Statins may be of benefit in lowering non-HDL cholesterol levels in patients with high triglycer- In an era before the routine use of statins, 2 placebo-controlled trials reported that gemfibrozil treatment caused marked reductions in triglyceride levels and increased HDL levels, leading to significant reduction in car- Because of the dangers associated with gemfibrozil,167,168 fenofibrate therapy has been the focus of more recent studies as a treatment option for dyslipidemia and elevated triglycer- ide levels. Fenofibrate is a fibric acid derivative that activates the peroxisome proliferator activated receptor- , leading to lower triglyceride levels and increased HDL levels. Compared with statin monotherapy, fenofibrate monotherapy tends to improve triglyceride and HDL cholesterol levels to a greater extent, whereas statins improve LDL and total cholesterol lev- els to a larger degree.175 In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, 9797 patients with diabetes mellitus who were not taking statins were ran- domized to micronized fenofibrate 200 mg daily or matching placebo for 5 years. Treatment with fenofibrate did not sig- nificantly reduce the risk of the primary outcome of cardio- vascular death or nonfatal MI (HR, 0.89; 95% CI, 0.75 1.05; P=0.16), but it was associated with a reduction in the second- ary end point of total cardiovascular events (including nonfa- tal MI and coronary revascularization).160 Published more recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was a double-factor, randomized, clinical trial that studied inten- sive glucose and blood pressure (BP) control and the addition of fenofibrate therapy to statin treatment. In the lipid arm of ACCORD, 5518 participants who were treated with open- label simvastatin to achieve LDL levels <80 mg/dL were ran- domized to receive either fenofibrate or placebo. 