Impact of pemafibrate on lipid profile and insulin resistance in hypertriglyceridemic patients with coronary artery disease and metabolic syndrome

Heart Vessels. 2024 Jun;39(6):486-495. doi: 10.1007/s00380-024-02363-z. Epub 2024 Feb 23.

Abstract

This study examined the effects of pemafibrate, a selective peroxisome proliferator-activated receptor α agonist, on the serum biochemical parameters of male patients with coronary artery disease and metabolic syndrome (MetS). This was a post hoc analysis of a randomized, crossover study that treated hypertriglyceridemia with pemafibrate or bezafibrate for 24 weeks, followed by a crossover of another 24 weeks. Of the 60 patients enrolled in the study, 55 were male. Forty-one of 55 male patients were found to have MetS. In this sub-analysis, male patients with MetS (MetS group, n = 41) and those without MetS (non-MetS group, n = 14) were compared. The primary endpoint was a change in fasting serum triglyceride (TG) levels during pemafibrate therapy, and the secondary endpoints were changes in insulin resistance-related markers and liver function parameters. Serum TG levels significantly decreased (MetS group, from 266.6 to 148.0 mg/dL, p < 0.001; non-MetS group, from 203.9 to 97.6 mg/dL, p < 0.001); however, a percent change (%Change) was not significantly different between the groups (- 44.1% vs. - 51.6%, p = 0.084). Serum insulin levels and homeostasis model assessment of insulin resistance significantly decreased in the MetS group but not in the non-MetS group. %Change in liver enzyme levels was markedly decreased in the MetS group compared with that in the non-MetS group (alanine aminotransferase, - 25.1% vs. - 11.3%, p = 0.027; gamma-glutamyl transferase, - 45.8% vs. - 36.2%, p = 0.020). In conclusion, pemafibrate can effectively decrease TG levels in patients with MetS, and it may be a more efficient drug for improving insulin resistance and liver function in such patients.

Keywords: Insulin resistance; Liver function; Metabolic syndrome; Pemafibrate; Peroxisome proliferator-activated receptor (PPAR)-α.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Benzoxazoles* / pharmacology
  • Benzoxazoles* / therapeutic use
  • Bezafibrate / pharmacology
  • Bezafibrate / therapeutic use
  • Biomarkers / blood
  • Butyrates* / pharmacology
  • Butyrates* / therapeutic use
  • Coronary Artery Disease* / blood
  • Coronary Artery Disease* / drug therapy
  • Cross-Over Studies*
  • Humans
  • Hypertriglyceridemia* / blood
  • Hypertriglyceridemia* / complications
  • Hypertriglyceridemia* / diagnosis
  • Hypertriglyceridemia* / drug therapy
  • Hypolipidemic Agents / pharmacology
  • Hypolipidemic Agents / therapeutic use
  • Insulin Resistance*
  • Male
  • Metabolic Syndrome* / blood
  • Metabolic Syndrome* / complications
  • Metabolic Syndrome* / diagnosis
  • Metabolic Syndrome* / drug therapy
  • Middle Aged
  • PPAR alpha / agonists
  • Treatment Outcome
  • Triglycerides / blood

Substances

  • (R)-2-(3-((benzoxazol-2-yl-d4 (3-(4-methoxyphenoxy-d7)propyl)amino)methyl)phenoxy) butanoic acid
  • Benzoxazoles
  • Butyrates
  • Triglycerides
  • Hypolipidemic Agents
  • Biomarkers
  • PPAR alpha
  • Bezafibrate