Cited by 169Lipoproteins and Cardiovascular HealthLipid metabolism and disordersPeroxisome Proliferator-Activated Receptors

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Fenofibrate: A Review of its Use in Primary Dyslipidaemia, the Metabolic Syndrome and Type 2 Diabetes Mellitus

Keating, Gillian M, Croom, Katherine F·2007·Drugs

DOI 10.2165/00003495-200767010-00013

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Abstract

Fenofibrate is a fibric acid derivative indicated for use in the treatment of primary hypercholesterolaemia, mixed dyslipidaemia and hypertriglyceridaemia in adults who have not responded to nonpharmacological measures. Its lipid-modifying effects are mediated by activation of peroxisome proliferator-activated receptor-alpha. Fenofibrate also has nonlipid (i.e. pleiotropic) effects (e.g. it reduces fibrinogen, C-reactive protein and uric acid levels and improves flow-mediated dilatation). Fenofibrate improves lipid levels (in particular triglyceride [TG] and high-density lipoprotein-cholesterol [HDL-C] levels) in patients with primary dyslipidaemia. Its lipid-lowering profile means that fenofibrate is particularly well suited for use in atherogenic dyslipidaemia (characterised by high TG levels, low HDL-C levels and small, dense low-density lipoprotein [LDL] particles), which is commonly seen in patients with the metabolic syndrome and type 2 diabetes mellitus. Indeed, fenofibrate improves the components of atherogenic dyslipidaemia in patients with these conditions, including a shift from small, dense LDL particles to larger, more buoyant LDL particles. Greater improvements in lipid levels are seen when fenofibrate is administered in combination with an HMG-CoA reductase inhibitor (statin) or in combination with ezetimibe, compared with monotherapy with these agents. In the DAIS study, fenofibrate significantly slowed the angiographic progression of focal coronary atherosclerosis in patients with type 2 diabetes. In terms of clinical outcomes, although no significant reduction in the risk of coronary events was seen with fenofibrate in the FIELD trial in patients with type 2 diabetes, treatment was associated with a significantly reduced risk of total cardiovascular disease (CVD) events, primarily through the prevention of non-fatal myocardial infarction and coronary revascularisation. Subgroup analyses revealed significant reductions in total CVD events and coronary heart disease events in patients with no previous CVD, suggesting a potential role for primary prevention with fenofibrate in patients with early type 2 diabetes. Improvements were also seen in microvascular outcomes with fenofibrate in the FIELD trial. Fenofibrate is generally well tolerated, both as monotherapy and when administered in combination with a statin. Combination therapy with fenofibrate plus a statin appears to be associated with a low risk of rhabdomyolysis; no cases of rhabdomyolysis were reported in patients receiving such therapy in the FIELD trial. Thus, fenofibrate is a valuable lipid-lowering agent, particularly in patients with atherogenic dyslipidaemia.

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Authors: Keating, G. M., & Croom, K. F.
Affiliations: Wolters Kluwer Health (NZ)
Corresponding author: Keating, Gillian M
Venue: Drugs
Publisher: Springer Science and Business Media LLC
Published: 2007
Volume: 67
Issue: 1
Pages: 121-153
ISSN: 0012-6667 (ISSN-L)
DOI: 10.2165/00003495-200767010-00013
OpenAlex: W2005965794
Cited by: 169
References: 173
Citations by year: 2026: 3 · 2025: 13 · 2024: 10 · 2023: 7 · 2022: 6 · 2021: 2 · 2020: 2 · 2019: 6 · 2018: 3 · 2017: 7 · 2016: 7 · 2015: 9 · 2014: 8 · 2013: 10 · 2012: 9
FWCI: 3.08
Type: journal article
Language: en
Open access: closed
Locations: Drugs (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Peroxisome Proliferator-Activated Receptors
Keywords: fenofibrate, fibrates, PPARα, primary hypercholesterolemia, mixed dyslipidemia, hypertriglyceridemia, atherogenic dyslipidemia, metabolic syndrome, type 2 diabetes, statin combination therapy, ezetimibe, cardiovascular risk reduction, primary prevention, rhabdomyolysis
MeSH terms: Hypolipidemic Agents, Diabetes Mellitus, Type 2, Humans, Fenofibrate, Metabolic Syndrome, Dyslipidemias

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Fenofibrate: A Review of its Use in Primary Dyslipidaemia, the Metabolic Syndrome and Type 2 Diabetes Mellitus

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