It is evident that an efficient risk reduction is not simply related to drug choice simvastatin produced very different effects in 4S versus HPS , but is mostly the result of matching the right drug with the right patient type i.
The question arises, of course, of whether combination therapy with statin and fibrate would produce additive or synergistic effects and greater risk reductions compared with monotherapy with either drug in high-risk patients.
Such a question is being investigated in the NIH-sponsored ACCORD trial, designed to compare the effect of simvastatin monotherapy with the combination with fenofibrate in diabetic patients www.
The first results from this study should be expected in Fibrates meet the criteria of excellent drugs for cardiovascular prevention and are appropriate for the long-term management of dyslipidemia in patients with diabetes and the metabolic syndrome. These observations argue against the use of any one class of drugs in the management of high-risk dyslipidemia, and support a practice stance of matching a specific diagnosis of lipid abnormality with the therapeutic agent most likely to correct it.
The importance of such a position is evident for the common subjects with very high CVD risk and moderate combined dyslipidemia, i. The current guidelines encourage aggressive lipid lowering in patients with the metabolic syndrome and diabetes, but one should keep in mind that these patients present with different forms and degrees of dyslipidemia.
There are obvious scenarios where the drug choice is limited. In these subjects, a more targeted approach to therapy may be warranted based on the specific lipid abnormality. Sergio Fazio ,. Citation: US Cardiology ;1 1 :1—6. Open access: The copyright in this work belongs to Radcliffe Medical Media. Mechanism of Action of Fibrates Gemfibrozil and fenofibrate are the fibrates currently approved for use in the US and, in addition to these, bezafibrate and ciprofibrate are also available in Europe.
Conclusions Fibrates meet the criteria of excellent drugs for cardiovascular prevention and are appropriate for the long-term management of dyslipidemia in patients with diabetes and the metabolic syndrome. Vol II. Since gemfibrozil did not cause LDL reductions in this study, one can infer that either the correction of HDL and triglycerides or a direct effect of PPARa acitvation on the vessel wall explains these results. This study provides strong support to the claim that fibrate therapy may be particularly beneficial in subject with diabetes and the metabolic syndrome when LDL levels are not elevated.
Crossref PubMed Anonymous. Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomised study. Crossref PubMed Scandinavian, Simvastatin, Survival, Study, and Group, Randomised trial of cholesterol lowering in patients with coronary heart disease: the scandinavian simvastatin survival study 4S , Lancet , pp.
Cholesterol and Recurrent Events Trial investigators. Lowering cholesterol and triglycerides can help protect you from heart disease, heart attack, and stroke. Statins are thought to be the best drugs to use for people who need medicines to lower their cholesterol. Some fibrates may be prescribed along with statins to help lower cholesterol.
However, some studies show that using certain fibrates along with statins may not help reduce the risk of heart attack or stroke more than using statins alone. Fibrates may also be used to help lower very high triglycerides in people at risk for pancreatitis. Take your medicine as directed. It is generally taken 1 time per day. Do not stop taking your medicine without first talking with your health care provider. The medicine comes in liquid-filled capsule or tablet form.
Do not open capsules, chew, or crush tablets before taking. Read the instructions on your medicine label. Some brands should be taken with food. Others may be taken with, or without food. Follow a healthy diet while taking fibrates. This includes eating less fat in your diet. Other ways you can help your heart include:. Tell your provider about all of your medicines, supplements, vitamins, and herbs. Certain medicines may interact with fibrates. Be sure to tell your provider before taking any new medicines.
Antilipemic agent; Fenofibrate Antara, Fenoglide, Lipofen, Tricor, and Triglide ; Gemfibrozil Lopid ; Fenofibric acid Trilipix ; Hyperlipidemia - fibrates; Hardening of the arteries - fibrates; Cholesterol - fibrates; Hypercholesterolemia - fibrates; Dyslipidemia - fibrates. American Heart Association website. Cholesterol medications.
Updated November 10, Accessed March 4, Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. Philadelphia, PA: Elsevier; chap
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