Previous clinical studies of fibrates suggested that their effect on HF is independent of their lipid-modifying properties,20 while pre-clinical evidence indicated that an increase in fatty acid beta-oxidation via PPAR activation may contribute to preserving heart function.35 In our study, the combination of statin and fenofibrate significantly reduced triglyceride levels more than statin alone (see Supplementary material online, Table S2, −48.4 vs. −28.9 mg/dL; P < 0.001). This evidence concerns the gene PPARA and hydrops fetalis.