Fibrates and coronary heart disease reduction in diabetes

Fibrates are peroxisome proliferator-activated receptor-α (PPARα) ligands with a broad range of lipid effects, in particular normalizing HDL and triglyceride metabolism in individuals with obesity and insulin resistance who have a high prevalence of type 2 diabetes and cardiovascular events. With diabetic dyslipidemia and obesity there is also an increased inflammatory response, endothelial dysfunction, and impaired fibrinolysis. In recent clinical trials with fibrates, there is emerging evidence for a selective and preferential effect of fibrates in reducing cardiovascular events independent of reducing LDL-C in subjects with a typical diabetic dyslipidemia who have an increased body weight and/or diabetes.