Interessant bei Typ-2-Diabetes und metabolischem Syndrom - Stellenwert der Fibrate in der Prävention kardiovaskulärer Ereignisse

Fibrate sind - alternativ oder ergänzend zu den Statinen - eine wichtige Therapieoption zur Behandlung von Fettstoffwechselstörungen. Hauptsächlich senken Fibrate die Plasmatriglyzeride und erhöhen gleichzeitig das HDL-Cholesterin. Deshalb können Patienten, bei denen eine Hypertriglyzeridämie und eine Erniedrigung des HDL-Cholesterinspiegels im Vordergrund stehen, von einer Therapie mit Fibraten profitieren. Dies betrifft vor allem Typ-2-Diabetiker und Patienten mit metabolischem Syndrom, deren LDL-Wert oftmals nahe dem individuellen Zielwert liegt. Dennoch ist noch nicht ganz eindeutig geklärt, ob die Wirkungen der Fibrate auf das Lipidprofil einen klinischen Benefit ermöglichen, indem sie kardiovaskuläre Ereignisse und Mortalität senken. Die Kombinationstherapie von einem Fibrat mit einem Statin ist prinzipiell möglich. Die Therapieindikation sollte aber streng gestellt und der Patient intensiv betreut werden.

Beyond statins, fibrates offer an important therapeutic option in the treatment of disorders of lipid metabolism. Fibrates mainly lower plasma triglycerides and increase HDL cholesterol. Therefore, patients in whom elevated triglycerides and low HDL cholesterol predominate might receive particular clinical benefit. Above all this applies to individuals suffering from type 2 diabetes or the metabolic syndrome, since in these patients LDL cholesterol is often close to the individual target value. Nevertheless, it has not been demonstrated unequivocally so far whether or not the effects of fibrates on the lipid profile translate into clinical benefit in terms of lower incidence rate of cardiovascular events or death. In principle, fibrates can be combined with statins. However, the indication for this combination should be set carefully and patients should closely be monitored. In conclusion, the use of fibrates is an important alternative or complement to statins.

Key Words

triglycerides - HDL cholesterol - cardiovascular events - diabetes mellitus type 2 - metabolic syndrome

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1 Bezafibrate Coronary Atherosclerosis intervention Trial

2 St. Mary's, Ealing, Northwick Park Diabetes Cardiovascular Disease Prevention Study

3 Lipid Coronary Angiography Trial

4 Veterans Affairs High-Density Lipoprotein Cholesterol Intervention

5 Bezafibrate Infarction Prevention

6 Fenofibrate Intervention and Event Lowering in Diabetes

7 Diabetes Atherosclerosis Intervention Study

8 Action to Control Cardiovascular Risk in Diabetes

9 Ludwigshafen Risk and Cardiovascular Health

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