[Fibrates in the secondary prevention of ischemic cardiopathy].

Clinical trials have demonstrated that reduction of low density lipoprotein cholesterol (LDL-C) reduces the incidence of major cardiac events in patients with coronary heart disease (CHD). Recently, two major secondary prevention trials that evaluated the impact of increasing low serum levels of high density lipoprotein cholesterol (HDL-C) and decreasing serum triglycerides on cardiovascular morbidity and mortality were published. This paper briefly summarizes the characteristics and results of these two studies. In the veterans Affairs HDL Intervention Study (VA-HIT), LDL-C was not changed; HDL-C increased 6.0% and triglycerides were reduced 31% by gemfibrozil. The lipid changes in the Bezafibrate Infarction Prevention (BIP) study were LDL-C -6.5%, HDL-C 18%; and triglycerides -21%. In VA-HIT, there was a 22% reduction (p = 0.006) in major CHD events, whereas in the BIP study a nonsignificant reduction of only 9.4% was observed. It is not clear why the effectiveness of fibrate therapy was different in the two studies. From these results it has been suggested that for most CHD patients, the 3-hydroxy-3-methylghutaryl coenzyme A reductase inhibitors (statins) will remain the initial drugs of choice, but fibrates may be of use in a subgroup of patients.