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Fibrate Therapy: Impact on Dyslipidemia and Cardiovascular Events in Patients with Diabetes Mellitus Type 2

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Lipoproteins in Diabetes Mellitus

Part of the book series: Contemporary Diabetes ((CDI))

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Abstract

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in developed countries, especially among patients with diabetes mellitus type 2 (DM-2) and its essential precursor, insulin resistance. ASCVD risk is reduced in all patients primarily by lowering low-density lipoprotein cholesterol (LDL-C) levels, but statin-based LDL-C lowering prevents less than half of ASCVD events. Much of this residual risk is related to “the atherogenic dyslipidemia,” common in DM-2 and insulin resistance, and which consists primarily of elevated levels of triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), and decreased LDL particle size (small, dense LDL or sdLDL). The most widely used medications for this atherogenic dyslipidemia management, and especially for TG lowering, are the peroxisome proliferator activator receptor PPAR-alpha agonists, or fibrates. This chapter focuses on the impact of fibrate therapy on patients with DM-2 and other insulin-resistant states. We review fibrate effects to control atherogenic dyslipidemia and other ASCVD risk factors. We also review the published data regarding fibrate use and ASCVD incidence and look forward to cardiovascular outcome data with a new fibrate, pemafibrate, due in the near future.

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Authors and Affiliations

  1. Utah Lipid Center, Salt Lake City, UT, USA

    Eliot A. Brinton

  2. Warren Clinic Endocrinology, Tulsa, OK, USA

    Vishnu Priya Pulipati

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    Alicia J. Jenkins

  2. Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Peter P. Toth

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Brinton, E.A., Pulipati, V.P. (2023). Fibrate Therapy: Impact on Dyslipidemia and Cardiovascular Events in Patients with Diabetes Mellitus Type 2. In: Jenkins, A.J., Toth, P.P. (eds) Lipoproteins in Diabetes Mellitus. Contemporary Diabetes. Humana, Cham. https://doi.org/10.1007/978-3-031-26681-2_24

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