Keele Research Repository

Cardiovascular disease (CVD), a cause of mortality worldwide, accounted for 28% of United Kingdom deaths in 20121. Risk reduction is based on improving modifiable risk factors with lipid lowering therapy being particularly useful2. Because of the importance of reducing serum low density lipoprotein cholesterol (LDL-C), statins remain an effective way of reducing CVD risk2. However, despite statin use there remains a high residual CVD risk, due perhaps to other risk associated lipoproteins3. Fibrates may be useful in targeting these atherogenic lipoproteins especially in type 2 diabetes (T2DM) and the metabolic syndrome (MetS)4. We describe evidence of the usefulness of fibrates, identify patient groups who may benefit from their use, outline factors to be monitored during follow-up and describe effective holistic treatment of an anonymised clinic case.
Fibrates activate the peroxisome proliferator-activated receptor (PPAR) α which by upregulating transcription of various proteins associated with lipid metabolism, influences fatty acid and lipoprotein metabolism in hepatic, muscle and renal tissues5. This results in a variable increase in high density lipoprotein cholesterol (HDL-C), a greater reduction in triglycerides (TG) levels and a modest decrease in LDL-C4,5.