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ACCORDION: legacy survival benefit from fibrate treatment in dyslipidaemia patients

New insights from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid study showed that fibrate treatment in the initial trial period was associated with a legacy benefit in terms of improved survival during the post-trial follow-up. Patients completing the ACCORD Lipid study, a randomized controlled trial of 5,518 participants allocated simvastatin plus fenofibrate or simvastatin plus placebo, were invited to enter an extended follow-up study (ACCORDION). This analysis focused on 940 (17.0%) patients with dyslipidemia (484 assigned to fenofibrate-simvastatin therapy), which was defined as the combination of the highest tertile of triglycerides (204 mg/dL) and lowest tertile of high-density lipoprotein cholesterol (34 mg/dL) at baseline in the ACCORD Lipid. Overall, 765 of these patients entered the ACCORDION study. Over a median extended follow-up of 4.9 years, patients treated with fenofibrate in the ACCORD trial had lower incidences of cardiovascular mortality, nonfatal myocardial infarction, congestive heart failure and major coronary heart disease compared with the group allocated simvastatin alone. Furthermore, allocation to the combination of fenofibrate and simvastatin was associated with a beneficial legacy effect on all-cause mortality during the post-trial follow-up (adjusted Hazard ratio 0.65, 95% confidence interval 0.45–0.94, p= 0.02). This was achieved despite similar lipid profiles in both groups during the extended follow-up.
Legacy effect of fibrate add-on therapy in diabetic patients with dyslipidemia: a secondary analysis of the ACCORDION study.

Zhu L, Hayen A, Bell KJL.