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Fibrates: Risk Benefits and Role in Treating Dyslipidemias

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Dyslipidemias

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

There is a strong causative relationship between lipids and cardiovascular disease. The strongest body of evidence has been centered on the relationship of elevated concentrations of both total cholesterol and low-density lipoprotein (LDL) cholesterol with major cardiovascular outcomes. However, it is now widely recognized that LDL cholesterol is not the only atherogenic constituent of the lipid subfraction and that derangements in triglyceride and high-density lipoprotein (HDL) cholesterol concentrations are strong predictors for poor cardiovascular outcomes. For more than four decades, fibrates have been shown to effectively reduce triglyceride and elevate HDL-cholesterol concentrations. Fibrates are thus recommended as the primary treatment option for the management of hypertriglyceridemia and have also been suggested as an ideal pharmacotherapy aimed at reducing the residual cardiovascular risk observed in patients with mixed dyslipidemia. In spite of this, large outcome trials evaluating the effects of fibrates on major cardiovascular events have reported mixed results. In addition, although rare, reports of adverse effects, particularly when combined with statins, have limited the wider use of fibrates as lipid-lowering agents. However, recent meta-analyses, combining the outcome data from trials to date and post hoc analyses of large randomized controlled trials have reported significant cardiovascular benefits from fibrate therapy, showing risk reductions in major cardiovascular events, primarily as a consequence of a favorable effect on the risk of coronary events. In addition, recent studies have consistently reported that people with elevated triglyceride concentrations benefited the most from fibrate therapy, suggesting that while the overall risk reduction may be moderate compared to statin therapy, a substantially greater magnitude of benefit may exist in this subset of patients. These results suggest that fibrates have an important role in individualized approaches to management of patients at high risk of cardiovascular disease with mixed dyslipidemia.

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, University of Calgary, Health Sciences Building Room G233, 3330, Hospital Drive, Calgary, T2N4N1, Alberta, NW, Canada

    Dr. Min Jun PhD, MScMed(ClinEpi), Msc, BSc(Hons)

  2. The George Institute for Global Health, Level 13, 321 Kent St, 2000, Sydney, NSW, Australia

    Prof. Vlado Perkovic MBBS, PhD

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  1. Dr. Min Jun PhD, MScMed(ClinEpi), Msc, BSc(Hons)
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Correspondence to Min Jun PhD, MScMed(ClinEpi), Msc, BSc(Hons) .

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  1. Professor of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA

    Abhimanyu Garg

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Jun, M., Perkovic, V. (2015). Fibrates: Risk Benefits and Role in Treating Dyslipidemias. In: Garg, A. (eds) Dyslipidemias. Contemporary Endocrinology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-424-1_25

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