title: Use of fibrates in clinical practice: Queensland Lipid Group consensus recommendations.
abstract: BACKGROUND
  Fibrates have been prescribed for decades as 'broad-spectrum' lipid modifying agents that can improve plasma levels of triglycerides, high-density lipoprotein cholesterol, and triglyceride-rich lipoproteins, including very low- and intermediate-density lipoproteins. Fibrates are variably effective in lowering low-density cholesterol levels. Available fibrates include gemfibrozil, fenofibrate, bezafibrate, etiofibrate and ciprofobrate; only fenofibrate and gemfibrozil are available in Australia.
  
  
  METHODS
  Members of the Queensland Lipid Group provided consensus grades of recommendations for the clinical use of fibrates based on PubMed searches, product information, and personal clinical experience.
  
  
  RESULTS
  Fibrates are well tolerated, and the combination of fenofibrate with statins appears to be safer than gemfibrozil, particularly with regard to adverse effects on muscle. Evidence has been provided recently for the efficacy of fenofibrate in reducing microvascular complications in diabetic patients, including progression of retinopathy, progression of microalbuminuria and nephropathy, development of sensory neuropathy, and leg amputation. Macrovascular benefits appear to be confined to those with reduced high-density lipoprotein cholesterol and/or increased triglyceride levels, and the relationship of microvascular benefits of fenofibrate to baseline lipid levels is variable and requires further assessment.
  
  
  CONCLUSIONS
  Indications for fibrate therapy may be extended in the future to include protection from both macro- and micro-vascular disease, particularly in diabetic patients and patients with residual dyslipidaemia in spite of statin therapy. We provide recommendations on the use of fibrates in clinical practice to highlight these potential indications.
authors.affiliation: Department of Cardiology, Gold Coast Hospital, Griffith University School of Medicine, and Griffith Health Institute, Heart Foundation Research Centre, Southport, Queensland, Australia. ihcgriffith@gmail.com
authors.forename: Ian
authors.initials: I
authors.lastname: Hamilton-Craig
authors.forename: Karam Maximilien
authors.initials: KM
authors.lastname: Kostner
authors.forename: Stan
authors.initials: S
authors.lastname: Woodhouse
authors.forename: David
authors.initials: D
authors.lastname: Colquhoun
mesh_terms: D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D058607:Fibric Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011793:Queensland
chemical_list: D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents