AIMS The effect of fibrate treatment on cardiovascular risk is inconsistent. This meta-analysis aimed to assess the effect of fibrates on major adverse cardiovascular outcome (MACE) reduction. METHODS PubMed, Embase, and Cochrane library databases were searched up to February 2023 for randomized controlled trials comparing fibrate therapy against placebo and reporting cardiovascular outcomes and lipid profile changes. The primary outcome was the clinical outcomes of each trial that most closely corresponding to MACE, a composite of cardiovascular death, acute myocardial infarction, stroke, and coronary revascularization. A pre-specified meta-regression analysis to examine the relationship between the changes in lipid levels after fibrate treatment and the risk of MACE was also performed. RESULTS Twelve trials were selected for final analysis, with 25,781 patients and 2,741 MACEs in the fibrate group and 27,450 patients and 3,754 MACEs in the control group. Overall, fibrate therapy was associated with decreased risk of MACE (RR 0.87, 95% confidence interval [CI] 0.81-0.94) with moderate heterogeneity (I2 = 47%). In meta-regression analysis, each 1 mmol/L reduction in low-density lipoprotein cholesterol (LDL-C) after fibrate treatment reduced MACE (RR 0.71, 95% CI 0.49-0.94, p = 0.01), while triglyceride level changes did not show a significant association. (RR 0.96, 95% CI 0.53-1.40, p = 0.86) A sensitivity analysis with the composite outcome of cardiovascular death or acute myocardial infaction produced similar results. CONCLUSION Treatment with fibrates was associated with decreased risk of MACE. The reduction in MACE risk with fibrate therapy appears to be attributable to LDL-C reduction rather than a decrease in triglyceride levels.

中文翻译：

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贝特类药物对降低低密度脂蛋白胆固醇和降低心血管风险的作用：系统评价和荟萃分析。

目的 贝特类药物治疗对心血管风险的影响并不一致。这项荟萃分析旨在评估贝特类药物对减少主要不良心血管结局 (MACE) 的影响。方法 在 PubMed、Embase 和 Cochrane 图书馆数据库中检索截至 2023 年 2 月的随机对照试验，比较贝特类疗法与安慰剂并报告心血管结果和血脂变化。主要结局是每项试验与 MACE 最接近的临床结局，MACE 是心血管死亡、急性心肌梗死、中风和冠状动脉血运重建的综合结果。还进行了预先指定的荟萃回归分析，以检查贝特治疗后血脂水平的变化与 MACE 风险之间的关系。结果 选择12项试验进行最终分析，贝特组有25,781例患者和2,741例MACE，对照组有27,450例患者和3,754例MACE。总体而言，贝特类治疗与 MACE 风险降低相关（RR 0.87，95% 置信区间 [CI] 0.81-0.94），具有中等异质性（I2 = 47%）。在荟萃回归分析中，贝特治疗后低密度脂蛋白胆固醇 (LDL-C) 每降低 1 mmol/L，MACE 就会减少（RR 0.71，95% CI 0.49-0.94，p = 0.01），而甘油三酯水平的变化则不会减少显示出显着的关联。（RR 0.96，95% CI 0.53-1.40，p = 0.86）对心血管死亡或急性心肌梗死的复合结果进行的敏感性分析产生了类似的结果。结论 贝特类药物治疗与 MACE 风险降低相关。贝特类疗法降低 MACE 风险似乎是由于 LDL-C 降低，而不是甘油三酯水平降低。