Physicians' Academy for Cardiovascular Education

Pemafibrate lowers triglycerides, but not CV event rates

News - Nov. 5, 2022

PROMINENT: A Randomized Trial of Pemafibrate for Triglyceride Reduction in the Prevention of Cardiovascular Disease

Presented at the AHA Scientific Sessions 2022 by: Aruna D. Pradhan, MD - Minneapolis, MN, USA

Introduction and methods

Elevated triglyceride (TG) levels are associated with CV risk. However, prior strategies to lower TG with fibrates or niacin showed no effect on CV risk reduction. Treatment with icosapent ethyl did result in reduced CV risk, but the observed risk reduction could not be attributed to TG lowering. Post-hoc analyses of fibrate trials suggested that TG lowering in patients with T2DM, mild-to-moderate hypertriglyceridemia and low HDL-c may be beneficial.

The PROMINENT trial investigated the effect of pemafibrate on CV outcomes in patients with T2DM, TG 200-499 mg/dL and HDL ≤ 40 mg/dL. A total of 10,497 patients were randomized to pemafibrate 0.2 mg twice daily or placebo. All patients were on background LDL-c lowering therapy. The primary endpoint was MI, ischemic stroke, coronary revascularization or CV death. Median follow-up was 3.4 years.

Main results


Pemafibrate reduced TG, VLDL-c, remnant cholesterol and ApoCIII by 20 to 30% in patients with T2DM, mild-to-moderate hypertriglyceridemia and low HDL-c . However, pemafibrate did not reduce CV outcomes, compared with placebo in this population.

-Our reporting is based on the information provided at the AHA Scientific Sessions-

The results of this study were simultaneously published in N Engl J Med.

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