Which medications in the drug class Fibric Acid Derivatives are used in the treatment of Coronary Artery Atherosclerosis?

Updated: Apr 09, 2021
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Answer

Fibric Acid Derivatives

The precise mechanism of action of fibric acid derivatives, which includes fenofibrate (Tricor) and gemfibrozil (Lopid), is complex and incompletely understood. These agents increase the activity of lipoprotein lipase and enhance the catabolism of triglyceride-rich lipoproteins, which is responsible for an increase in the HDL-C fraction. A decrease in hepatic VLDL synthesis and an increase in cholesterol excretion into bile also appear to occur. The fibrates typically reduce triglyceride levels by 20-50% and increase HDL-C levels by 10-15%.

Fenofibrate is used as an adjunct to dietary therapy in treating hyperlipidemias (including types IV and V) associated with hypertriglyceridemia. It has not been proven to be of use in the prevention of CAD.

Gemfibrozil is used as an adjunct to dietary therapy in adult patients with type IV and V hyperlipidemias who present at risk for pancreatitis. It is also employed in adjunctive therapy in coronary heart disease prevention in patients with type IIb hyperlipidemia (low HDL, elevated LDL and triglycerides) who do not respond to other agents or to diet modifications.

The effect on LDL-C is variable. levels may be expected to decrease by 10-15%. In patients with marked hypertriglyceridemia, LDL-C levels may increase, which likely reflects the ability of the LDL receptor to clear the increased LDL generated by increased VLDL catabolism. Fibrate therapy may also be responsible for a decrease in the clotting ability of platelets and fibrinogen levels, which may account for some of the reported clinical benefits.

Fenofibrate (Tricor)

Adjunct to dietary therapy in treating hyperlipidemias associated with hypertriglyceridemia, including type IV and type V. Not proven to be of use in prevention of coronary artery disease.

Gemfibrozil (Lopid)

Adjunct to dietary therapy in adult patients with type IV and V hyperlipidemias presenting at risk for pancreatitis. Adjunctive therapy in coronary heart disease prevention in patients with type IIb hyperlipidemia (low HDL, elevated LDL and triglycerides) not responding to other agents or diet modifications.

Adjunct to dietary therapy in adult patients with type IV and V hyperlipidemias presenting at risk for pancreatitis. Adjunctive therapy in coronary heart disease prevention in patients with type IIb hyperlipidemia (low HDL, elevated LDL and triglycerides) not responding to other agents or diet modifications.


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