How do fibrates act and what are their effects on HDL-C?

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Multiple Choice

How do fibrates act and what are their effects on HDL-C?

Fibrates act by activating PPAR-α, a nuclear receptor that shifts liver metabolism toward fatty acid oxidation and enhances lipoprotein processing. This leads to reduced production of VLDL in the liver and greater breakdown of triglyceride-rich particles by lipoprotein lipase, so plasma triglycerides fall. Activation of PPAR-α also boosts production of apolipoproteins A-I and A-II and improves reverse cholesterol transport, which modestly raises HDL-C. In practice, the HDL-C increase is modest, often around 10–20%, while triglycerides drop more significantly. Other mechanisms described—like statins inhibiting HMG-CoA reductase, PPAR-γ agonists raising TG, or SREBP inhibitors—do not describe how fibrates work.

Fibrates act by activating PPAR-α, a nuclear receptor that shifts liver metabolism toward fatty acid oxidation and enhances lipoprotein processing. This leads to reduced production of VLDL in the liver and greater breakdown of triglyceride-rich particles by lipoprotein lipase, so plasma triglycerides fall. Activation of PPAR-α also boosts production of apolipoproteins A-I and A-II and improves reverse cholesterol transport, which modestly raises HDL-C. In practice, the HDL-C increase is modest, often around 10–20%, while triglycerides drop more significantly. Other mechanisms described—like statins inhibiting HMG-CoA reductase, PPAR-γ agonists raising TG, or SREBP inhibitors—do not describe how fibrates work.

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