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Perspectives

Fibrate therapy for dyslipidaemia and prevention of cardiovascular disease

Ian Hamilton-Craig, Karum M Kostner, David Colquhoun, Stan Woodhouse

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Abstract

The main use of fibrates is for the treatment of dyslipidaemia to lower plasma triglyceride levels and to raise HDL-cholesterol (HDL-C) levels. The effects of fibrates on LDL-cholesterol levels vary. Fibrates may be used either as monotherapy or in combination with statins. When combined with statins, fenofibrate is the preferred fibrate as it has a low risk of myopathy. The benefits of fibrate therapy in preventing ischaemic cardiovascular disease events appear to be confined to patients with baseline dyslipidaemia (raised triglyceride levels and/or low HDL-C levels).

Key Points

  • Fibrates are first-line drugs for the treatment of patients with high triglyceride levels and have variable effects on reducing LDL-cholesterol levels, for which statins are first-line therapy.
  • Fibrate therapy reduces concentrations of atherogenic small dense LDL-cholesterol, while raising HDL-cholesterol and lowering triglyceride levels. These changes are likely to be protective against ischaemic cardiovascular disease.
  • Several randomised controlled trials have consistently shown reduction of ischaemic heart disease events with fibrate therapy. This is confined to patients with dyslipidaemia (low HDL-cholesterol and/or high triglyceride levels).
  • Fenofibrate is preferred to gemfibrozil when combined with a statin because of a lower risk of muscle side effects.

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