Unexpected and abnormally low HDL cholesterol levels on combination hypolipidemic therapy

In general, Indians have low HDL cholesterol levels. Fenofibrate, a drug widely used in the treatment of hypertriglyceridemia, usually also increases HDL cholesterol. There have been a few reports in the literature of a paradoxical decrease in serum HDL-cholesterol in patients treated with fenofibrate, either alone or in combination with a statin. We report three cases of paradoxical decrease in serum HDL-cholesterol in type 2 diabetic patients treated with a statin-fenofibrate combination.