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Impact of pemafibrate on lipid profile and insulin resistance in hypertriglyceridemic patients with coronary artery disease and metabolic syndrome

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Abstract

This study examined the effects of pemafibrate, a selective peroxisome proliferator-activated receptor α agonist, on the serum biochemical parameters of male patients with coronary artery disease and metabolic syndrome (MetS). This was a post hoc analysis of a randomized, crossover study that treated hypertriglyceridemia with pemafibrate or bezafibrate for 24 weeks, followed by a crossover of another 24 weeks. Of the 60 patients enrolled in the study, 55 were male. Forty-one of 55 male patients were found to have MetS. In this sub-analysis, male patients with MetS (MetS group, n = 41) and those without MetS (non-MetS group, n = 14) were compared. The primary endpoint was a change in fasting serum triglyceride (TG) levels during pemafibrate therapy, and the secondary endpoints were changes in insulin resistance-related markers and liver function parameters. Serum TG levels significantly decreased (MetS group, from 266.6 to 148.0 mg/dL, p < 0.001; non-MetS group, from 203.9 to 97.6 mg/dL, p < 0.001); however, a percent change (%Change) was not significantly different between the groups (− 44.1% vs. − 51.6%, p = 0.084). Serum insulin levels and homeostasis model assessment of insulin resistance significantly decreased in the MetS group but not in the non-MetS group. %Change in liver enzyme levels was markedly decreased in the MetS group compared with that in the non-MetS group (alanine aminotransferase, − 25.1% vs. − 11.3%, p = 0.027; gamma-glutamyl transferase, − 45.8% vs. − 36.2%, p = 0.020). In conclusion, pemafibrate can effectively decrease TG levels in patients with MetS, and it may be a more efficient drug for improving insulin resistance and liver function in such patients.

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Data availability

The data that support the findings of this study cannot be shared publicly to protect the privacy of the study patients. The data will be shared by the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank Enago (www.enago.jp) for their assistance with English language editing.

Funding

This study received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiology, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka, 020-0066, Japan

    Akihiro Nakamura, Yuta Kagaya, Hiroki Saito, Masanori Kanazawa, Kenjiro Sato, Masanobu Miura, Masateru Kondo & Hideaki Endo

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  1. Akihiro Nakamura
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  2. Yuta Kagaya
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Contributions

AN, YK, KS, and HE conducted the study and performed clinical data analysis. AN, HS, MK, MM, and MK performed clinical work and data analysis. AN, HS, and HE designed the study. AN wrote the manuscript.

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Correspondence to Akihiro Nakamura.

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The present study was conducted in accordance with the principles of the Declaration of Helsinki, and the protocol was approved by the local ethics committee (Approval no. 540).

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Written informed consent was obtained from all patients before the initiation of the PEBE study, and also informed consent for this study was obtained in the form of opt-out.

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Nakamura, A., Kagaya, Y., Saito, H. et al. Impact of pemafibrate on lipid profile and insulin resistance in hypertriglyceridemic patients with coronary artery disease and metabolic syndrome. Heart Vessels 39, 486–495 (2024). https://doi.org/10.1007/s00380-024-02363-z

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