Paradoxical Lowering of High-Density Lipoprotein Cholesterol Level in 2 Patients Receiving Fenofibrate and a Thiazolidinedione
Authors: Zeynep Ebcioglu, John Morgan, Christina Carey, David Capuzzi
Journal: Annals of Internal Medicine (2003)

Letters4 November 2003Paradoxical Lowering of High-Density Lipoprotein Cholesterol Level in 2 Patients Receiving Fenofibrate and a ThiazolidinedioneZeynep Ebcioglu, MD, John Morgan, MD, Christina Carey, PA-C, and David Capuzzi, MDZeynep Ebcioglu, MDFrom Thomas Jefferson University Hospital; Philadelphia, PA 19107., John Morgan, MDFrom Thomas Jefferson University Hospital; Philadelphia, PA 19107., Christina Carey, PA-CFrom Thomas Jefferson University Hospital; Philadelphia, PA 19107., and David Capuzzi, MDFrom Thomas Jefferson University Hospital; Philadelphia, PA 19107.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-139-9-200311040-00022-w4 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Fenofibrate, a fibric acid derivative, is used to reduce triglyceride levels and increase high-density lipoprotein (HDL) cholesterol levels in diabetic dyslipidemia. Two patients taking a thiazolidinedione experienced a dramatic and paradoxical reduction of HDL cholesterol levels when fenofibrate therapy was started.Case Report: Patient 1, a 42-year-old man with type 2 diabetes mellitus, was referred for evaluation of a very low HDL cholesterol level (Table). He had been taking insulin; troglitazone, 400 mg/d; and metformin, 850 mg/d. Gemfibrozil was initially prescribed for hypertriglyceridemia, but fenofibrate, 201 mg, was then substituted. When the patient was first seen, his HDL cholesterol ...References1. Berger J, Moller DE. The mechanisms of action of PPARs. Annu Rev Med. 2002;53:409-35. [PMID: 11818483] CrossrefMedlineGoogle Scholar2. Staels B, Auwerx J. Regulation of apo A-I gene expression by fibrates. Atherosclerosis. 1998;137 Suppl S19-23. [PMID: 9694537] CrossrefMedlineGoogle Scholar3. Lehmann JM, Moore LB, Smith-Oliver TA, Wilkison WO, Willson TM, Kliewer SA. An antidiabetic thiazolidinedione is a high affinity ligand for peroxisome proliferator-activated receptor (PPAR ). J Biol Chem. 1995;270:12953-6. [PMID: 7768881] CrossrefMedlineGoogle Scholar4. Heinlein CA, Ting HJ, Yeh S, Chang C. Identification of ARA70 as a ligand-enhanced coactivator for the peroxisome proliferator-activated receptor . J Biol Chem. 1999;274:16147-52. [PMID: 10347167] CrossrefMedlineGoogle Scholar5. Oberfield JL, Collins JL, Holmes CP, Goreham DM, Cooper JP, Cobb JE, . A peroxisome proliferator-activated receptor ligand inhibits adipocyte differentiation. Proc Natl Acad Sci U S A. 1999;96:6102-6. [PMID: 10339548] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Thomas Jefferson University Hospital; Philadelphia, PA 19107. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySevere HDL-c reduction during rosiglitazone therapy in an obese woman with type 2 diabetesParadoxical Severe Decrease in High-Density Lipoprotein Cholesterol Due to Rosiglitazone-Fenofibrate InteractionHDL Cholesterol Reduction during Rosiglitazone and Fenofibrate Treatment in a Type 2 Diabetes Mellitus Patient with DyslipidemiaIatrogenic Severe Depression of High-Density Lipoprotein CholesterolFibratesCombination thiazolidinedione and fibrate effect on high-density lipoprotein cholesterol (HDL-C) concentration in a Veterans Affairs patient populationReduced High-density Lipoprotein Cholesterol in Patients Receiving Rosiglitazone and FenofibrateFibrate TherapyHigh incidence of reduced plasma HDL cholesterol in diabetic patients treated with rosiglitazone and fibrateSevere acquired (secondary) high-density lipoprotein deficiencyParadoxical HDL-C reduction during rosiglitazone and fibrate treatmentParadoxically Decreased HDL-Cholesterol Levels Associated with Rosiglitazone TherapySevere Decrease in Serum HDL-Cholesterol During Combination Therapy of Bezafibrate and PioglitazoneThiazolidinediones and Lowered HDL CholesterolSevere Hypo-α-Lipoproteinemia During Treatment With Rosiglitazone 4 November 2003Volume 139, Issue 9Page: W-80KeywordsApolipoproteinsCholesterolGene expressionHigh density lipoproteinLiverOilsPrimary care physiciansStable coronary artery diseaseTranscription factorsType 2 diabetes ePublished: 4 November 2003 Issue Published: 4 November 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...