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Fibrate - comparison with nicotinic acid with respect to lipid lowering

Authoring team

Lipid lowering effects of fibrates and nicotinic acid (1):

Fibrate

Nicotinic Acid

Total cholesterol

11% reduction

10% reduction

Triglycerides

36% reduction

20% reduction

Low-density lipoprotein cholesterol

8% reduction

14% reduction

High-density lipoprotein cholesterol

10% increase

16% increase

Apart from flushes in the niacin group, both fibrates and niacin appeared to be well-tolerated and safe in a 2005 study(1).

However - nicotinic acid/laropiprant (Tredaptive) was withdrawn across the EU in 2013, and nicotinic acid preparations are no longer available in the UK. Both the AIM-HIGH (2011) and HPS2-THRIVE (2014) trials showed no CV benefit and significant harm.

Reference:

  1. Birjmohun RS et al. Efficacy and safety of high-density lipoprotein cholesterol-increasing compounds: a meta-analysis of randomized controlled trials. J Am Coll Cardiol 2005;45:185-97.

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