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Five years of fenofibrate therapy reduced the rate of laser intervention for needed no phentermine prescription edema by 31% and for proliferative retinopathy by 30% compared with placebo, Anthony Keech, M.D., of the University of Sydney, and colleagues reported online in The Lancet. The improvement, which was limited to patients with a history of retinopathy, was unaffected by baseline lipid levels or the magnitude of reduction in lipid levels, suggesting a nonlipid mechanism of action. "The retinal benefits argue for consideration of using fenofibrate in the management of diabetic eye disease," the authors concluded. Elevated serum lipid levels have been linked to the risk and severity of diabetic retinopathy, the authors noted. Additionally, several studies have found higher lipid levels associated with needed no phentermine prescription edema and proliferative retinopathy. The benefits of lipid lowering therapy, however, have remained unclear. Statins proved unsuccessful for preventing diabetic retinopathy. On the other hand, small studies of PPAR α agonists (fibrates) showed beneficial effects on needed no phentermine prescription edema and needed no phentermine prescription hard exudates, the authors continued. Dr. Keech and colleagues reviewed data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, which examined almost 10,000 patients with type 2 diabetes. The trial evaluated fenofibrate's ability to reduce the risk of macrovascular and microvascular events compared with placebo (Lancet 2005; 366: 1849 1861). The analysis showed that treatment with fenofibrate reduced the risk of a first laser treatment from 4.9% in the placebo group to 3.4%. The difference translated into a hazard ratio of 0.69, representing a 31% reduction in the relative risk of laser treatment (P =0.0002). Treatment with fenofibrate did not reduce the risk of a two step progression in retinopathy in the entire cohort or in the subgroup of patients without retinopathy at baseline. In contrast, patients with pre existing retinopathy had a significant reduction in risk with fenofibrate compared with placebo (3.1% versus 14.6%, P =0.004). "The substantial benefits of fenofibrate on the need for laser treatment for diabetic retinopathy are likely to be additive to those benefits arising from tight control of blood glucose and blood pressure in the management of type 2 diabetes, and emerge rapidly after treatment is commenced," the authors concluded. In a commentary that accompanied the report, Rafael Simo, M.D., and Cristina Hernandez, M.D., of Vall d'Hebron University Hospital in Barcelona, Spain, focused on what they considered several prominent limitations of the study. They cite the lack of retinal photographs in the study, the lack of a standard definition for laser treatment indication, and the relatively small number of total events in the trial. "For all these reasons, further clinical and experimental studies are needed before fenofibrate can be launched as a new tool in the management of diabetic retinopathy," Drs. Simo and Hernandez concluded. ... needed no phentermine prescription