H3c

12 Clofibrate 13 Gemfibrozil 14 Fenofibrate

W CO2H CO2H N

15 Ciprofibrate 16 Bezafibrate 17 Niacin

Figure 8 Structures of approved fibrates and niacin as HDLc-elevating agents.

is complex and includes activation of peroxisome proliferator-activated receptor (PPAR), a family of nuclear receptors (PPAR-a, PPAR-b/S, PPAR-g) that act as transcription factors and control genes involved in both lipid and lipoprotein metabolism as well as glucose homeostasis. Fibrates are selective PPAR-a agonists.56 Niacin 17 is currently the best available therapy for raising HDLc, attaining increases of 30% or more.

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