title: Combination thiazolidinedione and fibrate effect on high-density lipoprotein cholesterol (HDL-C) concentration in a Veterans Affairs patient population.
abstract: BACKGROUND
  Type 2 diabetes mellitus (T2DM) is a coronary heart disease (CHD) risk equivalent warranting aggressive management of dyslipidemia and tight glycemic control. Recent reports demonstrate a paradoxic decrease in high-density lipoprotein cholesterol (HDL-C) with thiazolidinedione (TZD) and fibrate combination therapy.
  
  
  OBJECTIVE
  Evaluate change in HDL-C from start of combination therapy to 1 year and assess the proportion, characteristics, and regimens of patients who developed a ≥20% decrease in HDL-C from baseline.
  
  
  METHODS
  Patients with T2DM treated concurrently with a combination of TZD and fibrate were identified through retrospective query from a Veterans Affairs medical center database. HDL-C was recorded for 1 year after patients started combination therapy. Logistic regression analysis was performed to determine any predictors of HDL-C change.
  
  
  RESULTS
  A total of 322 patients were included in the analysis. There was no significant differences in mean ± standard deviation HDL-C from baseline to end point (36.8 ± 8.5 to 40.3 ± 11.8 mg/dL; P = 0.097). There was a subset of patients identified (13%; n = 43) on combination therapy who experienced a ≥20% reduction in HDL-C. Of these patients, a decrease in HDL-C was more likely to occur with fenofibrate-based regimens (odds ratio 3.08, 95% confidence interval 1.22 to 7.75; P = 0.018). There was a trend toward more of these patients in this subset to have the combination of rosiglitazone and fenofibrate in their profiles (odds ratio 2.82, 95% confidence interval 0.98 to 8.0; P = 0.064).
  
  
  CONCLUSIONS
  Our study demonstrated that a subset of patients with T2DM experienced a paradoxic decrease in HDL-C when taking a fibrate and TZD combination.
authors.affiliation: Texas Tech University Health Sciences Center, School of Pharmacy-DFW Campus Department of Pharmacy Practice, 4500 S. Lancaster Rd, Bldg. 7-R#119A, Dallas, TX 75216 USA and North Texas Veterans Affairs, Dallas, TX USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Alvarez
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Russell
authors.forename: Krystal L
authors.initials: KL
authors.lastname: Edwards
authors.forename: R Shane
authors.initials: RS
authors.lastname: Greene
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Chastain
authors.forename: Rick A
authors.initials: RA
authors.lastname: Weideman
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Busti