HDL Cholesterol Reduction during Rosiglitazone and Fenofibrate Treatment in a Type 2 Diabetes Mellitus Patient with Dyslipidemia

Mijeong Im; Minki Kim; Jin Kyung Lee; Yoon Hwan Chang; Dong Young Lee; Seok-Il Hong; Yun Yong Lee; Young Jun Hong

doi:10.3343/kjlm.2010.30.1.17

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Im, Kim, Lee, Chang, Lee, Hong, Lee, and Hong: HDL Cholesterol Reduction during Rosiglitazone and Fenofibrate Treatment in a Type 2 Diabetes Mellitus Patient with Dyslipidemia

Case Report

Korean J Leg Med 2010;30(1):17-19.

Published online: 14 January 2010

DOI: https://doi.org/10.3343/kjlm.2010.30.1.17

HDL Cholesterol Reduction during Rosiglitazone and Fenofibrate Treatment in a Type 2 Diabetes Mellitus Patient with Dyslipidemia

Mijeong Im, M.D.¹, Minki Kim, M.D.¹, Jin Kyung Lee, M.D.¹, Yoon Hwan Chang, M.D.¹, Dong Young Lee, M.D.¹, Seok-Il Hong, M.D.¹, Yun Yong Lee, M.D.², Young Jun Hong, M.D.¹

¹Departments of Laboratory Medicine, Korea Cancer Center Hospital, Seoul, Korea, Seoul, Korea

²Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea

Corresponding author: Young Jun Hong, M.D. Department of Laboratory Medicine, Korea Cancer Center Hospital, 75 Nowon-gil, Nowon-gu, Seoul 139-706, Korea Tel: +82-2-970-2492, Fax: +82-2-973-7143 E-mail: clinchem@kcch.re.kr

Revised 17 September 20094 December 2009 Accepted 29 December 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Thiazolidinediones (TZD), which are widely used as insulin sensitizers, and fibrates, which are lipid-lowering drugs, are used in the treatment of dyslipidemia that commonly accompanies diabetes. Several reports suggest elevated levels of high-density lipoprotein (HDL) cholesterol, but the paradoxical reduction of HDL cholesterol level during single or combined TZD and fibrate therapies has been occasionally reported. Herein, we report a case of paradoxical decrease in HDL cholesterol and apolipoprotein A-1 levels during rosiglitazone and fenofibrate treatment for the first time in Korea. The patient was a 56-yr-old man presenting with type 2 diabetes mellitus and dyslipidemia. His HDL cholesterol and apolipoprotein A-1 levels returned to normal after the cessation of fenofibrate therapy. Since diabetes is an established risk factor of cardiovascular diseases, low HDL cholesterol can be a key cause of concern for patients with diabetes. Therefore, HDL cholesterol level should be determined before and after starting TZD and/or fibrate therapy in diabetic patients.

Keywords: HDL cholesterol, Rosiglitazone, Fenofibrate

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Fig. 1.

Diagrammatic representation of the serum lipid levels in relation to oral hypoglycemic and lipid-lowering therapy.

Table 1.

Serum lipid levels in the patient during and after fenofibrate treatment

Test item	Reference interval	January∗ 2008	February 2008	April^† 2008	May 2008	June^‡ 2008
Total cholesterol (mmol/L)	≤5.17	6.54	4.24	3.85	4.76	4.47
HDL-cholesterol (mmol/L)	≥1.55	0.11	ND	0.09	ND	0.78
Apolipoprotein A-I (g/L)	1.10-1.80	0.20	ND	ND	ND	1.08
Triglyceride (mmol/L)	≤2.26	2.80	ND	2.24	ND	3.92

^∗ during fenofibrate treatment;

^† cessation of fenofibrate treatment;

^‡ 60 days after the cessation of fenofibrate treatment.

Abbreviations: ND, not determined

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