Benefits and risks of the treatment with fibrates--a comprehensive summary

Introduction: The need to reduce residual cardiovascular risk led to the development of novel therapeutic strategies to improve patients' outcomes. The residual risk in people with atherogenic dyslipidemia, despite LDL reduction obtained mainly by statins, remains high. Fibrates in those patients lead to significant clinical improvements. Those include reduction in the progression of atherosclerosis, which translates into decrease in cardiovascular events and improvements in microvascular diabetic complications. Furthermore, there are other clinical and biochemical benefits connected with fibrate therapy (e.g. improved insulin sensitivity). Nevertheless, similar to all effective therapeutic modalities, fibrates are associated with unfavorable effects that may lead to complications or treatment discontinuation. Here, we provide up-to-date review of benefits and potential risks associated with the therapy with fibrates. Area covered: A review of available data from clinical trials, meta-analyses and case-reports on the efficacy of fibrate treatment was performed. A specific attention was given to clinical and biochemical benefits as well as adverse events that were reported. Expert commentary: Fibrates are performing well as drugs that reduce residual risk in patients with atherogenic dyslipidemia and hypertriglyceridemia. The adverse events rate is not negligible, but definitely manageable by selection of proper target population and supervision of treated patients.