Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 10, 2016; 7(5): 74-88
Published online Mar 10, 2016. doi: 10.4239/wjd.v7.i5.74
Use of fibrates in the metabolic syndrome: A review
Kate E Shipman, Richard C Strange, Sudarshan Ramachandran
Kate E Shipman, Department of Clinical Biochemistry, University Hospital Birmingham, Birmingham B15 2TH, United Kingdom
Richard C Strange, Institute for Science and Technology in Medicine, Keele University Medical School, Staffordshire ST5 5BG, United Kingdom
Sudarshan Ramachandran, Department of Clinical Biochemistry, Heart of England NHS Foundation Trust, Good Hope Hospital, West Midlands B75 7RR, United Kingdom
Sudarshan Ramachandran, Department of Clinical Biochemistry, University Hospitals of North Midlands and Faculty of Health Sciences, Staffordshire University, West Midlands ST5 5BG, United Kingdom
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sudarshan Ramachandran, PhD, FRCPath, Professor, Department of Clinical Biochemistry, Heart of England NHS Foundation Trust, Good Hope Hospital, Rectory Road, Sutton Coldfield, West Midlands B75 7RR, United Kingdom. sud.ramachandran@heartofengland.nhs.uk
Telephone: +44-121-4247246 Fax: +44-121-3111800
Received: August 27, 2015
Peer-review started: August 31, 2015
First decision: October 8, 2015
Revised: October 30, 2015
Accepted: January 21, 2016
Article in press: January 22, 2016
Published online: March 10, 2016
Processing time: 190 Days and 8.6 Hours
Abstract

The use of fibrates in the treatment of dyslipidaemia has changed significantly over recent years. Their role appeared clear at the start of this century. The Helsinki Heart Study and Veterans Affairs High-Density Cholesterol Intervention Trial suggested significant benefit, especially in patients with atherogenic dyslipidaemia. However, this clarity disintegrated following the negative outcomes reported by the Bezafibrate Infarction Prevention, Fenofibrate Intervention and Event Lowering in Diabetes and Action to Control Cardiovascular Risk in Diabetes randomised controlled trials. In this review we discuss these and other relevant trials and consider patient subgroups such as those with the metabolic syndrome and those needing treatment to prevent the microvascular complications associated with diabetes in whom fibrates may be useful. We also discuss observations from our group that may provide some explanation for the varying outcomes reported in large trials. The actions of fibrates in patients who are also on statins are interesting and appear to differ from those in patients not on statins. Understanding this is key as statins are the primary lipid lowering agents and likely to occupy that position for the foreseeable future. We also present other features of fibrate treatment we have observed in our clinical practice; changes in creatinine, liver function tests and the paradoxical high density lipoprotein reduction. Our purpose is to provide enough data for the reader to make objective decisions in their own clinical practice regarding fibrate use.

Keywords: Fibrates; Metabolic syndrome; Paradoxical high density lipoprotein cholesterol decrease; High density lipoprotein cholesterol; Cardiovascular disease; Peroxisome proliferator-activated receptor; Randomised control trial; Triglycerides

Core tip: Atherogenic dyslipidaemia is characterised by low high density lipoprotein cholesterol (HDL-C) and raised triglycerides, this pattern being associated with adverse cardiovascular risk. The fibrate class of drugs has been shown to both elevate HDL-C and reduce triglyceride concentrations. Despite several randomised control trials the data remain conflicting in regards to the use of fibrates in cardiovascular disease management. Our objective is to consolidate and summarise the literature to clarify the current evidence base.