Fibric acid derivatives activate the nuclear transcription factor peroxisome proliferator-activated receptor (PPAR)-alpha (PPARĪ±), leading to regulation of Apo-CIII, ApoA-I, and lipoprotein lipase (LPL). This results in decreased triglyceride levels and increased HDL-C.
The clinical efficacy of fibric acid derivatives has been demonstrated in trials such as VA-HIT and the Helsinki Heart Study, showing reductions in cardiovascular events. However, due to concerns about interactions with statins, their contemporary use is limited. Subsequent trials with fenofibrate, such as FIELD and ACCORD, have shown mixed results, with hints of benefit in certain subgroups.
Fibric acid derivatives are indicated as adjuncts to diet control to reduce LDL-C, total cholesterol, triglycerides, and Apo-B, and to increase HDL-C, in patients with primary hypercholesterolemia or mixed dyslipidemia. They can also be used for triglyceride reduction in patients with severe hypertriglyceridemia.
Fibric acid derivatives are generally well tolerated, but side effects may include gastrointestinal upset, cutaneous manifestations, acute kidney injury, and hepatotoxicity, which is typically reversible upon discontinuation of the drug.
Fibric acid derivatives have been shown to be cost-effective in the primary prevention of coronary heart disease, meeting societal cost-effectiveness thresholds. Studies have also demonstrated their cost-effectiveness compared to other lipid-lowering therapies.
© The AtheroPrev Team (2024)
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