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Journal Article Review Ahead of print 1 citation

PubMed: 41172702 DOI: 10.1016/j.atherosclerosis.2025.120555

Not all fibrates are made equal: Learning from biology and clinical trials.

Atherosclerosis 411:120555

Authors: Alberto Zambon, Bart Staels, Michel Farnier, Michal Vrablik, Alberico L Catapano

Affiliations

  • Department of Medicine, University of Padua, Padua, Italy.
  • Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000, Lille, France.
  • Université Bourgogne Europe, PEC2 UR 7460, 21000, Dijon, France.
  • 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
  • IRCCS Multimedica, Milan, Italy; Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.

Abstract

Atherogenic dyslipidemia is an important risk factor for cardiovascular disease (CVD) in patients with type 2 diabetes, obesity, and metabolic disorders. Statin therapy, the standard treatment for dyslipidemia management, falls short of controlling the residual risk of adverse cardiovascular events, even with good control of low-density lipoprotein cholesterol (LDL-C). Apolipoprotein B (apoB), in addition to non-high-density lipoprotein cholesterol (non-HDL-C), is considered a better measure of residual risk and a more comprehensive treatment target in atherogenic dyslipidemia. Fibrates in combination with statins represent a proven therapeutic modality for atherogenic dyslipidemia. Fibrates lower triglyceride-rich lipoproteins (TRL), TRL remnants, and small dense LDL particles while increasing HDL-C levels. However, only fenofibrate appears to reduce apoB, whereas gemfibrozil and pemafibrate do not. This leads to a reduction in atherogenic lipids, as measured by a significant decrease in apoB/non-HDL-C levels, and a corresponding reduction in CVD risk. Real-world efficacy studies and CVD outcome trials have shown that fenofibrate may be an option in combination with statins compared to other fibrates and is well tolerated. Additionally, evidence from real-world studies of the fenofibrate-statin combination in patients over a period of up to 20 years has dispelled safety concerns regarding long-term use of fenofibrate.

MeSH

Cholesterol, Ldl, Lipoproteins, Dyslipidemias, Cholesterol, Therapeutics, Learning, Hydroxymethylglutaryl-Coa Reductase Inhibitors, Fenofibrate

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