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The production of cholesterol is linked to many important pathways in the body. These pathways can be altered or influenced by many common drugs. There are known drugs which can raise both cholesterol and triglycerides. In some of these compounds the increase is small and probably has little clinical significance. In others, the increase is much more significant and careful judgment about use of these agents is needed. The ultimate question is whether the benefit of taking any of these medications outweighs any increased risk associated with higher lipid levels.

Cardiovascular drugs that affect the lipid profile include diuretics, beta blockers and some angiotensin converting enzyme inhibitors (ACE inhibitors). Thiazide diuretics such as hydrochlorthiazide are well known to raise LDL, or "bad" cholesterol, by 5-10% and raise triglycerides by 5-15%. These increases in cholesterol levels often return to the original point after one year and are not as significant on lower doses. Beta blockers have little effect on LDL cholesterol but can raise triglycerides by 10-40% and lower HDL, "good" cholesterol, by 5-20%. Angiotensin converting enzyme inhibitors may increase triglycerides, especially in patients with diabetes.

In the hormone category, it is known that estrogens alone can increase triglycerides by as much as 40%. Progesterones can elevate LDL by about 15%. The different combinations of these hormones produce different additive effects. Oral contraceptives also elevate triglycerides by as much as 50%. The older generation contraceptives also increased LDL, or "bad" cholesterol, by as much as 10%. However, but some of the newer contraceptives can actually improve LDL. Danazol, a compound used mainly in endometriosis, raises LDL by 10-40% and lowers HDL by 50%.

Isoretinoids, used for acne treatment, have a profound effect on triglycerides, raising them by 35-140%. The also raise total cholesterol by 15%, mainly in the LDL component.

Immunosuppressive drugs used after organ transplant or in chemotherapy are also known to raise cholesterol and triglycerides by up to 50%.

Drugs used to treat HIV infections, called protease inhibitors, have an impact on lipids, raising total cholesterol and triglycerides by as much as 200%. Some of the newer agents in this category such as Saquinavir have no effect on lipids.

Antipsychotic drugs such as clozapine can cause marked weight gain and along with the gain an elevation of triglycerides of up to 50%.

The final category of drugs having significant impact on lipids is the anticonvulsants. Drugs such as tegretol, dilantin and valproic acid can raise total cholesterol by as much as 15%.

Every drug that is prescribed is a risk benefit decision. Some of these elevations in lipids may be quite secondary to treating the underlying, more serious, condition. For example, taking immunosuppressive medications after a transplant may not be an option, and a slightly elevated cholesterol level would be a small price to pay when the alternative is organ rejection. In other cases, the decision may be harder to make. As always, every person must work with his or her doctor to customize the best combination of treatments.

Learn more about this author, Erich Rosenberger M.D..
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