Correction of certain pathophysiological components of the cardiovascular-renal metabolic syndrome (part one): The role of fenofibrate

This article discusses the issues in optimizing the treatment of a wide range of patients with cardiovascular-renal-metabolic syndrome (CVRMS), which largely determines the increased risk of cardiovascular disease (CVD) complications in patients with the excess of pathological adipose tissue. Approaches to lowering blood triglyceride levels in clinical practice are considered. The results of the data analysis for subjects of the randomized clinical trials (RCTs) demonstrating the efficacy of fibrate/statin co-administration in the subgroups of patients with metabolic syndrome and type 2 diabetes mellitusare are discussed. The article presents recently obtained data on the results of long-term follow-up of patients in the RCTs evaluating the efficacy of fenofibrate vs placebo, which indicate an improvement in the long-term prognosis after the completion of the RCTs in patients who were initially allocated to the fibrate group. The current approaches to the treatment of patients with hypertriglyceridemia, as one of the important components of CVRMS, are reviewed. The role of fenofibrate and drugs that belong to the class of w-3 polyunsaturated fatty acids in the treatment of hypertriglyceridemia is discussed. The article presents current evidence on the pleiotropic effects of fenofibrate, which may determine the positive effect of its use on vascular wall stiffness. The results of large observational studies revealing association between fenofibrate use and decreased risk of chronic kidney disease progression in patients with type 2 diabetes mellitus are discussed. The data supporting a metabolic memory after discontinuation of fenofibrate use which is manifested as the long-term preservation of positive therapeutic effects on kidney function are provided.

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