From the Guidelines
Fibrates are indicated for patients with hypertriglyceridemia, particularly those at risk of pancreatitis, and for those with high triglyceride levels and low HDL-C, especially in combination with statins.
Indications for Fibrates
- Fibrates offer the most triglyceride reduction, with a 30-50% reduction in triglyceride levels 1
- They are the first-line treatment in patients with hypertriglyceridemia who are at risk of pancreatitis 1
- Fibrates are also useful for lowering elevated triglyceride or non-HDL-C levels, especially in patients with diabetes and no known vascular disease 1
Clinical Use of Fibrates
- Fibrates, niacin, and n-3 fatty acids, alone or in combination, should be considered in patients with moderate to severe hypertriglyceridemia 1
- Statins have a modest triglyceride-lowering effect and may be useful to modify cardiovascular risk in patients with moderately elevated triglyceride levels, but should not be used alone in patients with severe or very severe hypertriglyceridemia 1
- When prescribing fibrates or niacin, in combination therapy with a statin, care is needed to minimize the risk of adverse effects, such as myositis and rhabdomyolysis 1
Key Points
- Fibrates have been shown to reduce CVD rates and progression of carotid intimal medial progression in patients with low HDL-C 1
- The effect of fibrates on CVD risk reduction is more pronounced in patients with high triglyceride levels and low HDL-C, especially in those with diabetes or characteristics of the metabolic syndrome 1
From the FDA Drug Label
Treatment of Hypercholesterolemia Fenofibrate tablets are indicated as adjunctive therapy to diet for the reduction of LDL-C, Total-C, Triglycerides and Apo B in adult patients with primary hypercholesterolemia or mixed dyslipidemia (Fredrickson Types IIa and IIb) Treatment of Hypertriglyceridemia Fenofibrate tablets are also indicated as adjunctive therapy to diet for treatment of adult patients with hypertriglyceridemia (Fredrickson Types IV and V hyperlipidemia)
Fibrates are indicated for:
- Treatment of Hypercholesterolemia: as adjunctive therapy to diet for the reduction of LDL-C, Total-C, Triglycerides, and Apo B in adult patients with primary hypercholesterolemia or mixed dyslipidemia (Fredrickson Types IIa and IIb) 2
- Treatment of Hypertriglyceridemia: as adjunctive therapy to diet for treatment of adult patients with hypertriglyceridemia (Fredrickson Types IV and V hyperlipidemia) 2
From the Research
Indications for Fibrates
Fibrates are indicated for the treatment of certain lipid disorders, including:
- Hypertriglyceridaemia 3
- Hypercholesterolaemia 3
- Atherogenic dyslipidaemia, particularly in patients with diabetes mellitus (DM), metabolic syndrome (MetS), and high triglyceride and low high-density lipoprotein cholesterol (HDL-C) levels 4, 5
Primary Prevention of Cardiovascular Disease
Fibrates are effective in modifying atherogenic dyslipidaemia and lowering serum triglycerides, and may reduce the risk of cardiovascular disease (CVD) events in primary prevention, particularly in patients with DM and MetS 6, 4
- Reduced risk of CVD death, non-fatal myocardial infarction, or non-fatal stroke compared to placebo 6
- Reduced risk of combined coronary heart disease death or non-fatal myocardial infarction 6
Secondary Prevention of Cardiovascular Disease
Fibrates may be effective in secondary prevention of severe cardiovascular accidents, including coronary and cerebrovascular disease 7
- Protective effect of fibrates compared with placebo as regards a compound objective of non-fatal stroke, non-fatal myocardial infarction, and death of cardiovascular origin 7
Specific Patient Populations
Fibrates may be particularly beneficial in patients with: