 fold. Diabetic retinopathy affects over 50 million people, and ~15% of people with T2DM die of nephropathy. T2DM is also the commonest cause of non-traumatic amputation. Additional therapeutic strategies are needed. PPAR-Ȗ agents: Pioglitazone reduced the combination of MI, stroke, and death in metaanalysis, whereas rosiglitazone may increase myocardial ischemic events. Both agents can increase heart failure through fluid retention. An increased risk of bone fractures has been reported. PPAR-Į agents: Reductions in non-fatal myocardial infarction have been reported in metaanalysis and in individual trials, with less impact on CVD death. Gemfibrozil interacts with statins for metabolic clearance, likely increasing myositis risk. Fenofibrate interacts less or not at all, potentially being safer to use in combination with statins. Only fenofibrate has been shown to reduce microvascular complications of T2DM, in addition to reducing total CVD events.
FIELD study: In the FIELD study, fenofibrate non-significantly reduced coronary events (11%, p=0.16), but non-fatal MI (-24%), total CVD (-11%), revascularisation (-21%), ACS (-18%) and total MI (silent plus clinical, -20%) all fell (all p Conclusions: The choice of which PPAR-Ȗ or which PPAR-Į agent to use in clinical practice may be important in obtaining clinical benefits with good safety. Fenofibrate is the first lipidmodifying drug to significantly lower the microvascular complications of T2DM and could be useful add-on therapy in many subjects with diabetes. Salpeter SR, Walsh JM, Greyber E, Salpeter EE. Brief report: coronary heart disease events associated with hormone therapy in younger and older women. A meta-analysis. J Gen Intern Med 2006;21:363-366.
USE OF PPAR AGONISTS IN THE MANAGEMENT AND PREVENTION OF VASCULAR DISEASE IN DIABETES. A Keech Sydney, Australia Background: Type 2 diabetes (T2DM) increases CVD events by 3-4 fold. Diabetic retinopathy affects over 50 million people, and ~15% of people with T2DM die of nephropathy. T2DM is also the commonest cause of non-traumatic amputation. Additional therapeutic strategies are needed. PPAR-Ȗ agents: Pioglitazone reduced the combination of MI, stroke, and death in metaanalysis, whereas rosiglitazone may increase myocardial ischemic events. Both agents can increase heart failure through fluid retention. An increased risk of bone fractures has been reported. PPAR-Į agents: Reductions in non-fatal myocardial infarction have been reported in metaanalysis and in individual trials, with less impact on CVD death. Gemfibrozil interacts with statins for metabolic clearance, likely increasing myositis risk. Fenofibrate interacts less or not at all, potentially being safer to use in combination with statins. Only fenofibrate has been shown to reduce microvascular complications of T2DM, in addition to reducing total CVD events.
FIELD study: In the FIELD study, fenofibrate non-significantly reduced coronary events (11%, p=0.16), but non-fatal MI (-24%), total CVD (-11%), revascularisation (-21%), ACS (-18%) and total MI (silent plus clinical, -20%) all fell (all p Conclusions: The choice of which PPAR-Ȗ or which PPAR-Į agent to use in clinical practice may be important in obtaining clinical benefits with good safety. Fenofibrate is the first lipidmodifying drug to significantly lower the microvascular complications of T2DM and could be useful add-on therapy in many subjects with diabetes. Salpeter SR, Walsh JM, Greyber E, Salpeter EE. Brief report: coronary heart disease events associated with hormone therapy in younger and older women. A meta-analysis. J Gen Intern Med 2006;21:363-366.