Effect of fibrates on lipid profiles and cardiovascular outcomes: a systematic review.
OBJECTIVE
Fibrates might represent a viable treatment option for patients who do not meet their target low-density lipoprotein levels on statins or who are resistant or intolerant to statins. New data from fibrate trials can be synthesized with the existing literature to better estimate their effects.


METHODS
We systematically searched the literature to identify randomized, double-blind, placebo-controlled trials examining the effect of fibrates on lipid profiles or cardiovascular outcomes. We estimated the effect of fibrates on the incidence of nonfatal myocardial infarction and all-cause mortality using random effects models.


RESULTS
Compared with placebo, fibrates were associated with greater reductions in total cholesterol (range: -101.3 mg/dL to -5.0 mg/dL) and triglycerides (range: -321.3 mg/dL to -20.8 mg/dL), and a greater increase in high-density lipoprotein (range: +1.1 mg/dL to +17.9 mg/dL) in all trials. Fibrates tended to be associated with a greater reduction in low-density lipoprotein (range: -76.3 mg/dL to +38.7 mg/dL) than placebo, although these results were not consistent across all trials. Fibrates were more efficacious than placebo at preventing nonfatal myocardial infarction (odds ratio=0.78; 95% confidence interval, 0.69-0.89), but not all-cause mortality (odds ratio=1.05; 95% confidence interval, 0.95-1.15).


CONCLUSIONS
In addition to improving lipid profiles, fibrates are associated with an important decrease in nonfatal myocardial infarction, but do not substantially affect all-cause mortality. Potential applications include treatment for patients with statin resistance or isolated hypertriglyceridemia, or as an adjunct to other lipid-lowering therapies.
Abourbih
Samuel
S
Division of Cardiology, Jewish General Hospital, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Filion
Kristian B
KB
Joseph
Lawrence
L
Schiffrin
Ernesto L
EL
Rinfret
Stephane
S
Poirier
Paul
P
Pilote
Louise
L
Genest
Jacques
J
Eisenberg
Mark J
MJ
D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D001629:Bezafibrate / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000187:drug effects; D002995:Clofibric Acid / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D011345:Fenofibrate / Q000008:administration & dosage / Q000009:adverse effects; D015248:Gemfibrozil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D002995:Clofibric Acid; D015248:Gemfibrozil; D011345:Fenofibrate; D001629:Bezafibrate