Management of dyslipidemias with fibrates, alone and in combination with statins: role of delayed-release fenofibric acid

Abstract

Cardiovascular disease (CVD) represents the leading cause of mortality worldwide. Lifestyle modifications, along with low-density lipoprotein cholesterol (LDL-C) reduction, remain the highest priorities in CVD risk management. Among lipid-lowering agents, statins are most effective in LDL-C reduction and have demonstrated incremental benefits in CVD risk reduction. However, in light of the residual CVD risk, even after LDL-C targets are achieved, there is an unmet clinical need for additional measures. Fibrates are well known for their beneficial effects in triglycerides, high-density lipoprotein cholesterol (HDL-C), and LDL-C subspecies modulation. Fenofibrate is the most commonly used fibric acid derivative, exerts beneficial effects in several lipid and nonlipid parameters, and is considered the most suitable fibrate to combine with a statin. However, in clinical practice this combination raises concerns about safety. ABT-335 (fenofibric acid, Trilipix) is the newest formulation designed to overcome the drawbacks of older fibrates, particularly in terms of pharmacokinetic properties. It has been extensively evaluated both as monotherapy and in combination with atorvastatin, rosuvastatin, and simvastatin in a large number of patients with mixed dyslipidemia for up to 2 years and appears to be a safe and effective option in the management of dyslipidemia.

Keywords: atherogenic dyslipidemia; cardiovascular disease prevention; fenofibric acid; lipid-lowering treatment; statins.

Figure 1

Chemical structure of ABT-335. The chemical name for choline fenofibrate is ethanaminium, 2-hydroxy-N,N,Ntrimethyl, 2-{4-(4-chlorobenzoyl)phenoxy]-2-methylpropanoate. The empirical formula is C₂₂H₂₈ClNO₅ and the molecular weight is 421.91.