on August 23, 2007
Published online before print August 23, 2007, doi: 10.1161/ATVBAHA.107.148817
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Submitted on May 28, 2007
Accepted on August 10, 2007
Is There a Role for Fibrates in the Management of Dyslipidemia in the Metabolic Syndrome?
Philip J. Barter * and Kerry-Anne Rye
From The Heart Research Institute, Sydney, and the Faculty of Medicine, University of Sydney, Australia.
* To whom correspondence should be addressed. E-mail: barterp{at}hri.org.au.
Abstract—The outcomes of fibrate trials have varied: positive with gemfibrozil in the primary prevention Helsinki Heart Study and the secondary prevention VA-HIT trial; positive with reservations in the primary prevention WHO trial (clofibrate); and mixed with bezafibrate in the secondary prevention BIP study and with fenofibrate in the combined primary and secondary prevention FIELD study. Overall, the mixed results, combined with potential for adverse effects when given in combination with statins, have limited the use of these fibrates as cardioprotective agents. However, post hoc analyses of several of the fibrate studies have shown that people with features of the metabolic syndrome, particularly overweight people with high plasma triglyceride levels and low levels of HDL cholesterol, derive a disproportionately large reduction in cardiovascular events when treated with these agents. Thus, there is a strong case for the use of a fibrate to reduce the cardiovascular risk in overweight people with high triglyceride and low HDL-C. However, it should be noted that such people also have their cardiovascular risk reduced by statin therapy. It remains to be determined whether the combination of a fibrate plus statin reduces the risk beyond that achieved with a statin alone.
Key words: fibrates • metabolic syndrome • triglyceride • HDL • cardiovascular events
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