Overview of fenofibrate.
Fenofibrate is a broad spectrum lipid-lowering agent able to produce substantial reductions in plasma triglyceride and low density lipoprotein (LDL) and an increase in high density lipoprotein (HDL). It acts to promote the clearance of chylomicrons and very low density lipoproteins and can correct abnormalities in the LDL subfraction profile with a shift away from small, dense LDL. The drug is of particular use in correcting the atherogenic lipoprotein phenotype seen commonly in subjects with coronary heart disease. Recent investigations have revealed its likely mechanism of action at the molecular level. Fenofibrate binds to peroxisome proliferator activated receptor and initiates a sequence of events that leads to the reduction of apolipoprotein C-III synthesis in liver. This lipoprotein apoprotein inhibits the lipolysis and uptake of triglyceride-rich particles and suppression of its production causes enhanced catabolism. Further effects such as the changes in LDL and HDL follow from this primary action.