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Fibrates for CVD prevention; NICE

Currently approved fibrates in North America and Europe encompass gemfibrozil, fenofibrate, fenofibric acid, bezafibrate, etofibrate, and ciprofibrate, whereas clofibrate has been discontinued due to increased mortality (United Nations 2003; WHO 1978). Fibrates effectively modify atherogenic dyslipidemia, notably by reducing serum triglyceride levels, modestly elevating HDL-C levels, and slightly lowering LDL-cholesterol levels (Fazio 2004; Abourbih 2009; Jun 2010). This makes them particularly suitable for averting cardiovascular events in individuals with low HDL-C and high triglycerides (Khoury 2011).


NICE guidance on the use of Fibrates for CVD prevention

Fibrates for Preventing Cardiovascular DiseaseRecommendation
Do not offer fibrates for preventing CVD to:- People in primary prevention
- People in secondary prevention
- People with CKD
- People with type 1 diabetes
- People with type 2 diabetes

If we review the BNF indication for Fenofibrate we note that it is recommended for use by specialists & requires more regular monitoring





Indications and DoseMonitoring RequirementsPrescribing and Dispensing Information
Adjunct to diet in mixed hyperlipidaemia (if statin contraindicated or not tolerated)Monitor hepatic transaminases every 3 months during the first 12 months of treatment.Fibrates are mainly used in those with high triglycerides.
Adjunct to diet in severe hypertriglyceridaemiaMonitor serum...

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