Fibrate and the risk of cardiovascular disease among moderate chronic kidney disease patients with primary hypertriglyceridemia

Abstract

Introduction: Hypertriglyceridemia is the most prevalent dyslipidemia in patients with chronic kidney disease (CKD). However, research about fibrate treatment in CKD patients is limited, and assessing its benefits becomes challenging due to the frequent concurrent use of statins. Thus, this study is aimed to investigate the role of fibrate in CKD stage 3 patients with hypertriglyceridemia who did not receive other lipid-lowering agents.

Methods: This study enrolled patients newly diagnosed CKD3 with LDL-C<100mg/dL and had never received statin or other lipid-lowering agents from Chang Gung Research Database. The participants were categorized into 2 groups based on the use of fibrate: fibrate group and non-fibrate group (triglyceride >200mg/dL but not receiving fibrate treatment). The inverse probability of treatment weighting was performed to balance baseline characteristics.

Results: Compared with the non-fibrate group (n=2020), the fibrate group (n=705) exhibited significantly lower risks of major adverse cardiac and cerebrovascular events (MACCEs) (10.4% vs. 12.8%, hazard ratios [HRs]: 0.69, 95% confidence interval [CI]: 0.50 to 0.95), AMI (2.3% vs. 3.9%, HR: 0.52, 95% CI: 0.37 to 0.73), and ischemic stroke (6.3% vs. 8.0%, HR: 0.67, 95% CI: 0.52 to 0.85). The risk of all-cause mortality (5.1% vs. 4.5%, HR: 1.09, 95% CI: 0.67 to 1.79) and death from CV (2.8% vs. 2.3%, HR: 1.07, 95% CI: 0.29 to 2.33) did not significantly differ between the 2 groups.

Conclusion: This study suggests that, in moderate CKD patients with hypertriglyceridemia but LDL-C < 100mg/dL who did not take other lipid-lowering agents, fibrates may be beneficial in reducing cardiovascular events.

Keywords: AMI; TG; chronic kidney disease; fibrate; hypertriglyceridemia; stroke.

Figure 1

Patient inclusion–exclusion flowchart.

Figure 2

The cumulative event rate of major adverse cardiac and cerebrovascular events of patients with and without use of fibrate in the IPTW-adjusted cohort. IPTW, inverse probability of treatment weighting; CI, confidence interval.

Figure 3

Subgroup analysis of major adverse cardiac and cerebrovascular events stratified by pre-specified baseline characteristics in the IPTW adjusted cohort. IPTW, inverse probability of treatment weighting; HR, hazard ratio; CI, confidence interval; CKD, chronic kidney disease.

Figure 4

The risks of major adverse cardiac and cerebrovascular events across different triglyceride and high-density lipoprotein levels in patients who did not took fibrate compared those who took fibrate (the reference category). aHR, adjusted hazard ratio; CI, confidence interval.