Do fibrates offer special benefits in treating diabetic dyslipidaemia? Lessons from FIELD

Although levels of total cholesterol are similar between populations with and without diabetes, there are important differences in lipid sub- fractions, with diabetic dyslipidaemia characterised by reduced levels of high-density lipoprotein (HDL) cholesterol and elevated triglycerides. In addition, small, dense, low-density lipoprotein (LDL) particles may increase atherogenicity. These differences may account for the increased vascular risk reported in diabetic populations. The benefit of HMG Co-A reductase inhibitors, primarily through LDL cholesterol reduction, has been demonstrated in populations with ischaemic heart disease. Fibrates are synthetic activators of the a subclass of the peroxisome proliferator-activated receptor (PPAR), and are reported to raise HDL cholesterol and lower triglyceride levels preferentially. The FIELD study was designed to assess whether the theoretical benefit offered by fibrates in diabetic dyslipidaemia was reflected in improved cardiovascular outcomes.