What is the mechanism of action of fibrates in lipid management?

Fibrates primarily exert their effects by activating peroxisome proliferator-activated receptor alpha (PPAR-alpha). This nuclear receptor plays a critical role in regulating lipid metabolism. Upon activation, PPAR-alpha enhances the expression of genes involved in fatty acid oxidation, resulting in increased breakdown of fatty acids in the liver and muscles. This mechanism leads to a significant reduction in triglyceride levels, which are a key target in lipid management. Additionally, the activation of PPAR-alpha also contributes to an increase in high-density lipoprotein (HDL) cholesterol levels and has a modest effect on decreasing low-density lipoprotein (LDL) cholesterol levels.

The other options involve different mechanisms that are not reflective of how fibrates operate. For example, inhibiting cholesterol ester transfer protein does not directly relate to the actions of fibrates, as this mechanism pertains to drugs like niacin or CETP inhibitors. Similarly, while increasing HDL uptake in the liver or decreasing peripheral lipolysis may influence lipid profiles, they do not capture the primary mechanism of action of fibrates, which is focused on activating PPAR-alpha to promote fatty acid oxidation.