Cardiovascular effect of lowering triglyceride level with pemafibrate
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Reviewed by Dat Tien Nguyen, B.A, ScM.
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Posted on November 25th, 2022
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Increased blood triglyceride level is correlated with a higher risk of cardiovascular accidents such as myocardial infarction and ischemic stroke. However, it is unclear if lowering its concentration can improve the patients’ clinical prognosis. A study, recently published in the New England Journal of Medicine, had reported on the cardiovascular effect of lowering blood triglyceride level.
The study included 10,497 type II diabetic patients with a fasting triglyceride level between 200 and 499 mg per deciliter, and a high-density lipoprotein (HDL) level above 40 mg per deciliter. Half of them were randomly assigned to receive 1 tablet containing 200 mg of pemafibrate twice a day, and the other half was a placebo with similar appearance. The patients’ health was followed for 5 years, and in-person visit was scheduled every 2 and 4 months. The median age of both groups was 64 years old, and dominantly male (72.5% of the study population). In terms of racial composition, 5.6% of the pemafibrate group is Asian, and the percentage is 4.8% in the control. After 4 months of treatment, the study observed that pemafibrate was effective at reducing the triglyceride level by 26.2%, very-low-density lipoprotein (VLDL) cholesterol level by 25.6%, and apolipoprotein C-III concentration by 27.6%. However, this does not translate into better clinical outcomes, since pemafibrate usage does not decrease the risk of either myocardial infarction or ischemic stroke. In terms of safety, those in the treatment group reported a higher frequency of renal adverse events and venous thromboembolism; whereas, the frequency of non-alcoholic fatty liver disease is higher in the control group.
The study included 10,497 type II diabetic patients with a fasting triglyceride level between 200 and 499 mg per deciliter, and a high-density lipoprotein (HDL) level above 40 mg per deciliter. Half of them were randomly assigned to receive 1 tablet containing 200 mg of pemafibrate twice a day, and the other half was a placebo with similar appearance. The patients’ health was followed for 5 years, and in-person visit was scheduled every 2 and 4 months. The median age of both groups was 64 years old, and dominantly male (72.5% of the study population). In terms of racial composition, 5.6% of the pemafibrate group is Asian, and the percentage is 4.8% in the control. After 4 months of treatment, the study observed that pemafibrate was effective at reducing the triglyceride level by 26.2%, very-low-density lipoprotein (VLDL) cholesterol level by 25.6%, and apolipoprotein C-III concentration by 27.6%. However, this does not translate into better clinical outcomes, since pemafibrate usage does not decrease the risk of either myocardial infarction or ischemic stroke. In terms of safety, those in the treatment group reported a higher frequency of renal adverse events and venous thromboembolism; whereas, the frequency of non-alcoholic fatty liver disease is higher in the control group.