Nineteen (79%) patients were on statin therapy and 5 (21%) were on maximal statin therapy; 23 (96%) and 13 (54%) were on a fibrate
and omega-3 medication, respectively.
For severe hypertriglyceridaemia, fibrates
are the most effective drugs, except for patients with monogenic hypertriglyceridaemia, in whom they are usually not effective.
Three separate classes of drugs have been shown to be effective in treating hypertriglyceridemia: fibrates
decrease triglycerides by 30-50%, niacin by 10-30%, and n-3 fatty acids by 20-50%.
And even why not ask whether, depending on the case, would it be interesting to attempt initially only with EPA and DHA prior to prescribing fibrate
in specific cases, as we are dealing with patients using multiple medicines daily?
By multivariate analysis, old age, male sex, high HbA1c SD, high triglyceride, ACEI and/or ARB use, aspirin use, and statin and/or fibrate
use were associated with significantly increased risk of cardiovascular events.
The HRSA HIV care guide offers advice on whether to start with a statin, a fibrate
, niacin, or omega-3 fatty acids (fish oils) for specific lipid abnormalities (Table 3).
These regulatory events are thought to participate to the therapeutic benefits observed with fibrate
drugs in the context of several pathological situations.
Similarly, the jury is going to be out for a while on the future of niacin and the fibrates
in this game.
Rhabdomyolysis associated with fibrate
therapy: review of 76 published cases and a new case report.
Only sixteen of them were chronic renal failure before fibrate
therapy and only 10 patients had normal renal function during rhabdomyolysis (4).
The National Cholesterol Education Programme (NCEP) treatment guidelines recommend consideration of the use of a fibrate
with a statin in patients with triglycerides at or above 200 mg/dL who are at LDL cholesterol goal, but not at non-HDL cholesterol goal.
Similarly, treating multiple blood lipids with combination drug therapy of a fibrate
and a statin did not reduce the combined risk of cardiovascular disease events more than treatment with statin alone.