A total of 20 randomised trials (RCTs) (n=25,655) were included in the review: four evaluated benzafibrate (n=4,984); nine evaluated fenofibrate (n=12,398); and seven evaluated gemfibrozil (n=8,273).
Compared with placebo, fibrate therapy was associated with a statistically significant decrease in non-fatal myocardial infarction (OR 0.78, 95% CI 0.69 to 0.89, p=0.0001; five RCTs), but had no significant effect on all-cause mortality (OR 1.05, 95% CI 0.95, 1.15, p=0.34; six RCTs).
Relative to placebo, fibrates were associated with greater reductions in total cholesterol and triglycerides (range -321.3mg/dL to -20.8mg/dL) and an increase in high-density lipoprotein (range 1.1mg/dL to 17.9mg/dL). Fibrates tended to be associated with a reduction in low-density lipoprotein, although results were not entirely consistent.
Adverse event rates were similar between groups.