Effects of fibrates on lipid profile: a meta-analysis of randomized controlled trials
Open accessAbstract
We conducted a meta-analysis to compare the lipid-lowering effects of fibratesLiterature was searched up to December 2024. Absolute changes in triglycerides (TG), LDL-cholesterol (LDL‑C), apolipoprotein B (ApoB), and non-HDL cholesterol (non-HDL-C) were analyzed using both fixed and random effects models. We included 63 randomized controlled trials. Compared to placebo, all fibrates significantly reduced TG levels. Fenofibrate and bezafibrate significantly reduced LDL-C (–15.12 and –15.04 mg/dL, respectively), while only fenofibrate significantly lowered ApoB (–24.88 mg/dL) and non-HDL-C (–46.38 mg/dL), followed by gemfibrozil and pemafibrate for non-HDL-C. In combination with statins, no fibrates significantly reduced LDL-C, while fenofibrate remained the only fibrate to significantly lower ApoB (–10.42 mg/dL) and non-HDL-C (–12.02 mg/dL). Overall, we found that fibrates differ substantially in their lipid effects. Fenofibrate shows the most consistent and comprehensive lipid-lowering profile.
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Pemafibrate's triglyceride-lowering effects and safety profile appear generally comparable to existing agents (traditional fibrates).
“When placed in the context of traditional fibrates, pemafibrate’s triglyceride-lowering effects and safety profile appear generally comparable to existing agents.”
From Pemafibrate for hypertriglyceridemia: a meta-analysis of randomized controlled trials evaluating efficacy and safety outcomes (2026) · cites this paper as [25]
The Abstract (page not provided) reports that all fibrates significantly reduced triglycerides compared with placebo, supporting the triglyceride-lowering part of the claim. It does not establish that pemafibrate’s effect is comparable in magnitude to traditional fibrates, and the available text does not compare their safety profiles. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMeta-analytic evidence suggests that pemafibrate's lipid-modifying effects, including reductions in triglycerides and modest improvements in HDL-C, are broadly comparable to those seen with conventional fibrates.
“Meta-analytic evidence also suggests that pemafibrate’s lipid-modifying effects, including reductions in triglycerides and modest improvements in HDL-C, are broadly comparable to those seen with conventional fibrates, although the certainty of evidence varies and long-term clinical implications remain uncertain [25, 26].”
From Pemafibrate for hypertriglyceridemia: a meta-analysis of randomized controlled trials evaluating efficacy and safety outcomes (2026) · cites this paper as [25]
The Abstract (page unavailable) reports that all fibrates, including pemafibrate, significantly reduced triglycerides compared with placebo. It does not report HDL-C effects or establish that pemafibrate is broadly comparable to conventional fibrates; instead, it says fibrates differ substantially in their lipid effects. (LLM, conf=0.87)
Experimental — accuracy not yet measured
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“…suggests that pemafi-brate’s lipid-modifying effects, including reductions in triglycerides and modest improvements in HDL-C, are broadly comparable to those seen with conventional fibrates, although the certainty of evidence varies and long-term clinical implications remain uncertain [25, 26].”
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ALTERNATIVES TO STATINS IN THE TREATMENT OF HYPERCHOLESTEROLEMIA
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- Authors
- Olmastroni, E., Galimberti, F., Xie, S., Casula, M., & Catapano, A. L.
- Affiliations
- University of Milan (IT)
- MultiMedica (IT)
- Venue
- European Atherosclerosis Journal
- Published
- 2025-04-30
- Volume
- 4
- Issue
- 1
- ISSN
- 2785-7115 (ISSN-L)
- OpenAlex
- W4411417662
- Cited by
- 4
- References
- 24
- Citations by year
- 2026: 4
- FWCI
- 0.98
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- European Atherosclerosis Journal (publishedVersion, cc-by-nc-nd)
- Funders
- Ministero della Salute
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- fibrates, hypolipidemic effect, triglycerides, LDL cholesterol, apolipoprotein B, non-HDL cholesterol, fenofibrate, bezafibrate, gemfibrozil, pemafibrate, hypertriglyceridemia
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