Tags

Type your tag names separated by a space and hit enter

Fibrates: no ACCORD on their use in the treatment of dyslipidaemia.
Curr Opin Lipidol. 2010 Aug; 21(4):352-8.CO

Abstract

PURPOSE OF REVIEW

New data have emerged over the last few years about the role of fibrates in treatment of microvascular and macrovascular disease.

RECENT FINDINGS

Endpoint studies have been conducted with fibrates in coronary heart disease since 1971 and results have been contradictory. Fibrates have shown benefits in patients with low HDL-cholesterol and low LDL-cholesterol. Fibrates remain topical, given their actions on the lipid triad present in the metabolic syndrome and in diabetes. In the Fenofibrate Intervention in Endpoint Lowering in Diabetes study of mixed primary and secondary prevention cohorts, fenofibrate therapy resulted in an 11% reduction in coronary or cardiovascular events in monotherapy. Despite frequent use, there was little endpoint data on fibrate-statin combination therapy until recently. The Action to Control Cardiovascular Risk in Diabetes trial of fenofibrate added to baseline simvastatin therapy in diabetes showed a nonsignificant 8% reduction in cardiovascular events. The benefits were concentrated in men, and women did slightly worse with fibrate therapy. In post-hoc analysis, slight beneficial effects of fenofibrate were seen in patients with moderate hypertriglyceridaemia (>2.3 mmol/l) and low HDL-cholesterol (<0.88 mmol/l). The safety profile of fibrate-simvastatin combination was good.

SUMMARY

Fenofibrate and bezafibrate are reasonable second-line therapies for dyslipidaemia and in diabetes. They are safe in combination therapy with statins but add little endpoint benefit except possibly in patients with a significant degree of atherogenic dyslipidaemia (high triglycerides and low HDL-cholesterol). The benefits of fibrates on microvascular disease remain to be fully explored.

Authors+Show Affiliations

St Thomas' Hospital, London, UK. Anthony.Wierzbicki@kcl.ac.uk

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20625256

Citation

Wierzbicki, Anthony S.. "Fibrates: No ACCORD On Their Use in the Treatment of Dyslipidaemia." Current Opinion in Lipidology, vol. 21, no. 4, 2010, pp. 352-8.
Wierzbicki AS. Fibrates: no ACCORD on their use in the treatment of dyslipidaemia. Curr Opin Lipidol. 2010;21(4):352-8.
Wierzbicki, A. S. (2010). Fibrates: no ACCORD on their use in the treatment of dyslipidaemia. Current Opinion in Lipidology, 21(4), 352-8. https://doi.org/10.1097/MOL.0b013e32833c1e74
Wierzbicki AS. Fibrates: No ACCORD On Their Use in the Treatment of Dyslipidaemia. Curr Opin Lipidol. 2010;21(4):352-8. PubMed PMID: 20625256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fibrates: no ACCORD on their use in the treatment of dyslipidaemia. A1 - Wierzbicki,Anthony S, PY - 2010/7/14/entrez PY - 2010/7/14/pubmed PY - 2010/10/12/medline SP - 352 EP - 8 JF - Current opinion in lipidology JO - Curr. Opin. Lipidol. VL - 21 IS - 4 N2 - PURPOSE OF REVIEW: New data have emerged over the last few years about the role of fibrates in treatment of microvascular and macrovascular disease. RECENT FINDINGS: Endpoint studies have been conducted with fibrates in coronary heart disease since 1971 and results have been contradictory. Fibrates have shown benefits in patients with low HDL-cholesterol and low LDL-cholesterol. Fibrates remain topical, given their actions on the lipid triad present in the metabolic syndrome and in diabetes. In the Fenofibrate Intervention in Endpoint Lowering in Diabetes study of mixed primary and secondary prevention cohorts, fenofibrate therapy resulted in an 11% reduction in coronary or cardiovascular events in monotherapy. Despite frequent use, there was little endpoint data on fibrate-statin combination therapy until recently. The Action to Control Cardiovascular Risk in Diabetes trial of fenofibrate added to baseline simvastatin therapy in diabetes showed a nonsignificant 8% reduction in cardiovascular events. The benefits were concentrated in men, and women did slightly worse with fibrate therapy. In post-hoc analysis, slight beneficial effects of fenofibrate were seen in patients with moderate hypertriglyceridaemia (>2.3 mmol/l) and low HDL-cholesterol (<0.88 mmol/l). The safety profile of fibrate-simvastatin combination was good. SUMMARY: Fenofibrate and bezafibrate are reasonable second-line therapies for dyslipidaemia and in diabetes. They are safe in combination therapy with statins but add little endpoint benefit except possibly in patients with a significant degree of atherogenic dyslipidaemia (high triglycerides and low HDL-cholesterol). The benefits of fibrates on microvascular disease remain to be fully explored. SN - 1473-6535 UR - https://www.unboundmedicine.com/medline/citation/20625256/Fibrates:_no_ACCORD_on_their_use_in_the_treatment_of_dyslipidaemia_ L2 - http://dx.doi.org/10.1097/MOL.0b013e32833c1e74 DB - PRIME DP - Unbound Medicine ER -