Persistently increased HDL-cholesterolemia and reduced triglyceridemia in a large lipid clinic population treated with fenofibrate for 15 years or longer

Background: Fenofibrate, in the recent FIELD study in diabetics, induced a modest reduction of cardiovascular events, but unexpectedly there was an apparent loss of activity over time, thus, e.g., achieving only a 1.2% increase of HDL-cholesterolemia at study end. Method: Plasma lipid and lipoprotein changes were investigated in a large series of patients followed at 5-year intervals up to 15 years or longer at the Lipid Clinic of the University of Milano. Results: The HDL-cholesterol raising properties (mean of + 24.6% at 15 years) are well maintained over many years of treatment and tend to increase over time, particularly in diabetics. Fenofibrate also significantly reduced triglyceridemia and also LDL-cholesterolemia (- 54.9 and - 28.5%, respectively). There was a very low incidence of cardiovascular events. Conclusions: Long term fenofibrate treatment is associated with well maintained biochemical effects. The inadequate activity of fenofibrate over the 5 years of the FIELD study might be due to bioavailability problems previously noted with some slow release formulations.