A review of time courses and predictors of lipid changes with fenofibric acid-statin combination

Theodosios D Filippatos, Theodosios D Filippatos

Abstract

Fibrates activate peroxisome proliferator activated receptor α and exert beneficial effects on triglycerides, high-density lipoprotein cholesterol, and low density lipoprotein subspecies. Fenofibric acid (FA) has been studied in a large number of patients with mixed dyslipidemia, combined with a low- or moderate-dose statin. The combination of FA with simvastatin, atorvastatin and rosuvastatin resulted in greater improvement of the overall lipid profile compared with the corresponding statin dose. The long-term efficacy of FA combined with low- or moderate- dose statin has been demonstrated in a wide range of patients, including patients with type 2 diabetes mellitus, metabolic syndrome, or elderly subjects. The FA and statin combination seems to be a reasonable option to further reduce cardiovascular risk in high-risk populations, although trials examining cardiovascular disease events are missing.

Figures

Fig. 1
Fig. 1
Design of the pivotal trials evaluating the efficacy and safety of the combined use of fenofibric acid (FA) with different statins in patients with mixed dyslipidemia
Fig. 2
Fig. 2
Lipid alterations (%) with the combination of fenofibric acid (FA) 135 mg/day with simvastatin compared with simvastatin alone [22]. * p < 0.05 vs. corresponding statin dose. &p < 0.05 vs. FA monotherapy. Bars represent mean ± SEM. The numbers with white color represent the baseline values, whereas the numbers with black color represent the percent changes. HDL-C = high-density lipoprotein cholesterol, TG = triglycerides, LDL-C = low-density lipoprotein cholesterol
Fig. 3
Fig. 3
Lipid alterations (%) with the combination of fenofibric acid (FA) 135 mg/day with atorvastatin compared with atorvastatin alone [23]. *p < 0.05 vs. corresponding statin dose. &p < 0.05 vs. FA monotherapy. Bars represent mean ± SEM. The numbers with white color represent the baseline values, whereas the numbers with black color represent the percent changes. HDL-C = high-density lipoprotein cholesterol, TG = triglycerides, LDL-C = low-density lipoprotein cholesterol
Fig. 4
Fig. 4
Lipid alterations (%) with the combination of fenofibric acid (FA) 135 mg/day with rosuvastatin compared with rosuvastatin alone [24]. *p < 0.05 vs. corresponding statin dose. &p < 0.05 vs. FA monotherapy. Bars represent mean ± SEM. The numbers with white color represent the baseline values, whereas the numbers with black color represent the percent changes. HDL-C = high-density lipoprotein cholesterol, TG = triglycerides, LDL-C = low-density lipoprotein cholesterol
Fig. 5
Fig. 5
Two-year lipid alterations (%) with the combination of fenofibric acid (FA) 135 mg/day with moderate-dose statin [26]. Bars represent mean ± SD. The numbers with white color represent the baseline values, whereas the numbers with black color represent the percent changes. *p < 0.05 vs. FA + simvastatin. HDL-C = high-density lipoprotein cholesterol, TG = triglycerides, LDL-C = low-density lipoprotein cholesterol

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