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Effects of fibrates on lipid profile: a meta-analysis of randomized controlled trials

Effects of fibrates on lipid profile

Elena Olmastroni
Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy and IRCCS MultiMedica, Sesto San Giovanni (MI), Italy
Federica Galimberti
IRCCS MultiMedica, Sesto San Giovanni (MI), Italy
Sining Xie
Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
Manuela Casula
Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy and IRCCS MultiMedica, Sesto San Giovanni (MI), Italy
Alberico L Catapano
Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy and IRCCS MultiMedica, Sesto San Giovanni (MI), Italy
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Abstract

We conducted a meta-analysis to compare the lipid-lowering effects of fibratesLiterature was searched up to December 2024. Absolute changes in triglycerides (TG), LDL-cholesterol (LDL‑C), apolipoprotein B (ApoB), and non-HDL cholesterol (non-HDL-C) were analyzed using both fixed and random effects models.
We included 63 randomized controlled trials. Compared to placebo, all fibrates significantly reduced TG levels. Fenofibrate and bezafibrate significantly reduced LDL-C (–15.12 and –15.04 mg/dL, respectively), while only fenofibrate significantly lowered ApoB (–24.88 mg/dL) and non-HDL-C (–46.38 mg/dL), followed by gemfibrozil and pemafibrate for non-HDL-C. In combination with statins, no fibrates significantly reduced LDL-C, while fenofibrate remained the only fibrate to significantly lower ApoB (–10.42 mg/dL) and non-HDL-C (–12.02 mg/dL).
Overall, we found that fibrates differ substantially in their lipid effects. Fenofibrate shows the most consistent and comprehensive lipid-lowering profile.

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