When Should Fibrates Be Used?

Epidemiologic studies have shown that not only raised low density lipoprotein cholesterol but also dyslipidaeınic syndromes characterized by e levated plasma triglyceride and lo w high dens ity lipoprotein cholesterol are powerful risk factors for coronary heart d isease (CHD). Co ın b i ned hyperlipidemia and atherogenic l ipopro tein phenotype are the most common dyslip idaemia types seen in patients with CHD. An alternative approach is to increase high density lipoprotein cholesterol (HDL-c) level and to decrease plasma triglyceride (TG) level in addi tion to decreasing level of low density lipoprotein cholesterol (LDL-c) to reduce the risk of CHD. It is known that fibrates are useful for the treatment of low HDL-c with or without hypertrigliceridaemia. The recommendation for the use of fibrates in certain types dyslipidaemia has gained additic nal support from Helsinki Heart Study. Fibrates are a broad spectrum lipid lowering drug. They increase the HDL-c level while decreasing plasma TG level and LDL-c cons iderably. F urthe rmore, they change the composition of LDL-c. Highly atherogenic smail , dense LDL particules are converted to less atherogenic large LDL particules. The effects of fibrates are mediated by nuclear hormone recepter termed peroxisÔme proli fe rator activated reseptor (PPAR). Fibrates bi nd to PPAR and initiate a sequence of events that lead to hypolipidaemic effect. It has been supported by the recent data from multicenter large elinical studies that fi brates can be used safely and they can decrease CHD mortality and ın orbidi ty cons iderably by rai s ing HDL-c and lowering TG. In this rev iew, we focused on the mechanism of action of fi brates on the lipid metabolism and elinical studies investigating their effecs on CHD mortality/mo rbidity and elin ical indications.