Rosuvastatin and Fenofibrate Combination in The Treatment of Mixed Hyperlipidemia: A Narrative Review

Introduction: Patients with mixed dyslipidemia are presented with high levels of low-density lipid cholesterol (LDL-C), triglycerides (TG), and reduced high-density lipid cholesterol (HDL-C). Though useful in lowering LDL-C, therapy with rosuvastatin is insufficient in optimizing the overall lipid profile, thus putting the patient at risk of residual cardiovascular risk. A combination of statin with other lipid-modifying agents has been used with more efficient lipid control and cardiovascular risk prevention. Of these, fenofibric acid is the most frequently used, along with rosuvastatin. Methods: Authors conducted a literature search of published literature to assess the use of rosuvastatin and fenofibrate combination in the management of mixed hyperlipidaemia. Results and discussion: The authors selected a total of 46 articles to be included in the review. Due to the small number of articles and heterogeneity on the combination of rosuvastatin and fenofibrate combination in mixed hyperlipidemia, the findings herein are presented using narrative summaries. Based on the thorough assessment of the selected literature, the essential themes that emerged from the review include safety and efficacy of rosuvastatin and fenofibrate combination, place of therapy of rosuvastatin, and fenofibrate combination, and potential cardiovascular risk reduction with rosuvastatin and fenofibrate combination. Conclusion: Based on the review, the authors suggested that the combination therapy with fenofibric acid was beneficial, well-tolerated with a similar safety profile compared with statin monotherapy. The combination therapy of moderate dose rosuvastatin and fenofibric acid led to a reduction of cardiovascular risk factors via several pathways.

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Pharmacotherapy of Mixed Hyperlipidemia with Ezetimibe-Fenofibrate Combination Therapy

Clinical Medicine Therapeutics ◽

10.4137/cmt.s2036 ◽

2009 ◽

Vol 1 ◽

pp. CMT.S2036

Author(s):

Michel Farnier

Keyword(s):

Combination Therapy ◽

Hdl Cholesterol ◽

Poor Response ◽

Atherogenic Dyslipidemia ◽

Cardiovascular Risk Reduction ◽

Ldl Particles ◽

Statin Monotherapy ◽

Alternative Treatment Option ◽

First Choice ◽

Mixed Hyperlipidemia

Mixed hyperlipidemia is a frequent atherogenic dyslipidemia characterized by elevated triglycerides, low HDL cholesterol levels, and excess of small, dense LDL particles, often with elevated apolipoproteinB and non-HDL cholesterol concentrations. Although statins are the drug of first choice, many high-risk patients with mixed hyperlipidemia do not achieve the recommended goals with statin monotherapy. Due to the complementary effects of ezetimibe and fenofibrate on the components of atherogenic dyslipidemia, the combination of these two drugs is an alternative treatment option for patients with mixed hyperlipidemia. However, the potential benefit of ezetimibe-fenofibrate combination therapy in cardiovascular risk reduction strategies remains to be established and this combination therapy should only be considered as a second-line therapy and appears to be particularly useful for patients with a poor response or an intolerance to statin monotherapy.

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PCSK9: The functional relevance of fenofibrate–statin combination therapy to reduce residual cardiovascular risk

International Journal of Diabetes Mellitus ◽

10.1016/j.ijdm.2010.11.001 ◽

2015 ◽

Vol 3 (1) ◽

pp. 4-10 ◽

Cited By ~ 1

Author(s):

Jean-Charles Fruchart

Keyword(s):

Cardiovascular Risk ◽

Combination Therapy ◽

Residual Cardiovascular Risk ◽

Functional Relevance

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Statin combination therapy and cardiovascular risk reduction

Future Cardiology ◽

10.2217/fca-2015-0011 ◽

2016 ◽

Vol 12 (3) ◽

pp. 289-315 ◽

Cited By ~ 3

Author(s):

Peter P Toth ◽

Michel Farnier ◽

Joanne E Tomassini ◽

JoAnne M Foody ◽

Andrew M Tershakovec

Keyword(s):

Cardiovascular Risk ◽

Combination Therapy ◽

Risk Reduction ◽

Cardiovascular Risk Reduction

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Real-World Effectiveness of Therapy With Rosuvastatin Combined With Fenofibric Acid in a Sample of Colombian Patients With Mixed Dyslipidemia

Journal of Primary Care & Community Health ◽

10.1177/2150132720977733 ◽

2020 ◽

Vol 11 ◽

pp. 215013272097773

Author(s):

Manuel E. Machado-Duque ◽

Andrés Gaviria-Mendoza ◽

Jorge E. Machado-Alba

Keyword(s):

Cardiovascular Risk ◽

High Risk ◽

Lipid Profile ◽

Ldl Cholesterol ◽

Clinical Laboratory ◽

Lower Probability ◽

Fenofibric Acid ◽

High Cardiovascular Risk ◽

Mixed Dyslipidemia ◽

Very High

Background Ischemic heart disease is the leading cause of death in the world and is associated with dyslipidemia, high blood pressure, diabetes mellitus, and other factors. Objective To determine the clinical effectiveness on the lipid profile of the rosuvastatin + fenofibric acid combination in Colombian patients with high cardiovascular risk and mixed dyslipidemia. Methods Longitudinal observational study in a random sample of patients with a diagnosis of mixed dyslipidemia and moderate, high, or very high cardiovascular risk who were treated with rosuvastatin + fenofibric acid. Anthropometric, clinical, laboratory, comorbidity, and pharmacological variables were identified. Effectiveness on the lipid profile was determined. Results A total of 386 patients were analyzed. They had a mean age of 60.8 ± 11.4 years, 53.1% were female, and 75.6% had high/very high cardiovascular risk. The initial evaluation showed a mean LDL cholesterol of 138.4 ± 67.1 mg/dL and triglycerides of 679.7 ± 573.6 mg/dL. At the end of follow-up, mean LDL cholesterol was 87.5 ± 41.2 mg/dL (reduced by 43.3%; P < .001), and triglycerides were 243.5 ± 170.5 mg/dL (reduced by 64.2%; P < .001). Only 35.4% (n = 73) of patients with very high risk reached the goal of metabolic control, compared to 61.6% (n = 53) with high risk and 55.4% (n = 46) with moderate risk. Belonging to the very high-risk group was associated with a lower probability of achieving the control goal (OR: 0.32; 95%CI: 0.192-0.539). Conclusion The combination of rosuvastatin + fenofibric acid is an effective option in patients with mixed dyslipidemia and high cardiovascular risk, providing a therapeutic alternative for those conditions that require it.

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