title: Treatment of hypertriglyceridemia with fibric acid derivatives: impact on lipid subfractions and translation into a reduction in cardiovascular events.
abstract: This review investigates how the treatment of hypertriglyceridemia with fibric acid         derivatives impacts lipid concentrations, lipid particle size, and the rate of         cardiovascular events: expressly, to decide whether the use of fibric acid derivatives         is an effective treatment option in the reduction of cardiovascular endpoints for         patients with specific lipid parameters at baseline. Fibric acid derivatives reduce         fasting triglyceride (TG) values by 15% to 50% (depending on baseline level) and         low-density lipoprotein cholesterol (LDL-C) by 8%, and raise high-density         lipoprotein cholesterol (HDL-C) by 9%. In conjunction with a statin, the amount of         TG lowering is approximately doubled with the addition of the fibrate. When         measured, fibrates decrease the TG concentration of very low-density lipoprotein         cholesterol particles while increasing the TG content of LDL particles. The mean         size of LDL particles increases and there is a substantial reduction in the number         and proportion of small, dense LDL. In randomized trials in primary and secondary         prevention populations, fibrates were associated with a significant reduction in         nonfatal myocardial infarction in most studies. In the subgroup with elevated TG         and/or depressed HDL-C at baseline, all trials have found statistically significant         relative risk reductions of 27% to 65% in the primary cardiovascular endpoint of         myocardial infarction and cardiovascular death.
authors.affiliation: St. John Providence Health System, Providence Park Heart Institute, Novi, MI, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Amina B
authors.initials: AB
authors.lastname: Ahmed
authors.forename: Marc T
authors.initials: MT
authors.lastname: Zughaib
authors.forename: Eric D
authors.initials: ED
authors.lastname: Glanz
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Di Loreto
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000187:drug effects; D008078:Cholesterol, LDL / Q000187:drug effects; D004359:Drug Therapy, Combination; D058607:Fibric Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015228:Hypertriglyceridemia / Q000188:drug therapy*; D010316:Particle Size; D016032:Randomized Controlled Trials as Topic
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors