Abstract
Various alterations of lipid homeostasis have a significant role in the pathophysiology of the artherosclerotic process. The effects of usual lipid-lowering agents such as statins, fibrates, or niacin are well known, but other endocrine therapeutic agents could also affect the blood levels of various lipoproteins and, in turn, influence atheroma formation. In this review, we attempt to summarize the effect of several hormonal and non-hormonal endocrine agents on lipid metabolism, including insulin, thyroid hormone, sex hormones, glucocorticoids, growth hormone, and several anti-diabetic agents.
Highlights
Many endocrine therapeutic agents can affect lipid metabolism (Table 1)
Hypertriglyceridemia is one of the most common lipid abnormalities seen in poorly controlled diabetic patients and this is frequently associated with low plasma high-density lipoprotein (HDL) level and an increase in apolipoprotein B-containing lipoproteins
In the same study evaluating the post-prandial effects of exenatide, there was no significant decline in Non-esterified fatty acids (NEFA) in the early post-prandial period (0-4 hours) with exenatide versus placebo, but exenatide appeared to reduce NEFA levels in the late post-prandial period (6–8 hours), and the difference was significant (P < 0.0001). This prolonged reduction in NEFA may demonstrate a drug time–related effect with exenatide compared to placebo [43]. These findings demonstrated improvement in lipid profile independent of glucose tolerance status or weight loss associated with exenatide
Summary
Many endocrine therapeutic agents (hormonal and non-hormonal) can affect lipid metabolism (Table 1). Several small prospective studies reported elevations of total and HDL cholesterol levels, a neutral effect on LDL cholesterol, and variable response of the triglyceride levels with oral agents, but no significant changes of plasma lipids were seen with the inhaled preparations [34]. The addition of sitagliptin (Januvia; Merck & Co., Whitehouse Station, NJ) to metformin to help improve glycemic control in uncontrolled diabetic patients showed a small but statistically significant decrease in total cholesterol (2.8%), triglycerides (16.9%), and non-HDL cholesterol (4.8%) when compared with placebo. There was a small but statistically significant increase in HDL (2%) but no difference in LDL between the sitagliptin and placebo group [54] Another placebo-controlled study showed that treatment with vildagliptin (Galvus, Novartis) for 4 weeks improves postprandial plasma triglyceride and apoB-48–containing triglyceride-rich lipoprotein particle metabolism after a fat-rich meal [55].
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