Additive Beneficial Effects of Fenofibrate Combined With Atorvastatin in the Treatment of Combined Hyperlipidemia

Abstract

Combination therapy is safe and has beneficial additive effects on endothelial function in patients with combined hyperlipidemia.

Fibrate therapy and flow-mediated dilation: A systematic review and meta-analysis of randomized placebo-controlled trials

“…Finally, treatment with fibrates is associated with an increase in the levels of adiponectin [22,33,36,37,50,55], an adipose-derived factor that may improve endothelial function by multiple mechanisms. It mimics the metabolic actions of insulin [56], which exerts many cardioprotective effects and may also directly increase production of NO in the vascular wall [57].…”

“…It is conceivable that trial results may considerably differ according to the background cardiovascular risk of participants. Findings from our meta-analysis may be influenced by participants in the studies testing fenofibrate [21][22][23]33,35,37,38]: they were obese and/or dyslipidemic and all had endothelial dysfunction at baseline (basal FMD < 6%, range 3.1-5%), representing a high-risk category, where improvement in the lipid profile is expected to exert beneficial effects on vascular health. Taking into account that low HDL-C and high triglycerides levels have been associated with reduced post-ischemic endothelial vasodilation, as shown in a cohort of patients with metabolic syndrome [58], findings of the present meta-analysis might contribute to the interpretation of results of FIELD and ACCORD trials [58,58,61].…”

“…Considering that seven studies had a crossover design [22][23][24][32][33][34][35], globally 380 subjects were in the fibrate group and 387 subjects in the control group. Excluding the studies that did not perform NMD [32,36,37], we selected a total of 462 subjects (328 subjects in the study group and 335 in the control group) for the analysis of NMD.…”

“…Excluding the studies that did not perform NMD [32,36,37], we selected a total of 462 subjects (328 subjects in the study group and 335 in the control group) for the analysis of NMD. Two studies did not plan a wash-out period [33,35], while the other five included different wash-out periods ranging from 10 days to 2 months [22][23][24]32,34].…”

“…Moreover, it can improve brachial artery FMD in statin-treated non-diabetic subjects with dyslipidemia [22]. It has been proposed that fenofibrate significantly improves endothelium-dependent brachial artery FMD without change in endothelium-independent nitrate mediated dilation (NMD), by increasing the release and/or action of NO, thus reducing the cytotoxic effect of hyperlipemia [23].…”