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Fenofibrate-induced hyperhomocysteinaemia: clinical implications and management

Jutta Dierkes1, Sabine Westphal, Claus Luley

  • 1Institute of Clinical Chemistry and Biochemistry, University Hospital Magdeburg, Germany.

Drug Safety
|January 22, 2003
PubMed

Insights

Fenofibrate can increase homocysteine levels, a risk factor for cardiovascular disease. Supplementing with folic acid and vitamin B12 may prevent this increase during long-term fenofibrate therapy.

Area of Science:

  • Cardiovascular Pharmacology
  • Nutritional Biochemistry

Background:

  • Fenofibrate is a first-line treatment for hypertriglyceridemia and low HDL-cholesterol, both cardiovascular disease risk factors.
  • Elevated homocysteine levels have been observed with fenofibrate and bezafibrate therapy, but the mechanism remains unclear.
  • Homocysteine is an atherogenic amino acid linked to cardiovascular risk.

Purpose of the Study:

  • To investigate the effect of fenofibrate on homocysteine levels.
  • To explore potential mechanisms for fenofibrate-induced homocysteine elevation.
  • To evaluate the efficacy of vitamin supplementation in mitigating fenofibrate's impact on homocysteine.

Main Methods:

  • Review of recent studies on fenofibrate and homocysteine levels.
  • Analysis of potential contributing factors such as vitamin status, renal function, and creatine metabolism.
  • Examination of data from studies involving folic acid and vitamin B12 supplementation alongside fenofibrate therapy.

Main Results:

  • Fenofibrate and bezafibrate therapies are associated with elevated homocysteine levels.
  • Vitamin status deterioration is unlikely to be the primary cause; renal function and creatine metabolism are probable factors.
  • Folic acid and vitamin B12 supplementation, alone or in combination, effectively reduced homocysteine levels in fenofibrate-treated patients.

Conclusions:

  • Addition of folic acid and vitamin B12 to fenofibrate therapy is recommended to prevent homocysteine level increases.
  • Long-term fenofibrate treatment necessitates consideration of homocysteine-related cardiovascular risk.
  • Alternative lipid-lowering drugs like gemfibrozil, which do not elevate homocysteine, may be considered.

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