HYPOCHOLESTEROLEMIA SECONDARY TO ATROVASTATIN THERAPY
AbstractAfter the advent of Statins in 1960’s, they are being extensively used as Antiathrogenic drug forPrimary Hyperlipidemia, Angina, Ischemic Heart Disease (Medical or Post Surgical), Atherosclerosis,Diabetes mellitus and Hypertension. Rarely, these drugs have been observed to causehypocholesterolemia. We present a case of forty years old male who was started on Atorvastatin afterhis angioplasty following anterior myocardial infarction. Six weeks after the start of antilipid drugpatient developed symptoms of phobias, nightmares, insomnia, forgetfulness, body aches, musclecramps, cognitive, sexual and psychomotor disturbances. On investigation he was found to havehypocholesterolemia. Atorvastatin was stopped and dietary restrictrictions were lifted. Over five monthpatients symptoms resolved as the serum cholesterol levels became normal. Because of similarities ofsymptoms of hypocholesterolemia secondary to antilipid therapy and the disease itself,hypocholesterolemia was overlooked initially by physicians. Patients on antilipids must be evaluatedfor any fall in serum cholerterol if they develop unusual symptoms and patients on long term antilipidsmust have regularly lipid profile checked.Keywords: Hypocholesterolemia, Statins, Fiberates, HMG-CoA reductase, VLDL, HDL,Triglycerides, LPL
Tobert JA. Lovastatin and beyond: the history of the HMGCoA reductase inhibitors. Nat Rev Drug Discov. 2003;2:517–
Endo A. The discovery and development of HMG-CoA
reductase inhibitors. J Lipid Res. 1992 Nov;33:1569–82
Endo A. The discovery and development of HMG-CoA
reductase inhibitors. 1992.Atheroscler Suppl. 2004;5(3):67–80.
Thorp JM, Warning WS. Modification of metabolism and
distribution of lipids by ethyl chlorophenoxyisobutyrate.
Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam
MB, et al. Gemfibrozil for the secondary prevention of
coronary heart disease in men with low levels of high-density
lipoprotein cholesterol. Veterans Affairs High-Density
Lipoprotein Cholesterol Intervention Trial Study Group. N
Engl J Med. 1999;341:410–8
Wallace A, Chinn D, Rubin G. Taking simvastatin in the
morning compared with in the evening: randomised controlled
trial. BMJ 2003;327(7418):788.
Knatterud GL, Rosenberg Y, Campeau L, Geller NL,
Hunninghake DB, Forman SA, et al Forrester JS, Gobel FL,
Herd JA, Hickey A, Hoogwerf BJ, Terrin ML, White C. Longterm effects on clinical outcomes of aggressive lowering of lowdensity lipoprotein cholesterol levels and low-dose
anticoagulation in the post coronary artery bypass graft trial. Post
CABG Investigators. Circulation. 2000;102(2):157–65
Haines TH. Do sterols reduce proton and sodium leaks through
lipid bilayers? Prog Lipid Res. 2001;40:299–324
Cilla DD Jr, Gibson DM, Whitfield LR, Sedman AJ.
Pharmacodynamic effects and pharmacokinetics of atorvastatin
after administration to normocholesterolemic subjects in the
morning and evening. J Clin Pharmacol 1996;36:604–9.
Smith LL. Another cholesterol hypothesis: cholesterol as
antioxidant. Free Radic Biol Med 1991;11(1):47–61.
Moutzouri E, Elisaf M, Liberopoulos EN.
Hypocholesterolemia. Curr Vasc Pharmacol. 2011;9:200–12
Evans M, Roberts A, Davies S, Rees A. Medical lipidregulating therapy: current evidence, ongoing trials and future
developments. Drugs 2004;64:1181–96.
Acharjee S, Welty FK. Atorvastatin and cardiovascular risk
in the elderly patient considerations. Clin Interv Aging.
Song JX, Ren JY, Chen H. Primary and secondary
hypocholesterolemia. Beijing Da Xue Xue Bao.
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