Eff ects of fi brates on cardiovascular outcomes: a systematic review and meta-analysis

Findings We identifi ed 18 trials providing data for 45 058 participants, including 2870 major cardiovascular events, 4552 coronary events, and 3880 deaths. F ibrate therapy produced a 10% RR reduction (95% CI 0–18) for major cardiovascular events (p=0·048) and a 13% RR reduction (7–19) for coronary events (p<0·0001), but had no benefi t on stroke (–3%, –16 to 9; p=0·69). We noted no eff ect of fi brate therapy on the risk of all-cause mortality (0%, –8 to 7; p=0·92), cardiovascular mortality (3%, –7 to 12; p=0·59), sudden death (11%, –6 to 26; p=0·19), or non-vascular mortality (–10%, –21 to 0·5; p=0·063). Fibrates reduced the risk of albuminuria progression by 14% (2–25; p=0·028). Serious drugrelated adverse events were not signifi cantly increased by fi brates (17 413 participants, 225 events; RR 1·21, 0·91–1·61; p=0·19), although increases in serum creatinine concentrations were common (1·99, 1·46–2·70; p<0·0001).