Severe HDL Cholesterol Reduction with Bempedoic Acid and Fenofibrate

This correspondence reports a case of a 55-year-old man with familial hypercholesterolemia who experienced an extreme reduction in HDL cholesterol levels—nadir of 5 mg/dL—after initiating bempedoic acid in combination with fenofibrate. The patient’s HDL levels, reminiscent of those seen in Tangier disease, returned to normal upon discontinuation of fenofibrate. Retrospective review of previously published data revealed similar cases. The authors suggest a drug interaction between bempedoic acid and fenofibrate as the likely cause of this reversible phenomenon and call for further research, given the potential cardiovascular risks associated with severely diminished HDL cholesterol.

This correspondence reports a case of a 55-year-old man with familial hypercholesterolemia who experienced an extreme reduction in HDL cholesterol levels—nadir of 5 mg/dL—after initiating bempedoic acid in combination with fenofibrate. The patient’s HDL levels, reminiscent of those seen in Tangier disease, returned to normal upon discontinuation of fenofibrate. Retrospective review of previously published data revealed similar cases. The authors suggest a drug interaction between bempedoic acid and fenofibrate as the likely cause of this reversible phenomenon and call for further research, given the potential cardiovascular risks associated with severely diminished HDL cholesterol.