Expediency of the use of fibrates for primary and secondary prevention of cardiovascular complications.

Fibrates primarily cause lowering of triglycerides and elevation of high density cholesterol levels. In WHO, HHS and VA-HIT trials fibrates were shown to decrease development of complications of cardiovascular diseases. Efficacy of fenofibrate in subjects with moderate risk and type 2 diabetes combined with mild dyslipidemia was studied in the placebo controlled FIELD study. Administration of fenofibrate was associated with insignificant 11% decrease of cardiovascular events (19% decrease after adjustment for statin use) and significant 24% decrease of nonfatal myocardial infarctions. Among effects on secondary end points were significant decreases of coronary revascularizations (-21%), strokes (-11%) and requrements in laser therapy for diabetic retinopathy (-30%). Fenofibrate also caused significant slowing of progression of albuminuria and nephropathy. Fenofibrate can be used in subjects with high coronary risk and metabolic syndrome combined with atherogenic dyslipidemia (total cholesterol/high density lipoprotein cholesterol >4 mmol/l), as well as in patients with moderate and pronounced hypertriglyceridemia or normal or elevated high density lipoprotein cholesterol. One of important indications for administration of fenofibrate is type 2 diabetes without ischemic heart disease but with microvascular complications. Fenofibrate can be also used in combination with other lipid lowering drugs (e.g. statins) in primary and secondary prevention for facilitation of achievement of target lipid levels.