What are fibrates?
Fibric acid derivatives (fibrates) are a class of medication that lowers blood triglyceride levels. Fibrates lower blood triglyceride levels by reducing the liver's production of VLDL (the triglyceride-carrying particle that circulates in the blood) and by speeding up the removal of triglycerides from the blood. Fibrates also are modestly effective in increasing blood HDL cholesterol levels; however, fibrates are not effective in lowering LDL cholesterol.
Very high triglyceride levels (usually >1000 mg/dl) can cause pancreatitis (inflammation of the pancreas that can result in a serious illness with severe abdominal pain ). By lowering blood triglycerides, fibrates are used to prevent pancreatitis.
Fibrates are not effective in lowering LDL cholesterol; however, when a high risk patient (see NCEP recommendations) also has high blood triglyceride or low HDL cholesterol levels, doctors may consider combining a fibrate, such as fenofibrate (Tricor), with a statin. Such a combination will not only lower LDL cholesterol but also will lower blood triglycerides and increase HDL cholesterol levels.
Fibrates also have been used alone to prevent heart attacks especially in patients with elevated blood triglycerides and low HDL cholesterol levels. In one large study, gemfibrozil decreased the risk of heart attacks but did not affect the overall survival of persons with high cholesterol levels.
What are the side effects of fibrates?
The side effects of fibrates include nausea, stomach upset, and sometimes diarrhea. Fibrates can irritate (inflame) the liver. The liver irritation usually is mild and reversible, but it occasionally can be severe enough to require stopping the drug.
Fibrates can cause gallstones when used for several years.
Fibrates can increase the effectiveness of blood thinners, such as warfarin (Coumadin), when both medications are used together. Thus, the dose of warfarin should be adjusted to avoid over-thinning of the blood which can lead to excessive bleeding.
Fibrates can cause muscle damage particularly when taken together with statin medications. Gemfibrozil interferes with the breakdown of certain statins (for example, simvastatin [Zocor] or lovastatin [Mevacor, Altoprev]), resulting in higher statin blood levels, and hence a higher likelihood of muscle toxicity from the statin. Doctors generally avoid combining a statin with fibrates because of concern over the higher risk of muscle damage with the combination. Gemfibrozil should not be combined with simvastatin and if combined with lovastatin the dose of lovastatin should not exceed 20 mg daily. However, fenofibrate does not interfere with the breakdown of statins and should be the safer fibrate to use if it is necessary to use a fibrate with a statin. Furthermore, pravastatin (Pravachol) seems to have fewer muscle toxic effects than the other statins when combined with fibrates, but the risk still exists.
What are examples of fibrates available in the U.S.?
Examples of fibrates available in the U.S. include:
Fibrates (fibric acid derivatives) are a class of medication that lowers blood triglyceride levels. Fibrates modestly effective in increasing HDL cholesterol levels. Examples of fibrates available in the U.S. are gemfibrozil (Lopid) and fenofibrate (Tricor, Fibricor). Side effects, dosing, drug interactions, and pregnancy information should be reviewed prior to taking fibrates.
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Angina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
Cholesterol (Lowering Your Cholesterol)
High cholesterol and triglyceride levels increase the risk of cardiovascular disease. Getting your cholesterol and triglyceride levels in an optimal range will help protect your heart and blood vessels. Cholesterol management may include lifestyle interventions (diet and exercise) as well as medications to get your total cholesterol, LDL, HDL, and triglycerides in an optimal range.
A heart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical instability of the heart.
Acute and Chronic Pancreatitis
Pancreatitis is a rare disease in which the pancreas becomes inflamed. There are two types of pancreatitis: acute and chronic. Symptoms of pancreatitis include abdominal pain, fever, nausea, vomiting, and a rapid pulse. Treatment of pancreatitis often requires hospitalization.
Heart Attack Prevention
Heart disease and heart attacks can be prevented by leading a healthy lifestyle with diet, exercise, and stress management. Symptoms of heart attack in men and women include chest discomfort and pain in the shoulder, neck, jaw, stomach, or back. Women experience the same symptoms as men; however, they also may experience: Extreme fatigue Pain in the upper abdomen Dizziness Fainting Leading a healthy lifestyle with a heart healthy low-fat diet, and exercise can help prevent heart disease and heart attack.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
High Cholesterol: Frequently Asked Questions
Cholesterol occurs naturally in the body. High blood cholesterol levels increase a person's risk of developing heart disease, heart attacks, strokes, TIAs, and more. In addition to medication (fibrates, statins, bile acid sequestrants, and niacin), lifestyle changes can be made to lower blood cholesterol levels
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