Is there a role for fibrates in the management of dyslipidemia in the metabolic syndrome?
Is there a role for fibrates in the management of dyslipidemia in the metabolic syndrome?
复制标题
DOI：
10.1161/atvbaha.107.148817
复制
发表时间：
2008-01-01
影响因子：
8.7
通讯作者：
Rye, Kerry-Anne
中科院分区：
文献类型：
--
作者：
Barter, Philip J.;Rye, Kerry-Anne
贝特类药物试验的结局各不相同：在一级预防赫尔辛基心脏研究和二级预防VA-HIT试验中，吉非贝齐的结果为阳性;在一级预防WHO试验（氯贝特）中，结果为阳性但有保留;在二级预防BIP研究中，结果与苯扎贝特混合;在一级和二级预防联合FIELD研究中，结果与非诺贝特混合。总体而言，混合的结果，结合与他汀类药物联合给药时潜在的不良反应，限制了这些贝特类药物作为心脏保护剂的使用。然而，对几项贝特类药物研究的事后分析表明，具有代谢综合征特征的人，特别是血浆甘油三酯水平高和HDL胆固醇水平低的超重人群，在使用这些药物治疗时，心血管事件会不成比例地大幅减少。因此，有一个强有力的情况下，使用贝特类药物，以减少心血管疾病的风险，在超重的人与高甘油三酯和低HDL-C。然而，应该注意的是，这些人也有他们的心血管风险降低他汀类药物治疗。贝特类药物联合他汀类药物是否能降低比单用他汀类药物更高的风险仍有待确定。
The outcomes of fibrate trials have varied: positive with gemfibrozil in the primary prevention Helsinki Heart Study and the secondary prevention VA-HIT trial; positive with reservations in the primary prevention WHO trial (clofibrate); and mixed with bezafibrate in the secondary prevention BIP study and with fenofibrate in the combined primary and secondary prevention FIELD study. Overall, the mixed results, combined with potential for adverse effects when given in combination with statins, have limited the use of these fibrates as cardioprotective agents. However, post hoc analyses of several of the fibrate studies have shown that people with features of the metabolic syndrome, particularly overweight people with high plasma triglyceride levels and low levels of HDL cholesterol, derive a disproportionately large reduction in cardiovascular events when treated with these agents. Thus, there is a strong case for the use of a fibrate to reduce the cardiovascular risk in overweight people with high triglyceride and low HDL-C. However, it should be noted that such people also have their cardiovascular risk reduced by statin therapy. It remains to be determined whether the combination of a fibrate plus statin reduces the risk beyond that achieved with a statin alone.