Fibrates lower Lp(a) more than statins, and adding fibrates boosts statins effect, a meta-analysis of 16 head-to-head trials and 1388 patients (BMC Med 2017)

Original title: Comparison of the effects of fibrates versus statins on plasma lipoprotein(a) concentrations: a systematic review and meta-analysis of head-to-head randomized controlled trials

BMC Med · 3 February 2017 · 6

Sahebkar A, Simental-Mendía LE, Watts GF, Serban MC, Banach M, Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group

This systematic review and meta-analysis of randomised head-to-head trials compared fibrates and statins for lowering plasma Lp(a). Pooling 16 trials with 1388 subjects, fibrates had a significantly greater Lp(a)-lowering effect than statins (weighted mean difference -2.70 mg/dL, 95% CI -4.56 to -0.84, P=0.004). Combination therapy with fibrates and statins had a significantly greater effect than statin monotherapy (weighted mean difference -1.60 mg/dL, 95% CI -2.93 to -0.26, P=0.019), though not significantly greater than fibrate monotherapy (weighted mean difference -1.76 mg/dL, 95% CI -5.44 to +1.92, P=0.349), and treatment duration did not significantly affect the fibrate-versus-statin difference (P=0.788). The findings show fibrates lower Lp(a) more effectively than statins, and adding fibrates to statin therapy enhances its Lp(a)-lowering effect.

Original abstract

Background: Raised plasma lipoprotein(a) (Lp(a)) concentration is an independent and causal risk factor for atherosclerotic cardiovascular disease. Several types of pharmacological approaches are under evaluation for their potential to reduce plasma Lp(a) levels. There is suggestive evidence that statins and fibrates, two frequently employed lipid-lowering drugs, can lower plasma Lp(a). The present study aims to compare the efficacy of fibrates and statins in reducing plasma concentrations of Lp(a) using a meta-analysis of randomized head-to-head trials.

Methods: Medline and Scopus databases were searched to identify randomized head-to-head comparative trials investigating the efficacy of fibrates versus statins in reducing plasma Lp(a) levels. Meta-analysis was performed using a random-effects model, with inverse variance weighted mean differences (WMDs) and 95% confidence intervals (CIs) as summary statistics. The impact of putative confounders on the estimated effect size was explored using random effects meta-regression.

Results: Sixteen head-to-head comparative trials with a total of 1388 subjects met the eligibility criteria and were selected for this meta-analysis. Meta-analysis revealed a significantly greater effect of fibrates versus statins in reducing plasma Lp(a) concentrations (WMD, -2.70 mg/dL; 95% CI, -4.56 to -0.84; P = 0.004). Combination therapy with fibrates and statins had a significantly greater effect compared with statin monotherapy (WMD, -1.60 mg/dL; 95% CI, -2.93 to -0.26; P = 0.019) but not fibrate monotherapy (WMD, -1.76 mg/dL; 95% CI, -5.44 to +1.92; P = 0.349) in reducing plasma Lp(a) concentrations. The impact of fibrates versus statins in reducing plasma Lp(a) concentrations was not found to be significantly associated with treatment duration (P = 0.788).

Conclusions: Fibrates have a significantly greater effect in reducing plasma Lp(a) concentrations than statins. Addition of fibrates to statins can enhance the Lp(a)-lowering effect of statins.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.