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Title: | Paradoxical decreases in high-density lipoprotein cholesterol with fenofibrate: A quite common phenomenon. | Authors: | Magee G.;Sharpe P.C. | Institution: | (Magee) Department of Medicine, Southern Health and Social Care Trust, Craigavon Area Hospital, Portadown, Northern Ireland, United Kingdom (Sharpe) Department of Clinical Biochemistry, Southern Health and Social Care Trust, Craigavon Area Hospital, Portadown, Northern Ireland, United Kingdom (Magee) Department of Endocrinology and Diabetes, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, United Kingdom | Issue Date: | 14-Oct-2012 | Copyright year: | 2009 | Publisher: | BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom) | Place of publication: | United Kingdom | Publication information: | Journal of Clinical Pathology. 62 (3) (pp 250-253), 2009. Date of Publication: March 2009. | Abstract: | Background: Reduced high-density lipoprotein cholesterol (HDL-C) concentration is considered to be an independent risk factor for cardiovascular morbidity and mortality. Fibrates are useful in managing dyslipidaemia; reports highlight an expected increase in HDL-C of 10-15% in conjunction with falls in plasma triglycerides of ~30%. Despite this, there are several reported cases of paradoxical decreases in HDL-C caused by fibrate treatment. Aim(s): To report the second largest observational study to date. Method(s): Fenofibrate use at a regional lipid clinic was associated with reductions in HDL-C in a considerable proportion of patients, necessitating cessation of the medication. In view of this, characteristics of the first 94 patients to be given fenofibrate were retrospectively analysed, and comparisons were made between those whose profiles responded as expected and those experiencing paradoxical decreases in HDL-C. Result(s): 94 patients (57 male; mean (SD) age 52.5 (12.5) years; mean (SD) body mass index 28.9 (4.5) kg/m2) were assessed. After 8-12 weeks on daily fenofibrate (200 mg micronised or equivalent), 43 of the patients (46%) showed a paradoxical decrease in HDL-C (in nine the decrease was >50% from baseline). When responses to fenofibrate were compared against baseline variables, there were no significant differences between groups other than a higher baseline HDL-C (p = 0.045) in patients responding appropriately. Conclusion(s): Fenofibrate was associated with a reduction in HDL-C in almost half the patients studied. This is substantially more than in most studies reported to date. Other HDL-C-raising strategies need to be considered in these patients, and the mechanisms need to be explored. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1136/jcp.2008.060913 | PubMed URL: | 19251953 [http://www.ncbi.nlm.nih.gov/pubmed/?term=19251953] | ISSN: | 0021-9746 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/31324 | Type: | Article | Subjects: | body mass clinical assessment controlled study drug dose increase drug response female human hypertriglyceridemia/dt [Drug Therapy] major clinical study male priority journal ezetimibe/dt [Drug Therapy] *fenofibrate/do [Drug Dose] *fenofibrate/pd [Pharmacology] *high density lipoprotein cholesterol/ec [Endogenous Compound] rosiglitazone/dt [Drug Therapy] simvastatin/dt [Drug Therapy] unclassified drug supralip atorvastatin/dt [Drug Therapy] adult article male priority journal drug dose increase controlled study drug response body mass clinical assessment female human hypertriglyceridemia / drug therapy major clinical study article adult |
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