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Paradoxical HDL-C reduction during rosiglitazone and fibrate treatment

C Shetty1, M Balasubramani, N Capps

  • 1Department of Biochemistry, Good Hope Hospital NHS Hospital Trust, Sutton Coldfield, UK.

Diabetic Medicine : a Journal of the British Diabetic Association
|January 18, 2007
PubMed
Abstract

Insights

Rosiglitazone combined with fibrates can paradoxically lower high-density lipoprotein cholesterol (HDL-C) in Type 2 diabetes mellitus patients. Routine monitoring of HDL-C is crucial to prevent increased cardiovascular risk.

Area of Science:

  • Endocrinology
  • Cardiology
  • Pharmacology

Background:

  • Dyslipidemia is a key factor in atherosclerosis development among Type 2 diabetes mellitus (T2DM) patients.
  • Thiazolidinediones (TZDs) are T2DM medications that influence lipid profiles, typically reducing triglycerides and increasing HDL-C.

Observation:

  • Five patients on rosiglitazone and a fibrate experienced a significant, unexpected decrease in HDL-C.
  • This decline in HDL-C could have been overlooked without routine monitoring, potentially increasing cardiovascular risk.

Findings:

  • HDL-C levels dropped by 50-89% in affected patients, with recovery taking 5-20 weeks after rosiglitazone discontinuation.
  • Apolipoprotein A1 changes mirrored HDL-C drops in most cases, suggesting complex mechanisms.
  • Despite the HDL-C effect, rosiglitazone improved glycemic control (HbA1c reduction of 0.6-3.0%) in four patients.

Implications:

  • Routine monitoring of HDL-C is recommended before and during rosiglitazone treatment, especially when combined with fibrates.
  • This highlights the need for careful lipid monitoring in T2DM patients undergoing TZD therapy.
  • Understanding these paradoxical lipid changes is vital for managing cardiovascular risk in T2DM.

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