Fenofibrate. Ever heard of that? As the name suggest, it's a member in fibrates group, with better safety profile than gemfibrozil.
It has been known as a drug to lower down LDL and most importantly, triglycerides. Now, seems like it has a new role: To lower the risk of amputation in type 2 diabetic patients.
FIELD study showed that amputation risk (first amputation) in type 2 diabetic patients was lower by 36% in patients assigned with long-term fenofibrate, compared with placebo.
For minor amputation events without known large-vessel disease (myocardial infarction, angina, coronary revascularisation, stroke or peripheral vascular disease), fenofibrate reduce the risk by 47%, compared to placebo.
However, for the risk of major amputations, there are no difference between these 2 groups.
The treatment effects of fenofibrate in FIELD study were irrespective of the level of glycaemic control and background use or not of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. In Heart Protection study, it showed no difference in amputation rates between groups, despite substantial reductions in total cholesterol and LDL cholesterol levels, and modest changes in triglyceride and HDL cholesterol levels. These findings suggest that the effect of fenofibrates in reducing amputation risk is non-lipid mediated, and beyond blood pressure and glycaemic measures.
These findings, could lead to a change in the standard for the prevention of diabetes-relate amputations.
Kushwin Rajamani et al. Effect of fenofibrate on amputation events in people with type 2 diabetis mellitus (FIELD study): A prespecified analysis of a randomised controlled trial. The Lancet 2009; 373: 1780 - 1788.
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetis: a randomised placebo controlled trial. The Lancet 2003; 361: 2005 - 2016