Doctors Push Fibrate Cholesterol Drugs Despite Scant Evidence of Effectiveness

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Fibrate Defenders See Use for Patients Who Are Obese, Have High Triglycerides

Dr. Joel Zonszein, a professor of clinical medicine at Albert Einstein College of Medicine in the Bronx, found fault with the study. First, he said doctors need "more and better studies" of fibrate use in patients with severe lipid abnormalities, particularly men and women who suffer from metabolic syndrome, a condition that includes high blood pressure, high cholesterol, obesity and resistance to insulin, which predispose them to heart attack, stroke and diabetes. Zonszein said the ACCORD and FIELD trials never addressed the effectiveness of fibrates in these patients, for whom early, aggressive treatment is important. As a result, he said the latest JAMA study provides a "non-accurate and erroneous message to the medical community."

Dr. Henry Ginsberg, an endocrinologist and director of the Irving Institute for Clinical and Translational Research at Columbia University Medical Center, who has been a consultant for Abbott, the pharmaceutical company that markets Tricor and Trilipix, said that as the lead investigator for the ACCORD Lipid trial, he believes the study was negative and agrees "that our results indicate that physicians should not give fenofibrate to every diabetic already receiving a statin: we did not find that adding fenofibrate to a statin provided any benefit over statin alone."

However, Ginsberg said that for a subgroup of diabetics whose cholesterol is well-controlled by statins, but whose triglycerides remain elevated, ACCORD provided what he called "good evidence" that they could benefit by adding fenofibrate. "I say fenofibrate and not gemfibrozil because fenofibrate does not interact with statins and the chance of severe muscle complications is almost non-existent," he said.

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