Effect of pemafibrate on LDL ‐cholesterol properties in type 2 diabetes and hypertriglyceridemia by lipid management status: PARM ‐ T2D post hoc analysis

Although pemafibrate attracts attention for reducing LDL-C in patients with high baseline LDL-C, its comprehensive effects remain unclear in patients with type 2 diabetes. This post hoc analysis of the PARM-T2D study investigated the effects of pemafibrate on LDL-C concentration and particle size in 156 subjects with type 2 diabetes and hypertriglyceridemia, categorized by baseline LDL-C levels. While triglycerides and remnant lipoprotein cholesterol significantly improved across all groups over 52 weeks, the impact on LDL-C was multifaceted and dependent on baseline status. In participants with low baseline LDL-C, concentrations increased without a rise in ApoB, suggesting an improvement in particle size. Conversely, in those with high baseline LDL-C, both LDL-C and ApoB decreased, reflecting favorable modifications according to baseline LDL-C control status. These findings suggest that pemafibrate exerts beneficial, status-dependent effects on LDL-C properties, potentially reducing cardiovascular risk by improving LDL particle quality and quantity in high-risk patients with diabetes.