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• W2064759870 abstract "In discussing the increase in venous thromboembolic events seen in the fenofibrate group of their randomised trial (Nov 26, p 1849),1The FIELD study investigatorsEffects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial.Lancet. 2005; 366: 1849-1861Summary Full Text Full Text PDF PubMed Scopus (2653) Google Scholar the FIELD study investigators note that they “are not aware of any thrombotic tendency from this treatment”. However, as could be predicted from previous fibrate studies,2Dierkes J Westphal S Luley C Serum homocysteine increases after therapy with fenofibrate or bezafibrate.Lancet. 1999; 354: 219-220Summary Full Text Full Text PDF PubMed Scopus (130) Google Scholar plasma homocysteine concentrations increased by about 4 μmol/L in fenofibrate-treated patients in FIELD.1The FIELD study investigatorsEffects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial.Lancet. 2005; 366: 1849-1861Summary Full Text Full Text PDF PubMed Scopus (2653) Google Scholar Since increased plasma homocysteine is an established risk factor for venous thrombosis,3Quere I Gris JC Dauzat M Homocysteine and venous thrombosis.Semin Vasc Med. 2005; 5: 183-189Crossref PubMed Scopus (21) Google Scholar disturbed homocysteine metabolism might well explain increases in venous thromboembolism in fibrate-treated patients. Third-generation fibrates significantly reduce progression of coronary atherosclerosis,4Diabetes Atherosclerosis Intervention Study InvestigatorsEffect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomised study.Lancet. 2001; 357: 905-910Summary Full Text Full Text PDF PubMed Scopus (796) Google Scholar but do not reduce coronary events.1The FIELD study investigatorsEffects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial.Lancet. 2005; 366: 1849-1861Summary Full Text Full Text PDF PubMed Scopus (2653) Google Scholar, 5The BIP Study groupSecondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: the Bezafibrate Infarction Prevention (BIP) Study.Circulation. 2000; 102: 21-27Crossref PubMed Scopus (1163) Google Scholar Promotion of atherothrombosis by fibrate-induced increases in homocysteine levels could account for this apparent discrepancy. I declare that I have no conflict of interest. The FIELD study – Authors' replyAs Bernhard Föger notes, at the close of the FIELD study we saw a 4 μmol/L higher average plasma homocysteine concentration among those allocated fenofibrate than among those in the placebo-allocated group. In epidemiological studies, naturally occurring differences in plasma homocysteine have been positively associated with atherothrombotic events1 and venous thromboembolism.2 Whether fenofibrate-induced changes in plasma homocysteine carry similar risk associations or constitute an epiphenomenon is not yet clear, but we agree that the possibility needs further assessment. Full-Text PDF" @default.
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• W2064759870 title "The FIELD study" @default.
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• W2064759870 doi "https://doi.org/10.1016/s0140-6736(06)68499-7" @default.
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