Evidence map›Paper›PMID 26398765›Full record

ArticlePloS one2015

Use of Fibrates Monotherapy in People with Diabetes and High Cardiovascular Risk in Primary Care: A French Nationwide Cohort Study Based on National Administrative Databases.

Ronan Roussel, Christophe Chaignot, Alain Weill, Florence Travert, Boris Hansel, Michel Marre, Philippe Ricordeau, François Alla, Hubert Allemand

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Ronan RousselINSERM, UMR 872, Centre de Recherche des Cordeliers, 15 rue de l'école de médecine, 75006 Paris, France; Université Paris 7, Faculté de Médecine, 16 rue Huchard, 75018 Paris, France; Hôpital Bichat, AP-HP, Diabetology Endocrinology Nutrition, 46 rue Huchard, 75018 Paris, France.
Christophe ChaignotStrategy and Research Department, National Health Insurance, CNAMTS 50, avenue du Professeur André Lemierre 75986 Paris Cedex 20, Paris, France.
Alain WeillStrategy and Research Department, National Health Insurance, CNAMTS 50, avenue du Professeur André Lemierre 75986 Paris Cedex 20, Paris, France.
Florence TravertINSERM, UMR 872, Centre de Recherche des Cordeliers, 15 rue de l'école de médecine, 75006 Paris, France; Université Paris 7, Faculté de Médecine, 16 rue Huchard, 75018 Paris, France; Hôpital Bichat, AP-HP, Diabetology Endocrinology Nutrition, 46 rue Huchard, 75018 Paris, France.
Boris HanselINSERM, UMR 872, Centre de Recherche des Cordeliers, 15 rue de l'école de médecine, 75006 Paris, France; Université Paris 7, Faculté de Médecine, 16 rue Huchard, 75018 Paris, France; Hôpital Bichat, AP-HP, Diabetology Endocrinology Nutrition, 46 rue Huchard, 75018 Paris, France.
Michel MarreINSERM, UMR 872, Centre de Recherche des Cordeliers, 15 rue de l'école de médecine, 75006 Paris, France; Université Paris 7, Faculté de Médecine, 16 rue Huchard, 75018 Paris, France; Hôpital Bichat, AP-HP, Diabetology Endocrinology Nutrition, 46 rue Huchard, 75018 Paris, France.
Philippe RicordeauStrategy and Research Department, National Health Insurance, CNAMTS 50, avenue du Professeur André Lemierre 75986 Paris Cedex 20, Paris, France.
François AllaGeneral division, National Health Insurance, CNAMTS 50, avenue du Professeur André Lemierre 75986 Paris Cedex 20, Paris, France.
Hubert AllemandGeneral division, National Health Insurance, CNAMTS 50, avenue du Professeur André Lemierre 75986 Paris Cedex 20, Paris, France.
Inserm · FRl'Assurance Maladie · FRConservatoire National des Arts et Métiers · FRUniversité Paris Cité · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimAccording to guidelines, diabetic patients with high cardiovascular risk should receive a statin. Despite this consensus, fibrate monotherapy is commonly used in this population. We assessed the frequency and clinical consequences of the use of fibrates for primary prevention in patients with diabetes and high cardiovascular risk.

designRetrospective cohort study based on nationwide data from the medical and administrative databases of French national health insurance systems (07/01/08-12/31/09) with a follow-up of up to 30 months.

methodsLipid-lowering drug-naive diabetic patients initiating fibrate or statin monotherapy were identified. Patients at high cardiovascular risk were then selected: patients with a diagnosis of diabetes and hypertension, and > 50 (men) or 60 (women), but with no history of cardiovascular events. The composite endpoint comprised myocardial infarction, stroke, amputation, or death.

resultsOf the 31,652 patients enrolled, 4,058 (12.8%) received a fibrate. Age- and gender-adjusted annual event rates were 2.42% (fibrates) and 2.21% (statins). The proportionality assumption required for the Cox model was not met for the fibrate/statin variable. A multivariate model including all predictors was therefore calculated by dividing data into two time periods, allowing Hazard Ratios to be calculated before (HR < 540) and after 540 days (HR > 540) of follow-up. Multivariate analyses showed that fibrates were associated with an increased risk for the endpoint after 540 days: HR < 540 = 0.95 (95% CI: 0.78-1.16) and HR > 540 = 1.73 (1.28-2.32).

conclusionFibrate monotherapy is commonly prescribed in diabetic patients with high cardiovascular risk and is associated with poorer outcomes compared to statin therapy.

Indexed as

Databases as TopicPrimary Health CareAgedAged, 80 and overCardiovascular DiseasesCohort StudiesDiabetes MellitusFemaleFibric AcidsFranceHumansMaleMiddle AgedProportional Hazards ModelsRisk FactorsSurvival AnalysisFibric Acids

Identifiers

PMID26398765
PMCPMC4580631
OpenAlexW2291815261

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.