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Elevated triglyceride levels are associated with increased cardiovascular risk. However, clinical trials of triglyceride lowering, including with fibrates, have not improved cardiovascular outcomes (e.g., NEJM JW Cardiol Mar 2017 and JAMA Cardiol 2017; 2:370). Pemafibrate — a fibrate with potent, selective peroxisome proliferator–activated receptor-alpha activity — is licensed for clinical use in Japan but not the U.S. To assess whether pemafibrate reduces cardiovascular risk beyond mere triglyceride lowering, investigators in the multinational, manufacturer-funded PROMINENT trial (NCT03071692) randomized 10,497 patients with type 2 diabetes, triglyceride levels of 200–499 mg/dL, and HDL-cholesterol levels ≤40 mg/dL to receive pemafibrate (…