Rosenson Robert S
Lipoprotein Disorders and Clinical Atherosclerosis Research, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
Expert Rev Cardiovasc Ther. 2008 Nov;6(10):1319-30. doi: 10.1586/14779072.6.10.1319.
Fenofibrate is a PPAR-alpha agonist indicated for the treatment of hypertriglyceridemia and mixed dyslipidemia, and is approved for the treatment of hypercholesterolemia, lipid abnormalities commonly observed in patients at high risk of cardiovascular disease, including Type 2 diabetes and/or metabolic syndromes. Treatment with fenofibrate lowers triglycerides, raises HDL-cholesterol and decreases concentrations of small LDL-cholesterol particles and apolipoprotein B. Fenofibrate is particularly effective for reducing postprandial VLDL and LDL particle concentrations, and the increased oxidative stress and inflammatory response that occurs after a fatty meal. In addition, nonlipid pleiotropic effects mediated by PPAR-alpha are likely to contribute to the reduction in atherosclerosis progression and cardiovascular events, and have beneficial effects on diabetes-related microvascular diseases. While current approaches to treating dyslipidemia to prevent cardiovascular diseases focus on statin therapy, it is increasingly clear that substantial residual risk persists. The clinical significance of combination therapy with fenofibrate and a statin to macrovascular and microvascular risk is being evaluated in a large outcomes study.
非诺贝特是一种过氧化物酶体增殖物激活受体α（PPAR-α）激动剂，适用于治疗高甘油三酯血症和混合性血脂异常，且被批准用于治疗高胆固醇血症，这是在心血管疾病高危患者（包括2型糖尿病和/或代谢综合征患者）中常见的脂质异常。非诺贝特治疗可降低甘油三酯水平，升高高密度脂蛋白胆固醇（HDL-C），并降低小低密度脂蛋白胆固醇颗粒和载脂蛋白B的浓度。非诺贝特在降低餐后极低密度脂蛋白（VLDL）和低密度脂蛋白颗粒浓度以及减少高脂餐后发生的氧化应激和炎症反应方面特别有效。此外，由PPAR-α介导的非脂质多效性作用可能有助于减少动脉粥样硬化进展和心血管事件，并对糖尿病相关的微血管疾病产生有益影响。虽然目前治疗血脂异常以预防心血管疾病的方法主要集中在他汀类药物治疗，但越来越明显的是，仍存在大量残余风险。一项大型结局研究正在评估非诺贝特与他汀类药物联合治疗对大血管和微血管风险的临床意义。
