Effect of fenofibrate in 1113 patients at low-density lipoprotein cholesterol goal but high triglyceride levels: Real-world results and factors associated with triglyceride reduction

Abstract

Fibrates are used in patients with dyslipidemia and high cardiovascular risk. However, information regarding drug response to fibrate has been highly limited. We investigated treatment results and factors associated with triglyceride reduction after fenofibrate therapy using large-scale real-world data. Patients with one or more cardiovascular risk factors, at low-density lipoprotein-cholesterol goal but with triglyceride level ≥150 mg/dL, and undergoing treatment with fenofibrate 135–160 mg for the first time were included in this retrospective observational study. The outcome variable was the percentage changes of TG levels. The achievement rate of triglyceride <150 mg/dL was additionally analyzed. Factors associated with treatment results were also analyzed. Among 2546 patients who were initially screened, 1113 patients were enrolled (median age: 61 years; male: 71%). After median follow-up of 4 months, the median change in triglyceride was -60%, and 49% of the patients reached triglyceride <150 mg/dL. After adjusting for confounding variables, female sex, non-diabetic status, coronary artery disease, lower baseline triglyceride, and no statin use were identified to be independently associated with achievement of triglyceride <150 mg/dL. Among them, female sex, non-diabetic status, and coronary artery disease were also related to median or greater percentage reduction of triglyceride. In conclusion, only half of the study patients reached triglyceride levels <150 mg/dL after real-world fenofibrate therapy. This study indicates that more attention is needed on some subgroups to obtain optimal triglyceride levels when treating with fenofibrate.

Efficacy of a micronized, nanocrystal fenofibrate formulation in treatment of hyperlipidemia in dogs

“…In the above‐mentioned studies of dogs with primary and secondary hyperlipidemia, similar median decreases in TG of 84% (range, 68%‐95%) and 88% (range, 62%‐99%) were documented with bezafibrate and fenofibrate, respectively 30,31 . In people, fenofibrate has consistently been associated with substantial reductions in TG (15%‐60%) with the magnitude of reduction being directly proportional to baseline TG which vary with etiology 36‐39 . In contrast, we demonstrated normalization of TG in dogs with fenofibrate regardless of baseline TG.…”

“…30,31 In people, fenofibrate has consistently been associated with substantial reductions in TG (15%-60%) with the magnitude of reduction being directly proportional to baseline TG which vary with etiology. [36][37][38][39] In contrast, we demonstrated normalization of TG in dogs with fenofibrate regardless of baseline TG. The smaller effect observed in people may reflect the role of fenofibrate in the management of cardiovascular disease where the primary emphasis is on lowering LDL-C and increasing HDL rather than achieving normalization of TG.…”

“…The smaller effect observed in people may reflect the role of fenofibrate in the management of cardiovascular disease where the primary emphasis is on lowering LDL‐C and increasing HDL rather than achieving normalization of TG. 36 , 37 , 38 , 39 Other disease processes, such as diabetes mellitus, are also known to impair optimal response to fenofibrate. 39 The hypolipidemic effect of fenofibrate in dogs with naturally occurring DM has not been studied yet but we have had anecdotal success with it.…”

“… 36 , 37 , 38 , 39 Other disease processes, such as diabetes mellitus, are also known to impair optimal response to fenofibrate. 39 The hypolipidemic effect of fenofibrate in dogs with naturally occurring DM has not been studied yet but we have had anecdotal success with it. We have also observed a successful reduction in serum lipids in a canine model of toxin‐induced diabetes mellitus (under review).…”

“…In contrast, we demonstrated normalization of TG in dogs with fenofibrate regardless of baseline TG. The smaller effect observed in people may reflect the role of fenofibrate in the management of cardiovascular disease where the primary emphasis is on lowering LDL‐C and increasing HDL rather than achieving normalization of TG 36‐39 . Other disease processes, such as diabetes mellitus, are also known to impair optimal response to fenofibrate 39 .…”