Iatrogenic severe depression of high-density lipoprotein cholesterol

Area of Science:

• Cardiology
• Pharmacology
• Clinical Lipidology

Background:

• Fibrate medications are commonly prescribed to manage dyslipidemia.
• Paradoxical depression of high-density lipoprotein (HDL) cholesterol is a rare but significant adverse effect.
• Understanding the specific agents and patient populations affected is crucial for clinical practice.

Observation:

• Five cases of severe HDL cholesterol depression were observed in patients treated with fenofibrate.
• A retrospective review identified these cases within a lipid clinic population.
• Mean HDL cholesterol levels dropped significantly when patients were on fenofibrate compared to when they were not.

Findings:

• Fenofibrate was implicated in 5 cases (1% of total patients, 7.4% of fibrate users) of significantly depressed HDL cholesterol.
• A literature review identified 37 additional cases linked to fibrates, either alone or in combination with other drugs.
• In combination therapies, fibrates were the likely cause of HDL depression in a notable proportion of cases.

Implications:

• Fibrates, particularly fenofibrate, should be considered a potential cause of profound HDL cholesterol reduction.
• Clinicians should monitor HDL cholesterol levels in patients receiving fibrate therapy.
• Further research may be warranted to elucidate the mechanisms behind fibrate-induced HDL depression.