Fenofibrate: treatment of hyperlipidemia and beyond

Abstract

Fenofibrate is a PPAR-α agonist indicated for the treatment of hypertriglyceridemia and mixed dyslipidemia, and is approved for the treatment of hypercholesterolemia, lipid abnormalities commonly observed in patients at high risk of cardiovascular disease, including Type 2 diabetes and/or metabolic syndromes. Treatment with fenofibrate lowers triglycerides, raises HDL-cholesterol and decreases concentrations of small LDL-cholesterol particles and apolipoprotein B. Fenofibrate is particularly effective for reducing postprandial VLDL and LDL particle concentrations, and the increased oxidative stress and inflammatory response that occurs after a fatty meal. In addition, nonlipid pleiotropic effects mediated by PPAR-α are likely to contribute to the reduction in atherosclerosis progression and cardiovascular events, and have beneficial effects on diabetes-related microvascular diseases. While current approaches to treating dyslipidemia to prevent cardiovascular diseases focus on statin therapy, it is increasingly clear that substantial residual risk persists. The clinical significance of combination therapy with fenofibrate and a statin to macrovascular and microvascular risk is being evaluated in a large outcomes study.

Keywords::

• cardiovascular
• combination treatment
• diabetic retinopathy
• dyslipidemia
• dyslipoproteinemia
• efficacy
• fenofibrate
• microvascular

Financial & competing interests disclosure

Abbott Laboratories is a manufacturer of fenofibrate. Robert Rosenson serves on the Speaker’s Bureau for Abbott Laboratories and he receives honoraria for those activites. He has funded research studies from Abbott Laboratories and these funds are paid directly to the University of Michigan. Robert Rosenson has ownership in Liposcience, Inc. and has served on the Scientific Advisory Board. The author serves on the Speakers Bureau for AstraZeneca and he receives honoraria for those activities. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was utilized in the production of this manuscript. Jane Stock PhD, Medical Writing Consultant, who received support from Solvay, Inc., provided editorial assistance for this manuscript.

Notes

^*Greater effect in patients with high TGs.

Apo: Apolipoprotein; TG: Triglyceride.

AP: Activator protein; CRP: C-reactive protein; hs-CRP: High-sensitivity C-reactive protein; LV: Left ventricular; MCP: Monocyte chemoattractant protein; TG: Triglycerides.

FIELD: Fenofibrate Intervention and Event Lowering in Diabetes; Hb_A1c: Glycosylated hemoglobin; TG: Triglyceride.

Adapted from [60,61].