Drug evaluation: The combination of fenofibrate and simvastatin for the treatment of dyslipidemia: When and for whom?

Simvastatin and fenofibrate are the most frequently co-prescribed drugs for the treatment of dyslipidemia, manifesting beneficial effects on non-lipid parameters as well. The combination of these two drugs has been shown to increase success in the management of combined hyperlipidemia. Their different mechanism of action allows for the targeting of two types of lipid abnormalities: increased cholesterol and atherogenic dyslipidemia. Clinical studies have demonstrated that statin and fibrate combination therapy is effective in improving multiple lipid abnormalities, that may further decrease overall cardiovascular (CV) risk of patients with combined dyslipidemia. However, the clinical use of this combination therapy is still limited due to persistent controversy with respect to clinical trial outcomes and safety issues. The available evidence supports fenofibrate/simvastatin therapy as a viable treatment for mixed dyslipidemia. It seems to be particularly beneficial in subjects with high triglycerides and low high-density lipoprotein cholesterol, including subjects with type 2 diabetes (T2DM). However, larger prospective studies are needed to better quantitate the effect of this combination therapy on CVD morbidity and mortality of T2DM subjects as well as nondiabetic patients with mixed dyslipidemia.