The effect of fibrates on lowering low-density lipoprotein cholesterol and cardiovascular risk reduction: a systemic review and meta-analysis
Open accessAbstract
Aims: The effect of fibrate treatment on cardiovascular risk is inconsistent. This meta-analysis aimed to assess the effect of fibrates on major adverse cardiovascular outcome (MACE) reduction. Methods and results: PubMed, Embase, and Cochrane library databases were searched up to February 2023 for randomized controlled trials comparing fibrate therapy against placebo and reporting cardiovascular outcomes and lipid profile changes. The primary outcome was the clinical outcomes of each trial that most closely corresponding to MACE, a composite of cardiovascular death, acute myocardial infarction, stroke, and coronary revascularization. A pre-specified meta-regression analysis to examine the relationship between the changes in lipid levels after fibrate treatment and the risk of MACE was also performed. Twelve trials were selected for final analysis, with 25 781 patients and 2741 MACEs in the fibrate group and 27 450 patients and 3754 MACEs in the control group. Overall, fibrate therapy was associated with decreased risk of MACE [RR 0.87, 95% confidence interval (CI) 0.81–0.94] with moderate heterogeneity (I2 = 47%). In meta-regression analysis, each 1 mmol/L reduction in low-density lipoprotein cholesterol (LDL-C) after fibrate treatment reduced MACE (RR 0.71, 95% CI 0.49–0.94, P = 0.01), while triglyceride level changes did not show a significant association (RR per 1mmol/L reduction 0.96, 95% CI 0.53–1.40, P = 0.86). A sensitivity analysis with the composite outcome of cardiovascular death or acute myocardial infarction produced similar results. Conclusion: Treatment with fibrates was associated with decreased risk of MACE. The reduction in MACE risk with fibrate therapy appears to be attributable to LDL-C reduction rather than a decrease in triglyceride levels.
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A subsequent meta-analysis suggested that any cardiovascular benefit associated with fibrates was largely explained by reductions in LDL cholesterol rather than triglycerides.
“A subsequent meta-analysis suggested that any cardiovascular benefit associated with fibrates was largely explained by reductions in LDL cholesterol rather than triglycerides, helping to account for the difference between early and more contemporary trials [82].”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [82]
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- Authors
- Kim, K. A., Kim, N. J., & Choo, E. H.
- Affiliations
- The Catholic University of Korea Seoul St. Mary's Hospital (KR)
- Catholic University of Korea (KR)
- Corresponding author
- Choo, Eun Ho
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-10-19
- Volume
- 31
- Issue
- 3
- Pages
- 291-301
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W4387765664
- Cited by
- 36
- References
- 35
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 9
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed (publishedVersion)
- 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, LDL cholesterol lowering, major adverse cardiovascular events, cardiovascular risk reduction, triglyceride lowering, lipid-lowering therapy, acute myocardial infarction, cardiovascular mortality, stroke, coronary revascularization
- MeSH terms
- Heart Disease Risk Factors, Hypolipidemic Agents, Cardiovascular Diseases, Humans, Cholesterol, LDL, Myocardial Infarction, Risk Factors, Triglycerides, Biomarkers, Randomized Controlled Trials as Topic, Treatment Outcome, Risk Assessment, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Dyslipidemias, Fibric Acids
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