Fibrates: Statin’s Trusty Sidekick or Lackluster Fallback?

Fibrates: Statin’s Trusty Sidekick or Lackluster Fallback?

This weeks Tools for Practice examines the evidence for Fibrates.

Clinical Question: Do fibrates reduce cardiovascular (CV) events?


When used alone, fibrates reduce non-fatal coronary events, but have no effect on mortality or other CV events, including stroke. Current evidence suggests fibrates provide no advantage when added to statin therapy.

Meta-analysis of 18 trials (45,058 patients) of fibrates versus placebo over one to six years:

  • 10% (confidence interval 0-18%) relative risk reduction (RRR) in CV events.
  • No significant effect on all-cause mortality, vascular mortality or stroke.
  • Coronary benefits seen in both primary and secondary prevention trials.

Before initiating a fibrate, consider optimizing other CV interventions that provide better value.

In a primary prevention patient with 10% risk of CV disease over 10 years:

  • Fibrates reduce CV risk to 9%
  • Statins reduce CV risk to 7.5%
  • Thiazides reduce CV risk to 7%

Whereas fibrate benefits are limited to non-fatal coronary events, statins and thiazides also reduce stroke and mortality risk.

References are at the Tools for Practice site.

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