Lipid lowering with fibric acid derivatives
- Robert S Rosenson, MD
Robert S Rosenson, MD
- Professor of Medicine
- Mount Sinai School of Medicine
- Director, Cardiometabolic Disorders
- Mount Sinai Heart
Lipid altering agents encompass several classes of drugs that include HMG CoA reductase inhibitors or statins, fibric acid derivatives, bile acid sequestrants, and nicotinic acid. These drugs differ with respect to mechanism of action and to the degree and type of lipid lowering. Thus, the indications for a particular drug are influenced by the underlying lipid abnormality. Conventional dosing regimens and common adverse reactions are described in a table (table 1), and the range of expected changes in the lipid profile are listed in another table (table 2).
Lipid lowering is beneficial in patients with dyslipidemias for both primary and secondary prevention of coronary heart disease (CHD). (See "Clinical trials of cholesterol lowering for primary prevention of coronary heart disease" and "Clinical trials of cholesterol lowering in patients with cardiovascular disease or diabetes".)
The mechanisms of benefit seen with lipid-lowering are incompletely understood. Regression of atherosclerosis occurs in only a minority of patients; furthermore, the benefit of lipid lowering is seen in as little as six months, before significant regression could occur. Thus, other factors must contribute; these include plaque stabilization, reversal of endothelial dysfunction, and decreased thrombogenicity. (See "Mechanisms of benefit of lipid-lowering drugs in patients with coronary heart disease".)
The characteristics and efficacy of the fibric acid derivatives will be reviewed here. Other lipid lowering drugs and dietary supplements are discussed separately. (See "Lipid lowering with drugs other than statins and fibrates" and "Statins: Actions, side effects, and administration" and "Lipid lowering with diet or dietary supplements".)
Fibrates available in the United States include gemfibrozil and fenofibrate. Clofibrate, available in the past, should not be used since it has been associated with cholangiocarcinoma and other gastrointestinal cancers . Other fibrates that are available worldwide include bezafibrate and ciprofibrate.
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