Choline fenofibrate add-on to statins in persistent hypertriglyceridemia: efficacy, apoB-containing lipoprotein remodeling, and renal function

Q: What are the key findings of this study?

Choline fenofibrate add-on therapy reduced triglycerides by 48.9% at 24 weeks (p<0.001) and decreased small-dense LDL fraction from 6.84% to 3.80% (p<0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Persistent hypertriglyceridemia on statin therapy (n=882). Intervention: Choline fenofibrate add-on to statin therapy vs. Baseline (statin therapy alone). Primary outcome: Change in triglycerides (TG) at Week 24 (p=<0.001).

Q: What does this research mean for the field?

Adding choline fenofibrate to statin therapy in persistent hypertriglyceridemia significantly reduces triglycerides and small-dense LDL while increasing LDL particle size, accompanied by a decline in estimated glomerular filtration rate. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate changes in lipid subfractions, apolipoprotein B-containing lipoproteins, and renal function in statin-treated patients receiving add-on choline fenofibrate for persistent hypertriglyceridemia.

Byung Jin Kim; Hyeon Ju Jeong; Eun Seok Kang; Min-Woong Kim; Sang-Hyun Kim; Yong-Hyun Kim; Ki Hong Lee; Geu-Ru Hong; Young Sup Byun; Hoyoun Won; Dong Heon Yang; Jae Hyuk Lee; Myung Soo Park; Se Eun Park; Sung Uk Kwon; Si‐Hyuck Kang; Min Seop Song

doi:10.1016/j.athplu.2026.100622

October 31, 2026Atherosclerosis PlusOpen Access

Choline fenofibrate add-on to statins in persistent hypertriglyceridemia: efficacy, apoB-containing lipoprotein remodeling, and renal function

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Key result

Choline fenofibrate add-on linked to ~49% reduction in triglycerides at 24 weeks.

P<0.001
n=882

Graphical abstract published by Atherosclerosis Plus — Graphical abstract · Published by Atherosclerosis Plus

Why the study?

Fenofibrate added to statin therapy lowers triglycerides, but its effects on apoB-containing lipoproteins and renal function remain incompletely characterized.

Does choline fenofibrate add-on therapy improve triglycerides and apoB-containing lipoprotein profiles and affect renal function in statin-treated adults with persistent hypertriglyceridemia?

Key Points

To evaluate changes in lipid subfractions, apolipoprotein B-containing lipoproteins, and renal function in statin-treated patients receiving add-on choline fenofibrate for persistent hypertriglyceridemia.
A 26-center prospective observational study evaluated adults (N=882) with triglycerides ≥200 mg/dL on stable statin therapy at baseline, Week 12, and Week 24.
Lipoprotein subfraction distribution was assessed via Lipoprint analysis and kidney function was tracked using serum creatinine and cystatin C in participant subsets.
In the full cohort (N=882), triglycerides decreased by 48.9% at Week 24 (p<0.001) and low-density lipoprotein cholesterol (LDL-C) increased by 7.1 mg/dL, while apolipoprotein B showed no significant change (n=132).
Among the Lipoprint subset (n=62), small-dense LDL fraction dropped from 6.84% to 3.80% and mean LDL particle size expanded from 259.3 to 263.4 Å (both p<0.001).
Creatinine-based estimated glomerular filtration rate declined during treatment, a pattern consistently reflected by cystatin C-based filtration measurements in a paired subgroup (n=135).

Study Design

Type

Observational (n=882)

Multicenter

Yes

Structured PICO

Does choline fenofibrate add-on therapy improve triglycerides and apoB-containing lipoprotein profiles and affect renal function in statin-treated adults with persistent hypertriglyceridemia?

P

Population

882 statin-treated adults with persistent hypertriglyceridemia (TG ≥200 mg/dL) across 26 centers followed for 24 weeks.

E

Exposure

Choline fenofibrate add-on therapy to statins for 24 weeks

O

Outcome

Changes in triglycerides (TG), lipoprotein levels (LDL-C, apoB, small-dense LDL fraction, mean LDL particle size), and renal function (creatinine-based and cystatin C-based eGFR) at Week 12 and Week 24surrogate

Main Result

p-value: p=<0.001

Choline fenofibrate added to statin therapy significantly lowers triglycerides by nearly half and shifts LDL toward larger, less dense particles in patients with persistent hypertriglyceridemia, though declining eGFR necessitates renal monitoring.

Limitations

Apolipoprotein B (n=132), Lipoprint analysis (n=62), and cystatin C (n=135) findings were limited to smaller paired subsets.
Observational study design
Apolipoprotein B (n=132), Lipoprint analysis (n=62), and cystatin C (n=135) findings were limited to smaller paired subsets

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Implication

Supports add-on choline fenofibrate for persistent hypertriglyceridemia without increasing ApoB; leaves open whether these subfraction shifts improve cardiovascular outcomes despite cystatin C-confirmed eGFR decline.

Abstract

Background Fenofibrate added to statin therapy lowers triglycerides (TG), but its effects on apolipoprotein B (apoB)-containing lipoproteins and renal function remain incompletely characterized. Objective To evaluate lipid and lipoprotein changes and renal function during choline fenofibrate add-on therapy in statin-treated patients with persistent hypertriglyceridemia. Methods In this 26-center prospective observational study, adults with TG ≥200 mg/dL on statin therapy were evaluated at baseline, Week 12, and Week 24. Lipoprint analysis and cystatin C were available in subsets. Results Among 882 patients, TG decreased by 48.9% at Week 24 (p<0.001), whereas low-density lipoprotein cholesterol (LDL-C) increased by 7.1 mg/dL. ApoB did not change significantly in participants with paired measurements (n=132). In the paired Lipoprint subset (n=62), small-dense LDL (sdLDL) fraction decreased from 6.84% to 3.80% and mean LDL particle size increased from 259.3 to 263.4 Å (both p<0.001). Creatinine-based estimated glomerular filtration rate (eGFR) declined during treatment; cystatin C-based eGFR showed a similar direction in a smaller paired subset (n=135). Conclusions Choline fenofibrate add-on therapy markedly reduced TG and was accompanied by lower sdLDL fraction and larger LDL particle size despite a modest rise in LDL-C. ApoB and cystatin C findings were supportive but limited to subsets. Renal function should be monitored during treatment.

Discussion

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Cite This Study

Kim et al. (2026) conducted an observational in Persistent hypertriglyceridemia on statin therapy (n=882). Choline fenofibrate add-on to statin therapy vs. Baseline (statin therapy alone) was evaluated on Change in triglycerides (TG) at Week 24 (p=<0.001). Choline fenofibrate add-on therapy reduced triglycerides by 48.9% at 24 weeks (p<0.001) and decreased small-dense LDL fraction from 6.84% to 3.80% (p<0.001).

synapsesocial.com/papers/6aebc8ba3e63ca1b6c315df6 https://doi.org/10.1016/j.athplu.2026.100622

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Choline fenofibrate add-on to statins in persistent hypertriglyceridemia: efficacy, apoB-containing lipoprotein remodeling, and renal function

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Choline fenofibrate add-on to statins in persistent hypertriglyceridemia: efficacy, apoB-containing lipoprotein remodeling, and renal function

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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