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Dyslipidemia
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Fibrates can reduce total triglycerides by approximately 50%. They likely stimulate endothelial lipoprotein lipase (LPL). This results in increased fatty oxidation, within the liver and muscles, and lower hepatic VLDL synthesis. Fibrates also increase HDL by as much as 20%. They may cause abdominal pain, dyspepsia, and elevated liver enzymes. Rarely, they cause cholelithiasis. The fibrates may potentiate muscle toxicity if used with statins. They also potentiate the effects of warfarin. Statins can be used if the total triglycerides are below 500 mg/dL (5.65 mmol/L) when elevations of LDL are present. The statins can reduce LDL and total triglycerides by reducing VLDL. When only the total triglycerides are high, the fibrates should be used instead.
Identification and Management of Children with Dyslipidemia
Published in James M. Rippe, Lifestyle Medicine, 2019
Julie A. Brothers, Stephen R. Daniels
Fibric acid derivatives, or fibrates, work in a complex way to break down VLDL-C and TGs and decrease hepatic synthesis of TG. Fibrates have been shown to lower TGs and increase HDL-C levels without an increase in LDL-C levels. A lthough not currently FDA approved for children, a small study in children demonstrated efficacy in lowering TG levels.55 Prescribing fibrates in the pediatric population should occur only under the guidance of a lipid specialist.
Disorders of lipid metabolism
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Fibrates are generally well tolerated. However, they have important interactions with other drugs that are of particular relevance in the elderly. Due to increased risk of myopathy in combination with statins, fibrates should be used in this setting with only the utmost caution, and probably avoided in those with risk factors for myopathy. An interaction of warfarin with fibrates leads to an increase in warfarin levels and the international normalized ratio. Thus, warfarin is typically dosed at one third its standard dose when administered with fenofibrate and careful follow-up of the international normalized ratio is needed. Given fibric acid derivatives are excreted primarily through the kidney, if they are used in the setting of chronic kidney disease, then dose adjustment is necessary. Gastrointestinal side effects are common in patients taking fibrate therapy, including mild nausea during the first week of therapy. To reduce this potential side effect, it can be useful to start treatment with one half the normal dose for several days before increasing to a full dose.
Metabolic comorbidities and systemic arterial hypertension: the challenge faced by HIV patients on long-term use of antiretroviral therapy
Published in Hospital Practice, 2022
Cássia Cristina Pinto Mendicino, Alícia Amanda Moreira Costa, Gabriella Jomara da Silva, Letícia Penna Braga, Gustavo Machado Rocha, Ricardo Andrade Carmo, Mark Drew Crosland Guimarães, Cristiane A. Menezes de Pádua
We noticed a significant difference between heavy and moderate physical activities over the increase in the number of comorbidities, highlighting the importance of lifestyle. The concept of physical activity adopted in our study goes beyond physical exercises. It also comprises activities at work, locomotion, and during the leisure time [17,18]. Overall, the role of healthy physical habits in reducing the number of comorbidities represents an important protective factor for the occurrence of chronic diseases [40]. Nevertheless, healthy physical habits are not always sufficient, and sometimes, lipid-lowering therapy becomes necessary to manage metabolic disorders in PLHIV under ART. It seems essential to define the most appropriate management of dyslipidemia due to the potential drug interactions and the risk of reduced adherence to multiple treatments [28]. Reductase inhibitors (statins) represent the first-line therapy for dyslipidemia, but its treatment is problematic in PLHIV under ART; several statins are metabolized in the same enzyme complex with some antiretroviral agents especially PIs and NNRTIs [28,41]. Fibrates represent the first-line drugs for the treatment for hypercholesterolemia and, with more impact, hypertriglyceridemia, and they have not shown significant drug interactions with PIs and NNTRIs [28].
Targeting apoC-III and ANGPTL3 in the treatment of hypertriglyceridemia
Published in Expert Review of Cardiovascular Therapy, 2020
N.S. Nurmohamed, G.M. Dallinga – Thie, E.S.G. Stroes
In HTG, the treatment consists of two goals: reduce residual CVD risk and prevent acute pancreatitis; the latter is particularly important in severe HTG. During the last decades, multiple pharmacological strategies have been explored to effectively lower TG levels. Statins are the first choice of treatment to lower CVD risk in all hyperlipidemias, resulting in a reduction of plasma TG levels by 10–20% [20]. Fibrates currently are the most potent TG-lowering agents, achieving a TG lowering up to 50%, depending on baseline TG levels [20]. Large randomized clinical trials (RCT) have shown at best a modest effect of fibrates on CVD risk, evident in post hoc analyses of patients with elevated TG levels or when used without concomitant statin use [21–26]. Classic fibrates can also be associated with adverse effects regarding liver and renal function [27]. Currently, pemafibrate, a selective fibrate targeting peroxisome proliferator-activated receptor alpha (PPARα) with a more favorable side-effect profile, has entered a phase III outcomes study [28]. Its safety and efficacy was already extensively evaluated [29–32], whereas the PROMINENT trial will now provide results on CVD outcomes in primary prevention patients with diabetes [33].
Treatment of hypertriglyceridemia-induced acute pancreatitis with therapeutic plasma exchange in 2 pregnant patients
Published in Journal of Obstetrics and Gynaecology, 2019
A 37-year-old primiparous woman was admitted to the gastroenterology department of our hospital with complaints of epigastric pain and nausea during her 22nd week of gestation. She had an attack history of having HTG-AP, 3 years before this attack. In the medical history, there was an uncontrolled hypertriglyceridaemia with an irregular usage of fenofibrate for 10 years. The fibrate treatment was stopped due to her pregnancy. The patient’s weight was 63 kg, and her height was 162 cm. On physical examination, her arterial blood pressure was 105/60 mmHg, heart rate was 85/min, blood temperature was 37.0 °C. A physical examination revealed a rebound tenderness on epigastrium. The laboratory results are shown in Table 1. As a result of a sequence analysis, testing for APOA5 (apolipoprotein A5) ve LIPI (LIPASE I) genetic mutation associated with hypertriglyceridaemia were negative. The results of arterial blood gas analysis were pH: 7.40, PCO2: 33.8 mmHg, PO2: 41.5 mmHg, HCO3: 22.9 mmol/L, SO2: 77.2%. The Ranson’s score was 2 at admission and at the 48th hour. We stopped the oral intake and administered an analgesic and serum saline (4–6 L/day) therapy. Haemonetics MCS+ (Haemonetics Corp. Braintree, USA) was used in TPE procedures. Fresh frozen plasma was given for TPE at a volume of 40 mL per kg of body weight (BW), as well as a heparin infusion for an anticoagulation at a rate of 10 U/kg/hour. The 3200 and 2900 mL mean plasma volumes were exchanged/substituted during the extracorporeal procedures.