TUESDAY, March 22 (HealthDay News) -- Use of a class of
cholesterol-lowering drugs called fibrates is on the rise in the
United States despite research that suggests they may not do much
to improve health, researchers say.
Fibrates are often prescribed to people with low levels of HDL
("good") cholesterol and high levels of triglycerides, a harmful
form of fat circulating in the blood, experts explained.
The new study isn't questioning the ability of fibrates to lower
triglycerides, said lead study author Cynthia A. Jackevicius, an
associate professor of pharmacy at Western University of Health
Sciences in Pomona, Calif. Fibrates have also been shown to have a
"modest" effect on raising HDL cholesterol. (Statins, another
hugely popular family of cholesterol drugs that includes brands
such as Lipitor and Zocor, are used to lower LDL, or "bad,
The real question, according to the study authors, is whether
any decline in blood fats linked to fibrate use translates to a
benefit to users' health.
They point to two recent large trials conducted in people with
diabetes that found that taking fenofibrate, one type of fibrate,
not lower the risk of having a heart attack or dying compared
to taking statins alone.
Fenofibrate is sold in a generic form and under the brand names
Tricor, Antara, Lipofen and Triglide, among others, the researchers
"In some recent studies, the fibrates, particularly fenofibrate, was not found to reduce the chances of having a heart attack or of saving lives," Jackevicius said. "Just because the medicine may improve the cholesterol profile doesn't mean it also decreases the chance of a heart attack or death."
The study is published in the March 23/30 issue of the
Journal of the American Medical Association.
There is some research on fibrates that has shown a benefit in
warding off heart attacks, although not overall mortality,
according to the study. But in those studies, patients took another
generic fibrate that's been on the market since the 1980s, called
gemfibrozil (which raised some safety concerns when combined with
But even though most of the positive data on fibrates has come
from that older drug, the news research shows the major growth in
prescriptions in the United States has come from fenofibrate --
particularly its more expensive brand-name forms, Jackevicius
Use of fibrates has increased steadily in the United States,
especially for the brand-name fibrate product. Fenofibrates account
for more than $1 billion in U.S. sales, according to background
information in the study.
In the study, researchers compared U.S. and Canadian
prescription data between January 2002 and December 2009.
In the United States, prescriptions for fibrate medication
generally more than doubled -- from 336 prescriptions per 100,000
people in 2002 to 730 prescriptions per 100,000 people in December
2009. The increase in Canada wasn't as steep, from 402 to 474 per
And in the United States, prescriptions specifically for
fenofibrate nearly tripled -- from 150 prescriptions for every
100,000 people in 2002 to 440 for every 100,000 people in 2009. In
Canada, fenofibrate's use rose much less steeply, from 321 to 429
per 100,000, the study found.
The researchers also found that physicians tended to prescribe
the brand-name drug over generic fenofibrate in the United States,
but not in Canada, while costs for fibrates for every 100,000
people were nearly three times higher in the United States than in
A generic form of fenofibrate has been available in Canada much
longer than in the United States, Jackevicius noted.
She said the finding raised a key question for Americans
consumers: "Why use the brand name drug if you can use in the less
Despite the lack of benefit shown in the two studies in
diabetics, Dr. Jorge Plutzky, an American Heart Association
spokesman and director of the Brigham and Women's Hospital vascular
disease prevention program, said that fibrates remain an important
option for some patients, particularly those who've had a heart
attack already and/or have very high triglyceride levels (above 300
milligrams per deciliter of blood) and very low HDL (below 35
And he believes that, in a deeper look at the data in the
studies of diabetics in the subgroup of people with very high
triglycerides and very low HDL, fibrates may be beneficial. In
addition, some patients in those studies were also taking statins,
which may have obscured the benefits they might have derived from
fibrates, Plutzky said.
"When physicians see patients whose LDLs [cholesterol] are well-controlled, but who still have residual risk with elevated trigylcerides and low HDL, fibrates are a potential target for that," Plutzsky said. "The evidence has not been a strong as we would have liked, but there is also evidence I would not be willing to ignore."
Doctors typically choose fenofibrate over older, generic
gemfibozil because the former is a once-a-day dose, while the
latter has to be taken twice a day, he said, and people are more
likely to take a once-a-day medication. Whether people take the
generic or the brand name is usually determined by the insurance
plan, he added.
Researchers stressed that this research is not about statins,
which have been shown in numerous studies to reduce the chances of
a heart attack by lowering LDL cholesterol.
They also emphasized that patients should continue taking their
fibrates as prescribed and talk to their doctor if they have any
questions, Jackevicius said.
Eating a healthy diet, exercising, losing weight and improving
diabetes control can help also improve the cholesterol profile, the
American Heart Association has more on
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