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Fibrate therapy: an update.
Joshua Remick1, Howard Weintraub, Robert Setton
1Department of Cardiology, New York University Medical Center, New York, New York 10016, USA.
Cardiology in Review
|April 17, 2008
Summary
Fibrates effectively lower triglycerides and raise HDL cholesterol. While not reducing overall mortality, they may benefit metabolic syndrome patients and are generally safe with other lipid-lowering drugs.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Metabolic Diseases
Background:
- Fibrates are lipid-lowering drugs, typically used after statins.
- They act on peroxisome proliferator-activated receptor-alpha.
- Primary effects include reducing triglycerides and increasing HDL cholesterol.
Purpose of the Study:
- To review the benefits of fibrates beyond lipid modification.
- To assess the safety of fibrates in combination therapy.
- To evaluate the role of fibrates in cardiovascular disease prevention.
Main Methods:
- Review of clinical trials and angiographic studies on fibrates.
- Analysis of post hoc data regarding mortality benefits.
- Assessment of safety profiles, especially in combination with statins and ezetimibe.
Main Results:
- Fibrates slow atherosclerotic lesion progression in coronary arteries.
- No mortality reduction shown in major trials, but potential benefit in metabolic syndrome.
- Generally safe when combined with statins and ezetimibe, despite side effects like GI issues and elevated liver enzymes.
Conclusions:
- Fibrates offer benefits beyond lipid profiles, including anti-atherosclerotic effects.
- They are safe for combination therapy with other lipid-lowering agents.
- Lack of demonstrated mortality benefit prevents their use as first-line therapy for CAD prevention.
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