Patients with type 2 diabetes (T2D) have a high risk for developing heart failure (HF). A recent study published in ‘Diabetes Care’ investigated the effect of fenofibrate (vs. placebo) in HF outcomes among patients with T2D receiving simvastatin enrolled in the Action to Control Cardiovascular Risk in Diabetes lipid trial (ACCORD Lipid).  The study included 5,518 patients with a median age of 62 years. 31% of the cohort was women. Cox regression analysis with background glucose-lowering strategy as the stratification variable was used for the analysis. The median follow-up was 4.7 years.

The beneficial effect of fenofibrate to reduce HF hospitalizations or cardiovascular death was observed among patients receiving standard glucose-lowering strategy, HR 0.64, 95% CI 0.48–0.85, and not among patients receiving intensive glucose-lowering strategy, HR 1.02, 95% CI 0.79–1.33 (P interaction  = 0.017). HF hospitalizations alone also showed a similar pattern. The effect of fenofibrate on blood lipids was not influenced by background glucose-lowering therapy in a clinically important manner. Fenofibrate caused more transient worsening estimated glomerular filtration rate (eGFR) events but slowed long-term eGFR decline.

The authors suggested that in patients with T2D treated with simvastatin, fenofibrate reduced the composite of HF hospitalizations or cardiovascular mortality, and this was an effect predominated in patients with standard background glucose-lowering therapy.

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