ISSN: 1305-385X
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Fibrates ın Hyperlipidemia
Dr. Hüsniye YÜKSELa
aKardiyoloji AD, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, İSTANBUL
Recent statin trials have shown that reduction of levels of low density lipoprotein cholesterol (LDL-C) significantly reduces morbidity and mortality in coronary heart disease (CHD). However, the magnitute of the risk reduction achieved by targeting LDL-C averages around 30%, clearly indicating that there is a need to consider additional possible therapy that goes beyond LDL-C lowering to optimize the management of CHD risk in a significant proportion of patients.
Epidemiologic studies have shown that a low concentration of high-density lipoprotein cholesterol (HDL-C) and a high level of triglyceride (TG) are strong and independent predictors of CHD, even in subjects with normal LDL-C levels. It is also important to emphasize that low HDL concentration and high TG levels are frequently found in patients with type II diabetes and metabolic syndrome which are very important risk factors for CHD. Whereas statins remain the drug of choice for patients who need to achive the LDL-C goal, fibrate therapy may represent the alternative intervention for subject with type II diabetes and metabolic syndrome and an LDL-C already close to goal values.
Fibrates are a broad spectrum lipid lowering drug. They increase the HDL-C level while decreasing plasma TG level and LDL-C considerably. Furthermore, they change the composition of LDL-C. Highly atherogenic small, dense LDL particules are converted to less atherogenic large LDL particules. The effects of fibrates are mediated by nuclear hormone receptor termed peroxisome proliferator activated reseptor (PPAR). Fibrates bind to PPAR and initiate a sequence of events that lead to hypolipidaemic effect.
In addition, the concomitant use of fibrates seems to be attractive in patients whose LDL-C is controlled by statin therapy but whose HDL-C and/or triglyceride levels are still inappropriate.
It has been supported by the recent data from multicenter large clinical studies that fibrates can be used safely and they can decrease CHD mortality and morbidity considerably by raising HDL-C and lowering TG. In this review, we focused on the mechanism of action of fibrates on the lipid metabolism and clinical studies investigating their effecs on CHD mortality/morbidity and clinical indications.Keywords: Coronary heart disease, diabetes mellitus, fibrate, high density lipoprotein, hipertriglyceridemia, metabolic syndromeTurkiye Klinikleri J Int Med Sci 2006, 2(7):73-78
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