Objective To investigate whether fenofibrate as add-on to statin treatment reduce persistent cardiovascular risk in adults with metabolic syndrome in a real world setting.
Design Propensity matched cohort study.
Setting Population based cohort in Korea.
Participants 29 771 adults with metabolic syndrome (≥40 years) receiving statin treatment. 2156 participants receiving combined treatment (statin plus fenofibrate) were weighted based on propensity score in a 1:5 ratio with 8549 participants using statin only treatment.
Main outcome measure Primary outcome was composite cardiovascular events including incident coronary heart disease, ischaemic stroke, and death from cardiovascular causes.
Results The incidence rate per 1000 person years of composite cardiovascular events was 17.7 (95% confidence interval 14.4 to 21.8) in the combined treatment group and 22.0 (20.1 to 24.1) in the statin group. The risk of composite cardiovascular events was significantly reduced in the combined treatment group compared with statin group (adjusted hazard ratio 0.74, 95% confidence interval 0.58 to 0.93; P=0.01). The significance was maintained in the on-treatment analysis (hazard ratio 0.63, 95% confidence interval 0.44 to 0.92; P=0.02). The risk of incident coronary heart disease, ischaemic stroke, and cardiovascular death was lower in the combined treatment group than statin group but was not significant. Participant characteristics did not appear to be associated with the low risk of composite cardiovascular events with combined treatment.
Conclusion In this propensity weighted cohort study of adults with metabolic syndrome, the risk of major cardiovascular events was significantly lower with fenofibrate as add-on to statin treatment than with statin treatment alone.

目的探讨非诺贝特作为他汀类药物的添加物在现实环境中是否能降低代谢综合征成人的持续性心血管风险。
设计倾向匹配的队列研究。在韩国
设定以人口为基础的队列。
参与者29 771名代谢综合征（≥40岁）的成年人接受他汀类药物治疗。2156名接受联合治疗（他汀类药物和非诺贝特）的参与者根据倾向评分按1：5的比例加权，其中8549名仅接受他汀类药物治疗的参与者。
主要结局指标主要结局指标是复合性心血管事件，包括突发性冠心病，缺血性中风和心血管原因导致的死亡。
结果联合治疗组每1000人年复合心血管事件的发生率为17.7（95％置信区间14.4至21.8），他汀类药物组为22.0（20.1至24.1）。与他汀类药物治疗组相比，联合治疗组的复合心血管事件发生风险显着降低（调整后的危险比为0.74，95％置信区间为0.58至0.93； P = 0.01）。在治疗中分析中保持显着性（危险比0.63，95％置信区间0.44至0.92； P = 0.02）。联合治疗组的发生冠心病，缺血性中风和心血管死亡的风险低于他汀类药物治疗组，但并不显着。参与者的特征似乎与合并治疗的复合性心血管事件的低风险无关。
结论在这项针对成年人代谢综合征的倾向性加权队列研究中，非诺贝特作为他汀类药物治疗的主要心血管事件发生风险显着低于单独他汀类药物治疗。