Pemafibrate and cardiac reverse remodeling in patients with systolic heart failure receiving guideline-directed medical therapy

Pemafibrate is a selective peroxisome proliferator-activated receptor alpha (PPARα) activator. Pemafibrate has been shown to reduce serum triglyceride levels to an equivalent or greater extent than traditional fibrates, with a lower incidence of drug-related adverse events. Pemafibrate may have the potential to improve clinical outcomes in carefully selected patients with cardiovascular diseases by ameliorating dyslipidemia and stabilizing systemic arteriosclerosis. Additionally, several experimental studies have demonstrated a novel potential for pemafibrate in improving heart failure through its pleiotropic effects. We encountered two patients with systolic heart failure that was refractory to guideline-directed medical therapy. Both patients experienced further cardiac reverse remodeling and an improvement in hypertriglyceridemia following a six-month course of pemafibrate add-on therapy. Pemafibrate might facilitate cardiac reverse remodeling when incorporated into conventional heart failure medications. Further prospective randomized controlled studies are warranted to evaluate the clinical implications of incorporating pemafibrate into medical therapy for heart failure patients. Future research should also explore the long-term effects of pemafibrate on cardiovascular outcomes, the underlying mechanisms of its pleiotropic benefits, and its efficacy in diverse patient populations to solidify its role in heart failure management. Learning objective: Pemafibrate, a recently introduced selective peroxisome proliferator-activated receptor alpha activator that improves hypertriglyceridemia, may facilitate cardiac reverse remodeling when incorporated into conventional heart failure medications.