Fibrate therapy: an update.
Fibrates are a class of lipid-lowering medication primarily used as second-line agents behind statins. Acting via the peroxisome proliferators-activated receptor-alpha, their main lipoprotein effects are to lower serum triglyceride levels and to raise high-density lipoprotein-cholesterol, with modest effects on low-density lipoprotein-cholesterol. However, many clinical trials indicate that fibrates may have benefits beyond simply altering one's lipid profile. Several angiographic studies show retardation in the progression of atherosclerotic lesions in coronary vessels. Although clinical trials have failed to show a reduction in mortality with fibrates, several post hoc analyses indicate that there may be a mortality benefit in patients with features of the metabolic syndrome. Given that fibrates are often used as second-line agents, it is essential they are safe to be given in combination with other agents, particularly statins and ezetimibe. Although the side-effect profile of fibrates includes gastrointestinal symptoms, increased liver function tests, a reversible rise in creatinine and myositis, in general, fibrates seem to be safe to use in combination with other lipid lowering medications. Thus far, fibrates have not shown a mortality benefit in randomized clinical trials; as a result, they cannot be considered first-line medication for the primary or secondary prevention of coronary artery disease.
Remick
Joshua
J
Department of Cardiology, New York University Medical Center, New York, New York 10016, USA.
Weintraub
Howard
H
Setton
Robert
R
Offenbacher
Joseph
J
Fisher
Edward
E
Schwartzbard
Arthur
A
D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control; D002995:Clofibric Acid / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy*; D006801:Humans; D024821:Metabolic Syndrome / Q000188:drug therapy; D047493:PPAR alpha / Q000819:agonists
D000924:Anticholesteremic Agents; D047493:PPAR alpha; D002995:Clofibric Acid