title: Severe decrease in high-density lipoprotein cholesterol with the combination of fibrates and ezetimibe: A case series.
abstract: A sudden and severe drug-induced decrease in plasma high-density lipoprotein cholesterol (HDL-C) is a rare condition. We report 2 patients with familial hypercholesterolemia treated with statins and fibrates and 2 others with mixed dyslipidemia treated with fibrates, who presented with a sudden and severe decrease in HDL-C (from -44% to -95%, compared with baseline). Three of the patients were treated with fibrates and had a sudden decrease in HDL-C after the adjunction of ezetimibe. HDL-C returned to normal levels after discontinuation of the offending therapies. In 2 of these patients, the reintroduction of ezetimibe with no fibrates did not affect HDL-C. In conclusion, we report a new profile of patients who are at risk for a sudden drop of HDL-C related to treatment with a combination of fibrates and ezetimibe. Although a sudden drop of HDL-C is a rare event, we recommend to carefully monitor plasma HDL-C in patients submitted to both drugs.
authors.affiliation: Department of Endocrinology, Metabolic diseases and Nutrition, l'institut du thorax, CHU de Nantes, Nantes, France; CRNH, Human Nutrition Research Center, CHU, Nantes, France; INRA, UMR 1280, Physiologie des Adaptations Nutritionnelles, CHU Hôtel-Dieu, Nantes, France. Electronic address: estelle.nobecourt-dupuy@univ-nantes.fr.
authors.forename: Estelle
authors.initials: E
authors.lastname: Nobecourt
authors.affiliation: Department of Endocrinology, Metabolic diseases and Nutrition, l'institut du thorax, CHU de Nantes, Nantes, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cariou
authors.affiliation: CRNH, Human Nutrition Research Center, CHU, Nantes, France; Inserm UMR1188 DéTROI, Université de La Réunion, CHU de la Réunion, Sainte Clotilde, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lambert
authors.affiliation: Department of Endocrinology, Metabolic diseases and Nutrition, l'institut du thorax, CHU de Nantes, Nantes, France; CRNH, Human Nutrition Research Center, CHU, Nantes, France; INRA, UMR 1280, Physiologie des Adaptations Nutritionnelles, CHU Hôtel-Dieu, Nantes, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Krempf
mesh_terms: D008076:Cholesterol, HDL / Q000097:blood*; D004347:Drug Interactions; D000069438:Ezetimibe / Q000494:pharmacology* / Q000627:therapeutic use; D058607:Fibric Acids / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D008076:Cholesterol, HDL; D058607:Fibric Acids; D000069438:Ezetimibe
keywords: Cardiovascular disease; Ezetimibe; Fibrates; HDL-C