{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:19:17Z","timestamp":1781871557367,"version":"3.54.5"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peroxisome proliferator-activated receptor (PPAR) agonists are promising therapeutic agents for metabolic dysfunction-associated steatotic liver disease (MASLD), which increases cardiovascular risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We compared the efficacy of pemafibrate, a highly selective PPAR-\u03b1 agonist, and bezafibrate, a non-selective PPAR-\u03b1 agonist, in patients with coronary artery disease (CAD) and MASLD. This was a\n                      <jats:italic>post-hoc<\/jats:italic>\n                      analysis of a randomized, crossover study that treated hypertriglyceridemia with pemafibrate or bezafibrate for 24 weeks, followed by a crossover for another 24 weeks. Of the 60 enrolled patients, 21 were identified as having MASLD (fatty liver index [FLI] \u2265 60 and hepatic steatosis index [HSI] \u2265 36 as indicators). The primary outcomes were changes in serum alanine aminotransferase (ALT) levels and flow-mediated dilation (FMD). Secondary outcomes were changes in the FLI and HSI. Homeostasis model assessment of insulin resistance (HOMA-IR) was assessed as an exploratory outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The percentage reduction in ALT levels was significantly greater with pemafibrate treatment than with bezafibrate treatment (\u221223.1% vs. \u22129.2%, P = 0.035). FMD significantly increased in both groups, with no difference in the magnitude of the percentage change (P = 0.267). FLI significantly decreased in both groups with no difference in the magnitude of change (P = 0.983), while HSI was not significantly different before and after treatment in either group. Both treatments significantly lowered HOMA-IR; however, the decrease was similar between the groups (P = 0.724).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pemafibrate is more effective than bezafibrate at reducing ALT levels while offering similar beneficial effects on insulin resistance and endothelial function in CAD patients with MASLD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1750308","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T05:26:46Z","timestamp":1770787606000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative effectiveness of pemafibrate versus bezafibrate on hepatic and vascular endothelial function in patients with coronary artery disease and metabolic dysfunction-associated steatotic liver 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