Fibrate Use Increasing in U.S.

Although statins dominate the cholesterol-lowering drug marketplace, they are not the only medications that lower lipids. Another category of medicines called fibrates are also prescribed quite frequently, especially for people who experience side effects while taking statins. They work well to lower triglycerides and raise good HDL cholesterol, but there is no strong evidence they prolong life. That makes us wonder if they are worthwhile.
Fibrates include drugs such as Antara, Fenoglide, Lipofen, Lofibra, Tricor, Triglide and Trilipix. A large study involving people with type 2 diabetes found no improved survival for people taking fenofibrate with a statin. The authors conclude that fibrate use has increased steadily in the United States over the last ten years despite a lack of evidence that it saves lives. Perhaps persistent advertising has been more powerful than evidence.
[JAMA, March 23/30, 2011]
Here is an abstract from PubMed of an earlier study on the value, rather than the use, of fibrates:
Am J Ther. 2010 Nov-Dec;17(6):e182-8.
Prevention of cardiovascular disease utilizing fibrates–a pooled meta-analysis.
Loomba RS, Arora R.
VA Medical Center, North Chicago, IL 60064, USA.
Abstract
Dyslipidemia increases the risk of cardiovascular disease (CVD) risk which is a leading cause of mortality. This creates the need for therapies to effectively manage dyslipidemia to decrease the CVD risk associated with it. This meta-analysis evaluates fibrate therapy in respect to dealing with dyslipidemia and CVD risk. Fibrates significantly reduced plasma total cholesterol by 8% and significantly reduced triglyceride levels by 30%. High density lipoprotein cholesterol levels were raised by 9% with fibrates. All-cause mortality and noncardiovascular mortality were both significantly increased with fibrates but these significant changes no longer appeared after trials using clofibrate were removed from the analysis. There was no significant reduction in fatal myocardial infarction but there was a significant 22% reduction of nonfatal myocardial infarction. Fibrates can effectively reduce low density lipoprotein C (LDL-C) while also optimizing high-density lipoprotein and triglyceride levels as well, which statins do not. Negative effects of fibrates were not significant after clofibrate trials were removed from consideration in the study. It should be noted that gemfibrozil should not be used as well due to its adverse effects.