Short report

A paradoxical severe decrease in serum HDL-cholesterol after treatment with a fibrate

M A Crook¹, J Lynas¹ and R Wray²

¹ Department of Chemical Pathology, Guy's, St Thomas's, and University Lewisham Hospital, London SE1 9RT, UK
² Department of Cardiology, Conquest Hospital, Hastings, Sussex TN37 7RD, UK

Correspondence to:
Dr Crook Department of Chemical Pathology, 5th Floor Tower, Guy's Hospital, London SE1 9RT, UK martin.crook{at}gstt.sthames.nhs.uk

There have been a handful of reports in the literature of a paradoxical decrease in serum high density lipoprotein (HDL)-cholesterol in patients on fibrate drugs. The reason for this decline in cardioprotective HDL-cholesterol is not known and may have potential deleterious effects on the patient. This report describes a decrease in serum HDL-cholesterol in a patient on both simvastatin and bezafibrate. This patient also developed abnormal renal function, probably interstitial nephritis. In addition, the literature of fibrate induced serum HDL-cholesterol decline is reviewed and possible mechanisms for this phenomenon discussed.

Key Words: fibrate • high density lipoprotein-cholesterol • renal function

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