Background
Patients with metabolic syndrome (MS) are characterized by enhanced procoagulant activity caused by an increased fibrinogen (Fb) level, impaired fibrinolysis, and platelet activation. Fibrate treatment usually normalizes these conditions. The aim was to determine the effect of fenofibrate treatment on Fb level, fibrinolysis, and platelet function in patients with MS with regard to smoking status and type 2 diabetes.
Material and Method
Sixty-four patients with MS, including 20 active smokers, without clinical features of coronary heart disease were enrolled in the study. Before and during treatment with fenofibrate all patients took antihypertensive drugs and 25 patients with type 2 diabetes used oral antidiabetic drugs. Before and after the treatment the levels of lipids, fasting glucose insulin, Fb, PAI-1, t-PA, and platelet function expressed as closure time (CT, after Coll/Epi and Coll/ADP) were measured.
Results
Fenofibrate treatment resulted in normalization of abnormal lipid profiles and a reduction in Fb level. In smokers an increase in PAI-1 level and CT shortening after Coll/Epi and after Coll/ADP were found. In nonsmokers, CT was prolonged only after Coll/Epi. A slight reduction in PAI-1 and a reduction in fasting glucose were noted in the diabetics.
Conclusions
Fenofibrate partially corrected procoagulant state in patients with MS, which was manifested by a significant reduction in Fb level in all patients and inhibition of platelet function exclusively in nonsmokers. Smoking neutralizes the effects of treatment with fenofibrate as absence of inhibition of platelet function and a lack of improvement of the fibrinolysis system were observed in them.

Keywords: Thrombosis - physiopathology, Metabolic Syndrome X - physiopathology, Fenofibrate - therapeutic use, Smoking, Diabetes Mellitus, Type 2 - complications