<International Circulation>: The FIELD trial was a trial of fenofibrate monotherapy is that correct?

　　Prof. Wong: That is correct. This was around the time that the guidelines were changing and what is interesting is that one of the explanations for the failure of the FIELD trial to show a positive benefit was the fact that there was a lot of drop in statin use.

　　　<International Circulation>:  From the ACCORD trial and I also believe the FIELD trial， there was a decrease in retinopathy in microvascular outcomes regardless of triglyceride and HDL levels. Could you comment on that finding?

　　Prof. Wong:  Because fibrates have certain similar properties， like PPAR properties for example， as many diabetic medicines do， you do get a benefit in terms of microvascular complications. We also see this with the blood pressure lowering interventions as well as the hyperglycemia medicines. While their results may not be as conclusive for macrovascular outcomes， there are clearly microvascular benefits such as retinopathy as well as the prevention and progression of kidney disease from aggressive blood pressure control for example. Those effects are， in general， a lot stronger than you might get in preventing heart attacks.

　　<International Circulation>: Would you consider then that a fibrate might be useful for a patient who does not have a dyslipidemia but does have diagnosed retinopathy or progressive kidney disease?

　　Prof. Wong: Usually a higher priority is going to be placed on other conditions before giving a fibrate such as making sure that the A1C is well-controlled and in particular that the blood pressure is well-controlled. Those interventions are probably going to be more valuable for reducing microvascular complications than using a fibrate alone.
  

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