Before statins dominated the conversation about cholesterol management, another class of drugs was commonly prescribed: benzofibrates, often simply called fibrates.

While these medications were once a mainstay for treating abnormal cholesterol levels, today their use is much less common — and in many cases, avoidable altogether.

What Are Benzofibrates?

Benzofibrates are a type of fibrate drug designed to lower triglycerides and modestly raise HDL (“good”) cholesterol. Common benzofibrates include:

• Bezafibrate
• Ciprofibrate
• Gemfibrozil
• Fenofibrate

They work by activating a protein called PPAR-alpha (Peroxisome Proliferator-Activated Receptor Alpha), which helps regulate fat metabolism in the liver [1].

The main goals of fibrates are to:

• Lower high triglycerides
• Raise low HDL cholesterol
• Reduce small, dense LDL particles

Why Are Benzofibrates Less Popular Today?

Despite their early promise, fibrates have fallen out of favor for several important reasons:

1. Limited Impact on Cardiovascular Outcomes: Large clinical trials have shown that fibrates do not significantly reduce heart attacks, strokes, or overall mortality when used alone [2].
2. Better Alternatives Exist: Statins proved far more effective at lowering LDL cholesterol and reducing heart attacks, making them the dominant choice.

Side Effects

Fibrates are associated with risks like:

• Muscle pain and weakness, especially when combined with statins
• Gallstones
• Liver enzyme elevations

Is There Ever a Place for Benzofibrates?

In rare cases — such as severe genetic hypertriglyceridemia — benzofibrates may still be useful to prevent pancreatitis caused by extremely high triglyceride levels (>11.3 mmol/L or >1000 mg/dL).

But for the average person with moderately abnormal cholesterol levels, lifestyle changes and nutritional interventions should always be the first line of defense.

1. Staels B, et al. “Mechanism of action of fibrates on lipid and lipoprotein metabolism.” Circulation. 1998;98(19):2088-2093. 
2. Keech A, et al. “Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (FIELD study): randomized controlled trial.” Lancet. 2005;366(9500):1849–1861.