the Impact of Evista on Triglyceride Levels in Elderly Patients

Lipid disorders

Dear Dr.
He,
My mother is 84 years old and has a history of hyperlipidemia.
She has been taking the statin medication, Mevacor (lovastatin), for many years, and her triglycerides (TG) and total cholesterol (TC) levels have been reasonably controlled.
In 2018, her TG was 178 and TC was 227; in 2019, TG was 189 and TC was 206; by October 2019, TG rose to 305 while TC was 162.
Her cardiologist switched her to a lipid-lowering medication that is more effective for TG.
By February 2021, her TG decreased to 217 and TC to 177.

Two years ago, my mother suffered a compression fracture due to osteoporosis and completed a treatment course with Forteo (teriparatide).
Starting in February, she switched to Evista (raloxifene) for osteoporosis treatment, as she could not use bisphosphonates due to poor dental health.
In March, her routine health check showed TG rising again to 291 and TC at 171.
During this month, her diet and exercise habits did not significantly change.
The Evista package insert states that it does not affect triglycerides, but it also mentions that some women who previously experienced hypertriglyceridemia (>5.6 mmol/L or >500 mg/dL) due to oral estrogen or estrogen plus progestin may also experience elevated triglycerides while taking Evista.
I would like to ask you, based on your understanding and clinical experience, is it common for this selective estrogen receptor modulator to cause an increase in triglycerides? Thank you for taking the time to respond.

yts, 50~59 year old female. Ask Date: 2021/06/06

Dr. He Dongjin reply Cardiology

Hello, it is not uncommon for older individuals to take multiple medications, which can lead to potential drug interactions.
It is important to prioritize based on the severity of the issues at hand.
If the current concern is severe osteoporosis, it should be addressed first, while high triglycerides can be monitored as they are relatively less urgent and have a smaller impact.
This is just my personal opinion for your reference.
Changhua Hospital cares about you.

Reply Date: 2021/06/06

More Info

Evista (Raloxifene) is a selective estrogen receptor modulator (SERM) primarily used for the treatment of osteoporosis in postmenopausal women. It mimics estrogen's beneficial effects on bone density while avoiding some of the risks associated with estrogen therapy, such as breast and uterine cancer. However, its impact on lipid profiles, particularly triglycerides (TG), is an important consideration, especially in elderly patients with a history of hyperlipidemia.

In your mother's case, it is notable that her triglyceride levels increased significantly after starting Evista, rising from 217 mg/dL to 291 mg/dL within a month. While the product information for Evista states that it does not typically affect triglyceride levels, there are some nuances to consider.
1. Individual Variability: The response to medications can vary significantly among individuals. Some patients may experience changes in lipid levels due to various factors, including genetic predisposition, diet, physical activity, and concurrent medications. In elderly patients, these factors can be compounded by age-related physiological changes that affect drug metabolism and lipid metabolism.

2. Hormonal Influence: Evista, being a SERM, interacts with estrogen receptors and can have estrogen-like effects on certain tissues. In some cases, patients who have previously experienced hypertriglyceridemia while on estrogen therapy may also see similar effects with Evista. Although the incidence is not common, it is plausible that your mother could be one of the exceptions.

3. Monitoring and Management: Given your mother's history of hyperlipidemia and the recent increase in triglyceride levels, it is essential to monitor her lipid profile closely. If the elevation in triglycerides persists or worsens, it may be necessary to reassess her treatment plan. This could involve adjusting her Evista dosage, considering alternative osteoporosis treatments, or intensifying her lipid-lowering therapy.

4. Diet and Lifestyle: While the medication may play a role in her triglyceride levels, dietary habits and lifestyle choices are critical components of managing hyperlipidemia. Ensuring a heart-healthy diet, rich in omega-3 fatty acids, fiber, and low in saturated fats and sugars, can help mitigate triglyceride levels. Regular physical activity is also beneficial.

5. Consultation with Healthcare Providers: It is advisable to discuss these changes with her healthcare provider. They can evaluate her overall health status, consider potential interactions with her current medications (like statins), and determine the best course of action. This may include dietary counseling, medication adjustments, or further investigations to rule out other causes of elevated triglycerides.

In summary, while Evista is not commonly associated with increased triglyceride levels, individual responses can vary. Given your mother's situation, it is crucial to monitor her lipid levels closely and consult with her healthcare provider to ensure her treatment plan is optimized for her health needs.

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