Several randomized, double blind, placebo-controlled trials (RCTs) demonstrated that low-density lipoprotein-cholesterol (LDL-C) lowering by using statins reduced the development of cardiovascular disease (CVD). However, 56–79% of patients had the residual CVD risk after the trials. Our analysis of the characteristics of patients in such RCTs suggested that high triglyceride (TG) and low high-density lipoprotein-cholesterol (HDL-C) are important metabolic factors which determine the statin residual CVD risk. An increase of atherogenic lipoproteins such as small dense LDL and remnants which are significantly associated with high TG and low HDL-C can partially explain the statin residual CVD risk. We found that a novel selective peroxisome proliferator-activated receptor α modulator, pemafibrate, significantly reduced serum TG and increased HDL-C, and further improved liver function, uric acid and glucose metabolism. In another our study, the one-year pemafibrate treatment improved hepatic steatosis and fibrosis indexes in patients with hypertriglyceridemia. Furthermore, we demonstrated that the switching from fenofibrate to pemafibrate improved estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes. In conclusion, pemafibrate may be a promising therapeutic option for the residual CVD risk, metabolic-dysfunction-associated steatotic liver disease (MASLD) and chronic kidney disease (CKD). 

Hidekatsu Yanai is a Vice Director, National Center for Global Health and Medicine Kohnodai Hospital and a professor of Wayo Women’s University. He obtained MD and PhD degree in National Defense Medical College and Hokkaido University School of Medicine, respectively. He worked at the National Institutes of Health (NIH) as Invited PhD Research Fellow, U.S.A. (2002-2004). He obtained the Young Investigator Award, 18th Congress of the International Society on Thrombosis and Haemostasis in 2000, and the Travel Grant, 5th Congress of the Asian-Pacific Society of Atherosclerosis and Vascular Diseases in 2006, and Global Health and Medicine (GHM), High Citation Award 2022 in 2023. He is a director of Japanese Society for Medical Use of Functional Foods, and councillor of Japan Atherosclerosis Society, Japan Diabetes Society and Japan Endocrine Society. He published 291 peer-reviewed English papers (total impact factor, 1826).