What Is the Connection between Statins and Fibrates?

B. Chisholm
B. Chisholm

Statins and fibrates are connected in that they are both classes of drugs used to treat hypercholesterolemia, or high cholesterol levels. They work by different mechanisms of action and affect the different types of cholesterol in various ways. The choice of which class to use will be made by the prescribing doctor according to specific tests done which will establish each patient's lipid profile.

The statins and fibrates both consist of a number of drugs within each class. These are known by different trade names in different countries, according to manufacturer. In most countries they are available by prescription only. Dosage differs between each drug in each class and the prescribed dosage should never be exceeded.

Hypercholesterolemia, or high cholesterol, is a common clinical condition which may cause atherosclerosis or narrowing of the blood vessels. This may, in turn, have serious consequences such as heart attack or stroke. Initial treatment of high cholesterol includes lifestyle changes such as diet and exercise. Should medical treatment be required, the statins and fibrates may be considered.

While both the statins and fibrates work to lower the cholesterol in the body, they work differently. Cholesterol is divided into high density lipids (HDL), low density lipids (LDL) and triglycerides. LDL is deposited in the arteries and causes narrowing or clogging, while HDL protects the arteries. Triglycerides increase the risk of hardened arteries.

For this reason, raised LDL and/or triglyceride levels are problematic. The statins and fibrates act differently with the statins having a more defined effect on LDL, while fibrates may affect triglyceride levels more. The choice between them will be made clinically.

Fibrates work predominantly by stimulating lipoprotein lipase and hepatic lipase, enzymes which are responsible for the breakdown of triglycerides causing decreased triglyceride levels. They may also slightly increase HDL production and decrease LDL levels in the blood by decreasing its production in the liver. Statins on the other hand decrease LDL by inhibiting HMG-CoA reductase, an enzyme which is involved in the production of LDL. They also decrease triglycerides slightly and may increase HDL slightly.

As with any medications, both statins and fibrates may have adverse side effects, interact with other drugs, or be contraindicated in people with some clinical conditions. Any medicine, including complementary, homeopathic or over-the-counter drugs, should be discussed with the prescribing doctor before starting either drug. Underlying medical conditions, allergies, pregnancy or desired pregnancy and lactation should also be discussed.

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