by 10–20%. Fibrates also lower LDL cholesterol in primary hyper-
cholesterolaemia (type IIa hyperlipidaemia) by 15–25%. They are
first line treatment for severe hypertriglyceridaemia and (in
combination with statins) in severe mixed lipaemia. They are
second line drugs in patients intolerant of statins for hyper-
cholesterolaemia and mixed lipaemia. Data from end point clinical
trials are not extensive and concerns over fibrate safety have
remained since the original WHO clofibrate trial which was asso-
ciated with increased non-CHD deaths. However the Helsinki
Heart Study showed a positive outcome and the recent VA HIT
trial, again with gemfibrozil, was positive. However the recent
secondary BIP prevention study with bezafibrate was negative.
HHiigghh ddoossee ffiisshh ooiill ccaappssuulleesshave a role in the treatment of
severe hypertriglyceridaemia. They reduce hepatic VLDL output.
In practice they are used in combination with fibrates and
occasionally statins. The author has also used them in rare
patients with familial hypertriglyceridaemia during pregnancy to
protect against pancreatitis.
FFuurrtthheerr rreeaaddiinngg
Betteridge DJ, Morrell JM. Clinicians’ guide to lipids and coronary heart
disease.London: Chapman & Hall Medical, 1998.
Betteridge DJ, Illingworth DR, Shepherd J, eds. Lipoproteins in health and
disease.London: Edward Arnold, 1999.