Fibrates : Do They Still Have a Role in Therapy in 2025?

Purpose of Review: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of mortality despite opti mal LDL-C control, leaving substantial residual risk in patients with atherogenic dyslipidaemia. This review re-examines the evolving role of fibrates in the management of dyslipidaemia, metabolic dysfunction–associated steatotic liver disease (MASLD), chronic kidney disease (CKD), and diabetic microvascular complications. Recent Findings:Large trials have demonstrated modest or inconsistent cardiovascular benefits with fibrates, with effects mainly limited to patients with elevated triglycerides and low HDL-C. The PROMINENT trial confirmed that lowering tri glycerides alone does not improve cardiovascular outcomes. However, emerging evidence suggests that fibrates, particularly fenofibrate and pemafibrate, have beneficial effects on albuminuria, hepatic steatosis, and diabetic retinopathy, indicating pleiotropic metabolic benefits beyond lipid lowering. Summary: Fibrates remain therapeutically relevant in selected dyslipidaemic or metabolically altered phenotypes. Their future lies in precision metabolic therapy, targeting microvascular, hepatic, and renal complications within a personalised cardiometabolic approach