Hj. Milionis et al., Treatment of dyslipidaemias in patients with established vascular disease:A revival of the fibrates, CURR MED R, 16(1), 2000, pp. 21-32
The key 'statin trials' focussed on the beneficial effect of lowering the c
irculating concentrations of low-density lipoprotein cholesterol (LDL). How
ever, epidemiological surveys, mainly based on healthy populations, indicat
e that other lipid-related variables, such as high-density cholesterol (HDL
), triglycerides (TG), dense LDL subfraction distribution, and possibly lip
oprotein (a) (Lp(a)), are also predictors of vascular events. Furthermore,
TG and HDL levels influenced outcome within some of the statin trials. Plas
ma fibrinogen levels have also been shown to be powerful predictors of vasc
ular risk in healthy subjects and patients with established ischaemic heart
disease. The fibrates exert beneficial effects on all these variables that
predict vascular events.
The results from recent trials, the Bezafibrate Infarction Prevention (BIP)
study and the Veterans Administration HDL Intervention Trial (VA-HIT) have
revived our interest in fibrates. These trials involved bezafibrate and ge
mfibrozil that have a relatively poor LDL-lowering capacity. Therefore, the
benefits reported in BIP and VA-HIT must be attributed to actions on varia
bles other than a reduction in LDL quantity.
Ciprofibrate and fenofibrate have significantly greater LDL-lowering capaci
ty than bezafibrate or gemfibrozil. This advantage may render them more eff
ective, especially since they retain the additional beneficial actions asso
ciated with this class of lipid-lowering drugs.