Paradoxical High-Density Lipoprotein Reduction Induced by Fenofibrate and Ciprofibrate:

Recent studies have confirmed the benefit of cholesterol reduction in the secondary prevention of ischaernic heart disease! and a recent editorial has cogently summarized the reasons why.? The objective of therapy is to reduce total cholesterol values to 5·2 mrnol/L or less. The fibric acid derivative class of lipid lowering agent have been demonstrated to be useful agents for the treatment of hyperlipidaemia! and for regression of atheroma.' They are considered particularly useful when there is hyperlipidaemia associated with increased triglycerides and for their documented effect on increasing the highdensity lipoprotein fraction (HDL) as well as decreasing low-density lipoprotein (LDL).4 Such patients may be routinely monitored by following the total cholesterol. We present a case report of paradoxical reduction in HDL due to fenofibrate and illustrate the importance of lipoproteins in monitoring therapy.