Choline fenofibrate is a hydrophilic formulation of fenofibric acid that acts primarily by activating peroxisome proliferator-activated receptor alpha (PPARα). This nuclear receptor modulates the transcription of genes involved in lipid metabolism. Once activated, PPARα increases the expression of lipoprotein lipase (LPL), which hydrolyzes triglycerides in lipoproteins, thereby reducing plasma triglyceride levels. It also decreases the production of apolipoprotein C-III (ApoC-III), an inhibitor of LPL, further promoting triglyceride breakdown. Additionally, choline fenofibrate stimulates the synthesis of high-density lipoprotein cholesterol (HDL-C) by upregulating the expression of apolipoprotein A-I (ApoA-I) and apolipoprotein A-II (ApoA-II). This multifaceted mechanism helps in managing mixed dyslipidemia by lowering triglycerides and increasing HDL-C levels.