title: Low incidence of paradoxical reductions in HDL-C levels in dyslipidemic patients treated with fenofibrate alone or in combination with ezetimibe or ezetimibe/simvastatin.
abstract: BACKGROUND
  Fibrates have been reported to cause paradoxical decreases in HDL-C in certain patients.
  
  
  METHODS
  This post-hoc analysis explored the frequency/magnitude of HDL-C reductions in a pooled database of mixed dyslipidemic patients (LDL-C:3.4-5.7 mmol/L;TG:1.7-5.7 mmol/L) receiving placebo (PBO), fenofibrate (FENO), ezetimibe plus FENO (EZE+FENO), or EZE/simvastatin plus FENO (EZE/SIMVA+FENO) for 12 weeks.
  
  
  RESULTS
  PBO-treated patients had the highest incidence of HDL-C reductions from baseline (45%) compared with patients taking FENO (14%), EZE+FENO (9%), or EZE/SIMVA+FENO (9%). Reductions <30% reflected natural variability since the largest reduction in HDL-C approached 30% in the PBO group. Only 3 patients exhibited HDL-C reductions ≥30% (i.e., 2 patients in the FENO group and 1 in the EZE+FENO group). There were no differences in demographic/biochemical characteristics between patients with and without HDL-C reductions.
  
  
  CONCLUSIONS
  The incidence of paradoxical HDL-C reductions was low in mixed dyslipidemic patients receiving FENO alone or combined with EZE or EZE/SIMVA.
authors.affiliation: Point Medical, Dijon, France. MichelFarnier@nerim.net
authors.forename: Michel
authors.initials: M
authors.lastname: Farnier
authors.forename: Qian
authors.initials: Q
authors.lastname: Dong
authors.forename: Arvind
authors.initials: A
authors.lastname: Shah
authors.forename: Amy O
authors.initials: AO
authors.lastname: Johnson-Levonas
authors.forename: Philippe
authors.initials: P
authors.lastname: Brudi
mesh_terms: D000328:Adult; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001384:Azetidines / Q000627:therapeutic use*; D008076:Cholesterol, HDL / Q000097:blood*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy*; D000069438:Ezetimibe; D005260:Female; D011345:Fenofibrate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019821:Simvastatin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D008076:Cholesterol, HDL; D019821:Simvastatin; D000069438:Ezetimibe; D011345:Fenofibrate
references.citation: JAMA. 2009 Nov 11;302(18):1993-2000
references.pmid: 19903920
references.citation: Lancet. 2010 May 29;375(9729):1875-84
references.pmid: 20462635
references.citation: Eur Heart J. 2011 Jun;32(11):1345-61
references.pmid: 21531743
references.citation: Clin Chem. 2010 Jun;56(6):977-86
references.pmid: 20378768
references.citation: Am J Cardiol. 2010 Sep 15;106(6):757-63
references.pmid: 20816113
references.citation: Ann Intern Med. 2003 Nov 4;139(9):W80
references.pmid: 14597479
references.citation: Diabetes Care. 2010 Jan;33 Suppl 1:S4-10
references.pmid: 20042774
references.citation: J Clin Pathol. 2009 Mar;62(3):250-3
references.pmid: 19251953
references.citation: Curr Atheroscler Rep. 2001 Jan;3(1):83-92
references.pmid: 11123853
references.citation: N Engl J Med. 1987 Nov 12;317(20):1237-45
references.pmid: 3313041
references.citation: Endocr Pract. 2010 May-Jun;16(3):382-8
references.pmid: 20061291
references.citation: Ann Clin Biochem. 1997 Sep;34 ( Pt 5):573-4
references.pmid: 9293321
references.citation: J Atheroscler Thromb. 2006 Oct;13(5):263-4
references.pmid: 17146155
references.citation: Pharmacogenet Genomics. 2009 Feb;19(2):161-9
references.pmid: 19057464
references.citation: Diabetes Care. 2004 Sep;27(9):2241-2
references.pmid: 15333491
references.citation: Eur Heart J. 2007 Jan;28(1):88-136
references.pmid: 17220161
references.citation: N Engl J Med. 2010 Apr 29;362(17):1563-74
references.pmid: 20228404
references.citation: Ann Clin Biochem. 1999 Jul;36 ( Pt 4):523-5
references.pmid: 10456219
references.citation: N Engl J Med. 1999 Aug 5;341(6):410-8
references.pmid: 10438259
references.citation: J Am Coll Cardiol. 2005 Jan 18;45(2):185-97
references.pmid: 15653014
references.citation: N Engl J Med. 2010 Aug 12;363(7):692-4; author reply 694-5
references.pmid: 20842772
references.citation: Lancet. 2005 Nov 26;366(9500):1849-61
references.pmid: 16310551
references.citation: Ann Clin Biochem. 1996 Mar;33 ( Pt 2):159-61
references.pmid: 8729728
references.citation: Circulation. 2000 Jul 4;102(1):21-7
references.pmid: 10880410
references.citation: Cardiovasc Ther. 2010 Jun;28(3):153-60
references.pmid: 20337637
references.citation: Pharmacol Ther. 2006 Sep;111(3):893-908
references.pmid: 16574234
references.citation: Diabet Med. 2007 Jan;24(1):94-7
references.pmid: 17227331
references.citation: N Engl J Med. 2007 Sep 27;357(13):1301-10
references.pmid: 17898099
references.citation: Eur Heart J. 2011 Jul;32(14):1769-818
references.pmid: 21712404
references.citation: Ann Pharmacother. 2006 Sep;40(9):1672-6
references.pmid: 16912247