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Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
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Fibrates : Do They Still Have a Role in Therapy in 2025?
Angela Pirillo1, Alberto Zambon2, Alberico L Catapano3,4
1Center for the Study of Atherosclerosis, E. Bassini Hospital, Via Gorki 50, Cinisello Balsamo, Milan, 20092, Italy.
Current Atherosclerosis Reports
|December 26, 2025
Summary
Fibrates offer limited cardiovascular benefits but show promise for metabolic conditions like liver and kidney disease. Future use focuses on personalized therapy for specific patient phenotypes.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
- Hepatology
Background:
- Atherosclerotic cardiovascular disease (ASCVD) poses a significant mortality risk, even with optimal LDL-C control.
- Residual risk persists in patients with atherogenic dyslipidemia, necessitating further therapeutic strategies.
Purpose of the Study:
- To review the evolving role of fibrates in managing dyslipidemia.
- To explore fibrate utility in metabolic dysfunction-associated steatotic liver disease (MASLD), chronic kidney disease (CKD), and diabetic microvascular complications.
Main Methods:
- Review of large clinical trials and emerging evidence on fibrate efficacy.
- Analysis of pleiotropic effects beyond lipid-lowering.
Main Results:
- Fibrates demonstrate modest or inconsistent cardiovascular benefits, primarily in patients with high triglycerides and low HDL-C.
- The PROMINENT trial indicated that triglyceride reduction alone does not improve cardiovascular outcomes.
- Emerging data highlight fenofibrate and pemafibrate's benefits in reducing albuminuria, hepatic steatosis, and diabetic retinopathy.
Conclusions:
- Fibrates remain relevant for specific dyslipidemic and metabolically altered phenotypes.
- Future applications involve precision metabolic therapy targeting microvascular, hepatic, and renal complications.
- A personalized cardiometabolic approach is key for optimizing fibrate use.
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