Influence of 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitor, Pravastatin, on Corticosteroid Metabolism in Patients with Heterozygous Familial Hypercholesterolemia

Abstract

The present study examined whether hypolipidemic therapy with a potent 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, pravastatin, influences corticosteroid metabolism in patients with heterozygous familial hypercholesterolemia (FH). Urinary excretion of tetrahydrocortisone, tetrahydrocortisol, 6β-hydroxycortisol and free cortisol were determined in 22 patients with heterozygous FH before and after pravastatin administration (10 mg/day for 2 months). Pravastatin induced a statistically significant decrease in serum total cholesterol in patients with heterozygous FH from 6.9 ± 0.1 to 5.9 ± 0.1 mmol/l (p < 0.05). No significant changes were seen in the urinary tetrahydrocortisone, tetrahydrocortisol and free cortisol levels before and after pravastatin therapy. Urinary excretion of 6β-hydroxycortisol was significantly (p < 0.05) increased after pravastatin administration. These results suggest that the hypolipidemic effect of pravastatin in patients with heterozygous FH does not influence the corticosteroid metabolism. The increase in urinary 6β-hydroxycortisol may be caused by pravastatin-induced hepatic microsomal 6β-hydroxylase induction.

Effects of evolocumab therapy and low LDL‐C levels on vitamin E and steroid hormones in Chinese and global patients with type 2 diabetes

“…Assessment of gonadal hormone production in women receiving lipid‐lowering therapy is complicated by the menstrual cycle and menopause and has thus not been studied extensively. In men, most statin studies have not found any impairment in testosterone production . Similarly, we did not find any change in serum testosterone or gonadotropins during this study.…”

“…For statins, multiple studies have shown that the adrenal gland continues to synthesize cortisol normally, despite marked LDL lowering . However, even in patients with markedly impaired LDL receptor function (ie, homozygous familial hypercholesterolaemia), adrenal function is normal and remains normal on lipid‐lowering therapy .…”

Effects of Evolocumab on Vitamin E and Steroid Hormone Levels

“…35,36 The impact of statins on adrenal function has been studied in multiple populations with a wide variety of statins. 23,[25][26][27][28][29]31,32,[37][38][39][40][41][42][43][44][45] None of these studies showed clinically relevant impairment of adrenal function, secondary to statin therapy. Patients with heterozygous or homozygous familial hypercholesterolemia could also theoretically be at increased risk of adrenal dysfunction because of their reduced capacity to use LDL receptor-mediated cholesterol uptake.…”