Fibrates : Do They Still Have a Role in Therapy in 2025?
Abstract
Purpose of review Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of mortality despite optimal LDL-C control, leaving substantial residual risk in patients with atherogenic dyslipidaemia. This review re-examines the evolving role of fibrates in the management of dyslipidaemia, metabolic dysfunction-associated steatotic liver disease (MASLD), chronic kidney disease (CKD), and diabetic microvascular complications. Recent findings Large trials have demonstrated modest or inconsistent cardiovascular benefits with fibrates, with effects mainly limited to patients with elevated triglycerides and low HDL-C. The PROMINENT trial confirmed that lowering triglycerides alone does not improve cardiovascular outcomes. However, emerging evidence suggests that fibrates, particularly fenofibrate and pemafibrate, have beneficial effects on albuminuria, hepatic steatosis, and diabetic retinopathy, indicating pleiotropic metabolic benefits beyond lipid lowering. Fibrates remain therapeutically relevant in selected dyslipidaemic or metabolically altered phenotypes. Their future lies in precision metabolic therapy, targeting microvascular, hepatic, and renal complications within a personalised cardiometabolic approach.
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Emerging data suggest that fibrates may have benefits on diabetic retinopathy and metabolic liver disease, including hepatic steatosis.
“Furthermore, emerging data also suggest that the effects of fibrates may extend beyond cardiovascular events, with reported benefits on diabetic retinopathy and metabolic liver disease, including hepatic steatosis [84].”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [84]
The LENS study demonstrated significant reductions in retinopathy progression with fenofibrate, with benefits observed even when glycemic control and traditional lipid measures are accounted for.
“Dedicated trials, including the Lowering Events in Non-Proliferative Retinopathy in Scotland (LENS) study, have demonstrated significant reductions in retinopathy progression with fenofibrate, with benefits observed even when glycemic control and traditional lipid measures are accounted for, raising the possibility of direct retinal effects independent of triglyceride lowering [84].”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [84]
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Targeting triglycerides for cardiovascular risk reduction
Maiorca, C., Tramontano, D., Di Costanzo, A., & D’Erasmo, L. (2026) · Internal and Emergency Medicine · doi:10.1007/s11739-026-04383-1
- Authors
- Pirillo, A., Zambon, A., & Catapano, A. L.
- Affiliations
- Ospedale Bassini (IT)
- University of Padua (IT)
- University of Milan (IT)
- Corresponding author
- Catapano, Alberico L.
- Venue
- Current Atherosclerosis Reports
- Published
- 2025-12-26
- Volume
- 28
- Issue
- 1
- Pages
- 4-4
- ISSN
- 1523-3804 (ISSN-L)
- 1534-6242
- OpenAlex
- W7117292299
- Cited by
- 4
- References
- 27
- Citations by year
- 2026: 4
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Current Atherosclerosis Reports (publishedVersion)
- PubMed (publishedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- fibrates, fenofibrate, pemafibrate, atherosclerotic cardiovascular disease, residual cardiovascular risk, dyslipidemia, non-alcoholic fatty liver disease, chronic kidney disease, diabetic microvascular complications, triglyceride lowering, albuminuria, hepatic steatosis, diabetic retinopathy, pleiotropy
- MeSH terms
- Hypolipidemic Agents, Cardiovascular Diseases, Humans, Dyslipidemias, Atherosclerosis, Fibric Acids
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