The new guidelines of the National Cholesterol Education Program NCEP and the ADA highlight the importance of LDL reduction in high-risk patients, but at the same time encourage physicians to position all diabetic and insulin-resistant patients in the high cardiovascular risk category.
The importance of the atherogenic dyslipidemia can also be indirectly inferred by the results of the major statin trials. 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. Cholesterol medications. Updated November 10, Accessed March 4, Genest J, Libby P.
Lipoprotein disorders and cardiovascular disease. Philadelphia, PA: Elsevier; chap J Am Coll Cardiol. PMID: pubmed. In: Ballantyne CM, ed. Philadelphia, PA: Elsevier Saunders; chap US Food and Drug Administration website. Updated February 13, Updated by: Michael A. Editorial team. High triglycerides along with low HDL cholesterol increase the risk of heart disease and stroke.
How Fibrates Help. Fibrates are prescribed to adults. How to Take Fibrates. Store all of your medicines in a cool, dry place. Other ways you can help your heart include: Getting regular exercise Managing stress Quitting smoking. Know Your Risks. Before you start taking fibrates, tell your provider if you: Are pregnant, plan to become pregnant, or are breastfeeding. Nursing mothers should not take this medicine. Have allergies Are taking other medicines Plan to have surgery or dental work Have diabetes If you have liver, gallbladder, or kidney conditions, you should not take fibrates.
Regular blood tests will help you and your provider: See how well the medicine is working Monitor for side effects, such as liver problems. When to Call the Doctor. Call your provider if you notice: Abdominal pain Muscle pain or tenderness Weakness Yellowing of the skin jaundice Skin rash Other new symptoms.
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