Fenofibrate therapy and risk of heart failure outcomes in patients with type 2 diabetes: a propensity-matched cohort study

This study investigated the association between fenofibrate use and outcomes of heart failure (HF) in patients with type 2 diabetes (T2D). In a nationwide cohort database (2008-2022) in South Korea, patients with T2D (≥30 years) receiving statin therapy were 1:1 matched by propensity score into a statin plus fenofibrate group (n = 11,722) and statin only group (n = 11,722). The primary outcomes were hospitalisation for HF (HHF) and a composite of HHF or cardiovascular death. A Cox proportional hazards model was used to assess the association between treatments and outcomes. During a median of 50.4 months, the incidence rate per 1,000 person-years of HHF was 3.44 and 4.13 in the statin plus fenofibrate and statin only groups, respectively (adjusted hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.65-0.98). The adjusted HR for the composite outcome of HHF or cardiovascular death was 0.79 (95% CI, 0.65-0.96). Sensitivity analyses limited to individuals with ≥80% adherence showed consistent results (HHF: adjusted HR, 0.63; 95% CI, 0.43-0.92; composite outcome: adjusted HR, 0.68; 95% CI, 0.48-0.97). In this propensity-weighted cohort study, the addition of fenofibrate to statins was associated with significantly lower risks of HHF and the composite outcome of HHF or cardiovascular death in patients with T2D, suggesting a novel cardiovascular benefit of fenofibrate.