Combination Therapy With Fenofibrate and Rosiglitazone Paradoxically Lowers Serum HDL Cholesterol
- Lena Normén, PHD12,
- Jiri Frohlich, MD, FRCPC23,
- Julio Montaner, MD4,
- Marianne Harris, MD4,
- Tom Elliott, MBBS5 and
- Greg Bondy, MD, FRCPC23
- 1Canadian HIV Trials Network, Pacific Region, Vancouver, British Columbia, Canada
- 2Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- 3Healthy Heart Program, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- 4BC Centre for Excellence of HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- 5Department of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
- Address correspondence and reprint requests to Greg Bondy, MD, FRCPC, Healthy Heart Program, B180-1800 Burrard St., St. Paul’s Hospital, Vancouver, BC, V6Z 1Y6, Canada. E-mail: gbondy{at}providencehealth.bc.ca
Thiazolidinediones (TZDs) are insulin sensitizers widely used in the treatment of type 2 diabetes (1). Fibrates are lipid-lowering drugs that lower triglycerides (TGs) and increase HDL cholesterol (2). Individually, fibrates and TZDs generally raise HDL cholesterol. In this study, we report that certain patients treated with a combination of fibrates (fenofibrate) and a TZD (rosiglitazone) show a paradoxical fall in HDL cholesterol levels.
Chart reviews were performed to identify patients on combination therapy with TZDs and fibrates. Information about age, BMI, sex, type of treatment, duration of either single (fibrate) or combination therapy (fibrate + TZD), and blood lipids was collected. There were nine HIV-positive patients who started combination treatment with fenofibrate and rosiglitazone, of whom all experienced a decrease in serum HDL cholesterol concentrations (Table 1). We compared these changes in HDL cholesterol concentrations with those of HIV-negative patients with type …
