NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia.
Eur Heart J. 2010 Jan;31(1):92-9. doi: 10.1093/eurheartj/ehp377. Epub 2009 Sep 29.
To determine the incidence and predictors of, and effects of fenofibrate on silent myocardial infarction (MI) in a large contemporary cohort of patients with type 2 diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.
Routine electrocardiograms taken throughout the study were assessed by Minnesota-code criteria for the presence of new Q-waves without clinical presentation and analysed with blinding to treatment allocation and clinical outcome. Of all MIs, 36.8% were silent. Being male, older age, longer diabetes duration, prior cardiovascular disease (CVD), neuropathy, higher HbA(1c), albuminuria, high serum creatinine, and insulin use all significantly predicted risk of clinical or silent MI. Fenofibrate reduced MI (clinical or silent) by 19% [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69-0.94; P = 0.006], non-fatal clinical MI by 24% (P = 0.01), and silent MI by 16% (P = 0.16). Among those having silent MI, fenofibrate reduced subsequent clinical CVD events by 78% (HR 0.22, 95% CI 0.08-0.65; P = 0.003).
Silent and clinical MI have similar risk factors and increase the risk of future CVD events. Fenofibrate reduces the risk of a first MI and substantially reduces the risk of further clinical CVD events after silent MI, supporting its use in type 2 diabetes.
在 2 型糖尿病的 Fenofibrate 干预和事件降低（FIELD）研究中，确定大当代队列患者中发生、预测因子和非诺贝特对无症状心肌梗死（MI）的影响。
整个研究过程中进行的常规心电图检查，采用明尼苏达州编码标准评估有无新 Q 波而无临床表现，并对治疗分配和临床结局进行盲法分析。所有心肌梗死中，36.8%为无症状。男性、年龄较大、糖尿病病程较长、既往心血管疾病（CVD）、神经病变、较高的糖化血红蛋白（HbA(1c)）、白蛋白尿、高血清肌酐和胰岛素使用均显著预测临床或无症状 MI 的风险。非诺贝特可使 MI（临床或无症状）减少 19%[风险比（HR）0.81，95%置信区间（CI）0.69-0.94；P = 0.006]、非致死性临床 MI 减少 24%（P = 0.01）和无症状 MI 减少 16%（P = 0.16）。在发生无症状 MI 的患者中，非诺贝特可使随后的临床 CVD 事件减少 78%（HR 0.22，95%CI 0.08-0.65；P = 0.003）。
无症状和临床 MI 具有相似的危险因素，并增加未来 CVD 事件的风险。非诺贝特降低首次 MI 的风险，并显著降低无症状 MI 后进一步临床 CVD 事件的风险，支持其在 2 型糖尿病中的应用。
