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14-09-2009 | Cardiometabolic | Article

Fibrates useful alternative or add-on to statins for improving lipids

Abstract

Free abstract

MedWire News: Results from a systematic review show that fibrates are effective at improving lipids and reduce the risk for nonfatal myocardial infarction, providing a useful alternative or add-on therapy to statins for patients who are intolerant to statins or who have trouble reaching their lipid goals.

Statins are currently the number one drug of choice for treating dyslipidemia, explain Mark Eisenberg (McGill University, Montreal, Quebec, Canada) and team.

However, some groups of patients are unable to take statins due to intolerance, and others already receiving high statin doses are still unable to meet recommended lipid targets.

In this study, Eisenberg and colleagues carried out a systematic review of randomized controlled trials of fibrate therapy to assess its efficacy in improving lipids and reducing adverse events.

Trials were included in the analysis if they were double blind and placebo controlled, included at least 100 participants, had at least 8 weeks of follow-up, assessed the effects of fibrates on lipid profiles and cardiovascular outcomes, and tested bezafibrate, fenofibrate, or gemfibrozil. The resulting 20 trials that were included had a total of 25,655 participants.

Compared with placebo, fibrate treatment was associated with reductions in total cholesterol and triglycerides of 5.00–101.30 mg/dl (0.13–2.62 mmol/l) and 20.80–321.30 mg/dl (0.23–3.63 mmol/l), respectively, as well as increases in high-density lipoprotein (HDL) cholesterol of 1.10–17.90 mg/dl (0.03–0.46 mmol/l) across all the trials.

There was also a tendency for a greater reduction in low-density lipoprotein (LDL) cholesterol levels with fibrate treatment compared with placebo, but this was not consistent across all the trials.

Eisenberg et al report that fibrate treatment reduced the incidence of nonfatal myocardial infarction by 22%, but rates of all-cause mortality were not significantly reduced by fibrates.

The authors say their results indicate that, “although statins remain the recommended treatment for dyslipidemia, fibrates also might have a role to play.”

They conclude: “Physicians should consider their use as monotherapy in patients who are intolerant or resistant to statins, in patients who have hypertriglyceridemia, or as an adjunct to statin therapy.”

The results of this research are published in the American Journal of Medicine.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Helen Albert