Severe lipemia induced by tamoxifen

A 61-year-old woman was treated with tamoxifen for breast cancer and had marked hyperlipoproteinemia: high plasma triglyceride levels (2790 mg/dl); increased very low density lipoprotein (VLDL) cholesterol levels (241 mg/dl); and high VLDL apoprotein B levels (126 mg/dl). Low density lipoprotein (LDL) cholesterol was decreased (104 mg/dl) and LDL apoprotein B was at 107 mg/dl. A low activity of both postheparin plasma lipoprotein lipase (LPL) and hepatic triglyceride lipase (h-TGL) was also noted. All these observations were reversed following tamoxifen withdrawal. Plasma triglyceride levels fell to 361 mg/dl. VLDL cholesterol and VLDL apoprotein B decreased to 41 mg/dl (83%) and 21 mg/dl (83%), respectively. Meanwhile, LDL cholesterol rose to 194 mg/dl (86%) and LDL apoprotein B increased to 138 mg/dl (29%). LPL and h-TGL activities did increase following tamoxifen withdrawal. Our observations show that, in some patients, the previously described weak hypertriglyceridemic effect of tamoxifen is amplified. That observation supports the concept and helps to explain that, in such severe induced lipemia, reduction of the activities of LPL and h-TGL might impede the conversion of VLDL to LDL, thus causing an amplification of the effect.