The role of fibrates in managing hyperlipidemia: mechanisms of action and clinical efficacy.
The role of fibrates in managing hyperlipidemia: mechanisms of action and clinical efficacy.
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DOI：
10.1007/s11883-004-0104-8
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发表时间：
2004-03-01
影响因子：
5.8
通讯作者：
Linton, MacRae F
中科院分区：
文献类型：
--
作者：
Fazio, Sergio;Linton, MacRae F
在脂质管理指南越来越重视代谢综合征和糖尿病高危患者的识别和治疗的时候，显然需要平衡已知的降低低密度脂蛋白（LDL）的效果与来自调节高密度脂蛋白（HDL）和甘油三酯水平的临床疗效的新证据。尽管他汀类药物仍然是需要达到LDL目标的患者的首选药物，但贝特类药物治疗可能是致动脉粥样硬化性血脂异常和LDL已经接近目标的受试者的最佳干预措施。此外，伴随使用贝特类药物可显著降低LDL通过他汀类药物治疗得到控制的患者的心血管风险。在这篇综述中，我们评估贝特类药物的药理学特性，特别关注过氧化物酶体增殖物激活受体a激活在血脂异常控制以及动脉炎症衰减中的作用。贝特类药物的临床试验，如赫尔辛基心脏研究、退伍军人事务部高密度脂蛋白干预试验、糖尿病动脉粥样硬化干预研究和苯扎贝特心肌梗死预防试验，已经设想了贝特类药物的临床效用及其在治疗肥胖、胰岛素抵抗和糖尿病患者（表现为接近目标LDL和不适当的HDL和甘油三酯水平）方面可能优于他汀类药物的情景。
At a time when the lipid management guidelines give more and more emphasis to the identification and treatment of high-risk patients with the metabolic syndrome and diabetes, there is an obvious need to balance the known effects of low-density lipoprotein (LDL) lowering with the new evidence of clinical efficacy derived from the adjustment of high-density lipoprotein (HDL) and triglyceride levels. Whereas the statins remain the drug of choice for patients who need to reach the LDL goal, fibrate therapy may represent the best intervention for subjects with atherogenic dyslipidemia and an LDL already close to goal. In addition, the concomitant use of fibrates may significantly reduce cardiovascular risk in patients whose LDL is controlled by statin therapy. In this review, we evaluate the pharmacologic properties of the fibrate drugs, with particular attention to the effects of peroxisome proliferator activated receptor a activation in the control of dyslipidemia as well as in the attenuation of arterial inflammation. Clinical trials of fibrates, such as the Helsinki Heart Study, Veterans Affairs High-density lipoprotein Intervention Trial, Diabetes Atherosclerosis Intervention Study, and Bezafibrate Infarction Prevention trial, have conjured up a scenario for the clinical utility of fibrates and their possible superiority to statins in the management of obese, insulin-resistant, and diabetic patients presenting with near-goal LDL and inappropriate HDL and triglyceride levels.