Secondary dyslipidemia. Inadvertent effects of drugs in clinical practice.
OBJECTIVE
To examine the available literature on commonly prescribed drugs and their effects on blood lipid and lipoprotein levels.


METHODS
The review was based on searches of English-language articles from 1975 to 1990 by Medlars II and MEDLINE programs, the Index Medicus for 1980 to 1990, and references from identified articles. Relevant journals published within the last 6 months were also examined.


METHODS
More than 500 articles were identified for inclusion. Articles were selected on the basis of appropriateness of design to demonstrate significant results, determined by consensus when necessary.


METHODS
Studies were classified according to type (observational or interventional), length of follow-up, and type of controls. Quanitative analysis of lipid, lipoprotein, and apoprotein changes induced by drugs was computed as the percentage of change observed during the course of the study (interventional) or compared with the controls at a given time (observational).


RESULTS
Steroid hormones that have strong progestogenic and androgenic properties, retinoids, cyclosporine A, and phenothiazines are potentially atherogenic. Steroid hormones with dominant estrogenic properties, several anticonvulsants, biguanides, high-dose ketoconazole, and aminosalicylic acid are potentially antiatherogenic. Corticosteroids appear to elevate all the lipoprotein cholesterol levels. Oral estrogens, retinoids, and corticosteroids also can elevate triglyceride levels. Other drugs with questionable effects on lipoprotein metabolism are reviewed.


CONCLUSIONS
Although the long-term implications of drug-induced lipoprotein changes are still undefined, physicians need to consider these effects in clinical practice.
Henkin
Y
Y
Division of General and Preventive Medicine, University of Alabama, Birmingham 35294.
Como
J A
JA
Oberman
A
A
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D045930:Anabolic Agents / Q000009:adverse effects; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003276:Contraceptives, Oral / Q000009:adverse effects; D045166:Estradiol Congeners / Q000009:adverse effects; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000139:chemically induced; D006949:Hyperlipidemias / Q000139:chemically induced*; D011372:Progestins / Q000009:adverse effects; D012176:Retinoids / Q000009:adverse effects
D000305:Adrenal Cortex Hormones; D045930:Anabolic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D003276:Contraceptives, Oral; D045166:Estradiol Congeners; D011372:Progestins; D012176:Retinoids