Effects of Fibrates on the Altered Lipoprotein System in Hypertriglyceridemia

Fibric acid derivatives are being used for treatment of hyperlipidemia syndromes for more than 25 years. The drugs markedly lower plasma triglyceride levels, increase HDL cholesterol and have a variable effect on the LDL system. Accordingly, fibrates are considered among the first drugs of choice for patients with type III and type IV hyperlipidemia, are also effective in patients with type V and decrease LDL in some but not all patients with hyperlipidemia types IIA and IIB. The mechanisms responsible for the lipid lowering effects of fibrates are increase of low lipoprotein lipase activity, stimulation of LDL catabolism via receptor-dependent pathway and decreased catabolism of apo A-I the major apoprotein of high density lipoproteins (1). The drugs may also have a direct effect on hepatic lipid metabolism.