PowerPoint Slides for: Effects of High Density Lipoprotein Raising Therapies on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus, with or without Renal Impairment: The Action to Control Cardiovascular Risk in Diabetes Study

Background: The role of high density
lipoprotein-raising interventions in addition to statin therapy in
patients with diabetes remains controversial. Chronic kidney disease
(CKD) is a strong modifier of cardiovascular (CV) outcomes. We therefore
investigated the impact of CKD status at baseline on outcomes in
patients with diabetes randomized to standard statin or statin plus
fenofibrate treatment in the Action to Control Cardiovascular Risk in
Diabetes (ACCORD) lipid trial. Methods: Among 5,464
participants in the ACCORD lipid trial, 3,554 (65%) were free of CKD at
baseline, while 1,910 (35%) had mild to moderate CKD. Differences in CV
outcomes during follow-up between CKD and non-CKD subgroups were
examined. In addition, the effect of fenofibrate as compared to placebo
on CV outcomes was examined for both subgroups. Results:
All CV outcomes were 1.4-3 times higher among patients with CKD as
compared to non-CKD patients. In patients with CKD, the addition of
fenofibrate had no effect on any of the primary or secondary outcomes.
In patients without CKD, however, the addition of fenofibrate was
associated with a significant 36% reduction of CV mortality (hazards
ratio [HR] 0.64; 95% CI 0.42-0.97; p value for treatment
interaction <0.05) and 44% lower rate of fatal or non-fatal
congestive heart failure (CHF; HR 0.56; 95% CI 0.37-0.84; p value treatment interaction <0.03). Conclusions:
For patients with type 2 diabetes at high CV risk but no CKD,
fenofibrate therapy added to statin reduced the CV mortality and the
rate of fatal and non-fatal CHF.