Medication Induced Changes in Lipid and Lipoproteins

Excerpt

Several medications and medication classes have been reported to affect the lipid profile. Risk factors include elevated lipid levels at baseline and high cardiovascular (CV) risk patients. This should be considered when evaluating patients with elevated levels of total cholesterol (TC), low-density lipoproteins cholesterol (LDL-C), non-high-density lipoprotein cholesterol (Non-HDL-C), triglycerides (TG) and reductions in high-density lipoprotein cholesterol (HDL-C). Cardiovascular medications, antipsychotics, anticonvulsants, hormones and certain immunosuppressives are just some of the more commonly known medications to have a negative impact on lipid levels. In some cases, this is a class effect and in others it might depend on dose and specific drug. However, how this translates to atherosclerotic cardiovascular disease (ASCVD) risk remains unknown, as there is insufficient evidence on the impact of these metabolic changes on overall risk of ASCVD. While for many of these medications, there is an abundance of literature and comprehensive reviews discussing the potential harmful effects of on lipoprotein metabolism there remains much debate about the actual long-term implications, if any, of these changes. A thorough risk-benefit analysis of each treatment associated with an adverse effect on the lipid profile should be done based on individual patient factors. In general, if negative changes in the lipid profile are observed during therapy, replacement with an equivalent alternative therapy can be recommended. If no equivalent therapy is available and treatment must be initiated, then monitoring of serum lipid levels is vital. The use of existing guidelines for the management of dyslipidemia in the general population can be referred to and in extreme cases when benefits do not outweigh the risks; the use of the suspected medication should be reassessed. For complete coverage of this area and all of Endocrinology, visit www.endotext.org.