Fibrates help lower cholesterol by reducing a type of fat in the blood. Doctors use them in the management of conditions such as dyslipidemia, heart disease, and stroke.
While statins can lower so-called “bad” cholesterol, they do not do much for “good” cholesterol. Fibrates can help with both, lowering very low-density lipoprotein (VLDL) cholesterol and raising high-density lipoprotein (HDL) cholesterol. This may help reduce the risk of cardiovascular events, such as heart attacks.
This article explores the role of fibrates in cholesterol management, how they work, their types, potential side effects, and risks.
Fibrates increase HDL, sometimes called “good” cholesterol. They also help reduce VLDL cholesterol, which contributes to the formation of plaque in arteries.
Fibrates are especially useful for people with conditions where high triglycerides are the main concern, such as:
Statins, on the other hand, mainly lower LDL cholesterol, sometime called “bad” cholesterol. They do not have much effect on HDL.
Fibrates work by activating proteins known as peroxisome proliferator-activated receptors, which are important for the breakdown of fats in the body. They decrease the liver’s production of VLDL cholesterol, which can lower triglyceride levels by up to 25% to 50%.
These medications also increase the liver’s production of apolipoproteins A-I and A-II, raising HDL levels by approximately 5% to 20%, and improving how LDL receptors break down and remove LDL from the blood.
By lowering triglycerides and increasing HDL, fibrates help improve overall lipid balance and reduce cardiovascular risk.
There are several types of fibrates available, each with slightly different properties. A doctor will prescribe the type of fibrate depending on the person’s needs.
Some types of fibrates include:
Fibrates can cause side effects. They are generally mild and manageable. However, anyone experiencing persistent or severe symptoms should contact their doctor.
The most common side effects include:
While fibrates are usually safe when a person takes them according to a doctor’s instructions, there are some potential risks.
However, so far, clinical trials have not shown that fibrates contribute to kidney failure in people with otherwise healthy kidneys. These changes are also reversible, meaning they go back to typical levels if a person stops taking the fibrates.
Doctors will monitor a person’s liver and kidney health while they are taking fibrates. If levels of the substances listed above change significantly, a doctor may suggest adjusting the dose or discontinuing the drug.
People with the following conditions should not take fibrates, as they may make them worse:
Fibrates slightly increase the risk of blood clots, myopathy (disorders of the muscles), and cholelithiasis (gallstones) by less than 1%. Other less common but serious adverse effects can include:
It is also possible that some people may have allergic reactions to fibrates. People with a known hypersensitivity to fibrates should not take them, as this could result in a severe allergic reaction.
The safety of fibrates for children or for people who are pregnant or breastfeeding is unknown.
Drug interactions
Some fibrates can interact with statins, interfering with how the body processes them. When a person takes these two types of medication together, it can increase the risk of muscle-related side effects, including myopathy and rhabdomyolysis.
Fibrates can also increase the effects of some blood thinners, such as warfarin, as well as vitamin K antagonists.
A doctor will check it is safe for a person to try fibrates before prescribing them, and will carefully monitor people who are taking them.
Do not try new medications or supplements in combination with fibrates without consulting a doctor first.
Are fibrates safer than statins?
Fibrates and statins both have different potential risks. Whether one is safer depends on the individual’s health.
A 2021 study found that in adults with dyslipidemia, statins caused fewer serious side effects and fewer increases in creatinine levels than fibrates. However, statins were also more likely to raise liver enzymes.
Where can I get fibrates?
Fibrates are prescription medications. If a doctor determines that fibrates are an appropriate treatment option for a person, they will write a prescription.
Fibrates are medications that lower cholesterol by reducing blood fats, particularly triglycerides. Doctors prescribe them for conditions such as dyslipidemia, heart disease, and stroke.
While statins effectively lower “bad” cholesterol (LDL), fibrates increase “good” cholesterol (HDL) and help manage triglycerides, reducing the risk of plaque buildup in arteries.
Though generally safe, fibrates can cause mild side effects, such as nausea and muscle pain, and they may not be suitable for everyone.