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Increasing high-density lipoprotein cholesterol: an update on fenofibrate
1Institute de Cardiologie de l'Hôpital Laval, Sainte-Foy, Quebec, Canada. jean-pierre.despres@crchul.ulaval.ca
Insights
Fenofibrate effectively increases high-density lipoprotein cholesterol (HDL-C) levels, particularly in those with low baseline levels. This medication also offers benefits for metabolic syndrome features and may slow coronary artery disease progression in type 2 diabetes.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Pharmacology
Background:
- Low high-density lipoprotein cholesterol (HDL-C) is linked to coronary artery disease and metabolic syndrome features, common in type 2 diabetes and abdominal obesity.
- Fenofibrate is a medication known to influence lipid profiles.
Purpose of the Study:
- To evaluate the efficacy of fenofibrate in increasing HDL-C levels across various dyslipidemic states.
- To compare fenofibrate's HDL-C raising effects with statins.
- To explore fenofibrate's pleiotropic effects on metabolic syndrome and its impact on coronary artery disease progression.
Main Methods:
- Analysis of results from three independent clinical trials investigating fenofibrate's effects on HDL-C.
- Comparison of fenofibrate's efficacy with statins based on published trial data.
- Review of angiographic evidence from the Diabetes Atherosclerosis Intervention Study (DAIS).
Main Results:
- Fenofibrate consistently increases HDL-C levels, with a more pronounced effect at lower baseline levels.
- Fenofibrate demonstrates a greater absolute increase in HDL-C compared to statins, making the 40-mg/dL target more achievable.
- Fenofibrate exhibits beneficial pleiotropic effects on metabolic syndrome components and may slow coronary artery disease progression in type 2 diabetes patients.
Conclusions:
- Fenofibrate is effective in raising HDL-C across diverse dyslipidemic conditions and surpasses statins in absolute HDL-C increase.
- Beyond lipid modification, fenofibrate's pleiotropic actions contribute to clinical benefits, particularly in patients with metabolic syndrome.
- Fenofibrate shows promise in managing coronary artery disease progression in type 2 diabetes, with ongoing trials like FIELD expected to provide further insights.
Abstract:
The inverse relation between coronary artery disease and the concentration of high-density lipoprotein cholesterol (HDL-C) is well established. A low HDL-C concentration is frequently accompanied by the features of the metabolic syndrome found in patients with type 2 diabetes and in individuals who are abdominally obese. Results from 3 independent trials are consistent in showing that fenofibrate is able to increase HDL-C levels across a wide range of dyslipidemic states. The HDL-C-increasing effect of fenofibrate is proportionately greater when baseline levels are low. Comparing results from published trials, the absolute increase in HDL-C produced by fenofibrate is greater than that with statins across all baseline HDL-C levels, and a 40-mg/dL treatment target HDL-C level is more likely to be achieved with fenofibrate therapy. Fenofibrate has favorable pleiotropic effects on several features of the metabolic syndrome, which are likely to explain the clinical benefits of fibrate therapy, beyond an impact on HDL-C levels. The additional reciprocal beneficial effect of fenofibrate in lowering low-density lipoprotein cholesterol (LDL-C) benefits those patients with low HDL-C and moderately increased LDL-C; the American Diabetes Association now recommends fibrate therapy in this case. Another trial, the Diabetes Atherosclerosis Intervention Study (DAIS) has also provided angiographic evidence to show that fenofibrate treatment may slow coronary artery disease progression in type 2 diabetes. Treatment effects on apolipoproteins suggest that not all fibrates affect HDL-C to an equal degree. A trial with fenofibrate focusing on coronary artery disease risk and mortality reduction in patients with type 2 diabetes that is currently under way, the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial is expected to report in 2005.