Effect of fibrate treatment on liver function tests in patients with the metabolic syndrome.
BACKGROUND
Fibrates are used especially in patients with hypertriglyceridaemia, a feature of the metabolic syndrome. Elevated LFTs are often observed in these patients perhaps related to fatty infiltration.


OBJECTIVE
We wished to study changes seen in LFTs (GGT, ALT and ALP) following fibrate therapy and then determine associated factors.


METHODS
This was a retrospective observational study in which data was collected from case notes of patients started on fibrates (n = 118, 2002-2008) in the lipid clinic at Good Hope Hospital and pre/post-fibrate lipid and LFT values were obtained. All biochemistry was performed on the Roche P-Unit using supplied reagents. Statistical analyses included t tests and regression analyses (factorised when quartiles were compared).


RESULTS
Of the study population 106 patients were on fenofibrate; the remaining on bezafibrate. Significant lowering of GGT (p < 0.0001), ALT (p = 0.0014) and ALP (p < 0.0001) levels were observed following fibrate treatment. Baseline lipid (cholesterol, triglycerides and HDL) concentrations, alcohol intake, length of treatment, gender, concurrent statin treatment and diabetes did not correlate with these changes in LFT in a multiple regression analysis. Higher pre-fibrate GGT (p < 0.0001), ALT (p < 0.0001) and ALP (p < 0.0001) concentrations were associated with larger decreases in each of these tests respectively with the highest 2 quartiles (GGT > 57 IU/l, ALT > 34 IU/l and ALP > 94 IU/l) significantly different to the lowest quartile. The above associations remained significant even when the regression analyses were corrected for changes in lipid values (which did not show an association).


CONCLUSIONS
Fibrate treatment led to improvements in LFT, the greatest benefit seen in patients with higher baseline LFT values. It appears that baseline and changes in lipid values post fibrate treatment were not associated with change in LFT.
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Nirav
N
Gandhi
Heart of England Foundation Trust, Birmingham, UK.
Richard
R
Lenton
Diabetes and Endocrinology, Sandwell and West Birmingham Hospitals, Birmingham, UK.
Mithun
M
Bhartia
Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Ahmed
A
Abbas
Heart of England Foundation Trust, Birmingham, UK.
Jessie
J
Raju
Department of Clinical Biochemistry, Good Hope Hospital, Heart of England NHS Foundation Trust, Rectory Road, Sutton Coldfield, West Midlands B75 7RR UK.
Sudarshan
S
Ramachandran
ALP; ALT; Fibrates; GGT; Metabolic syndrome; PPARα; Statins