Statement 9

From the Clinical Practice Guidelines for the Management of Dyslipidemia by the Philippine Heart Association
This guideline starts below.

Statement 9

Fibrates may be recommended as an alternative to statins if HDL is less than 35 mg/dl and LDL is less than 90 mg/dl

Summary of Evidence

The evidence on fibrates were from the Veteran's Affairs High-density lipoprotein Intervention Trial (VA-HIT) and the Bezafibrate Infarction Prevention (BIP) trial. Pooled estimates demonstrated that fibrates reduced the incidence of MI and stroke in patients with established atherosclerosis by 16% and 22%, respectively. No significant effect was seen on the outcomes of total mortality, cardiovascular death, revascularization and serious adverse events.

Crude cost analysis indicated that fibrates taken for 5 to 6 years would cost approximately PHP 2.1 to 2.7 million to prevent one MI and one stroke.

The benefit of fibrate therapy is limited to MI. Furthermore, the magnitude of benefit is small. Hence, after considering costs and marginal benefit, the consensus recommendation was to limit fibrates as an alternative to statins. Baseline HDL levels from the two studies approximated each other and those of DAIS and SENDCAP, while HDL and LDL treatment thresholds were harmonized with that of the primary prevention fibrate recommendations. These approximated the baseline values from VA-HIT, which was designed for patients with low HDL (the target subgroup for this recommendation).