Impact of mifepristone, a glucocorticoid/progesterone antagonist, on HDL cholesterol, HDL particle concentration, and HDL function

Stephanie T. Page, Ronald M. Krauss, Coleman Gross, Brian Ishida, Jay W. Heinecke, Chongren Tang, John K. Amory, Peter M. Schaefer, Cheryl J. Cox, John Kane, Jonathan Q. Purnell, Richard L. Weinstein, Tomaš Vaisar

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Context: Mifepristone is a glucocorticoid and progestin antagonist under investigation for the treatment of Cushing's syndrome. Mifepristone decreases high-density lipoprotein (HDL) cholesterol (HDL-C) levels in treated patients, but the clinical significance of this is unclear because recent studies suggest that functional properties of HDL predict cardiovascular disease status better than does HDL-C concentration. Objective: The aim of the study was to characterize the impact of mifepristone administration on HDL particle concentration and function. Design and Setting: We conducted a double-blind, randomized, placebo-controlled trial at a single-site, clinical research center. Participants: Thirty healthy postmenopausal female volunteers participated in the study. Intervention: Individuals were randomized to receive daily oral mifepristone (600 mg) or placebo for 6 wk. Main Outcome Measures: We measured HDL-C, serum HDL particle concentration, and HDL-mediated cholesterol efflux by treatment group. Results: As expected, ACTH, cortisol, estradiol, and testosterone levels increased in the mifepristone group. Mifepristone treatment decreased HDL-C and HDL particle concentration by 26 and 25%, respectively, but did not alter pre-β HDL concentration. In contrast, the serum HDL-mediated cholesterol efflux decreased with mifepristone treatment by only 12%, resulting in an effective increase of the efflux capacity per HDL particle. No changes were observed in cholesterol ester transfer protein or lecithin:cholesterol acyltransferase activity. Conclusions: Treatment with mifepristone reduced HDL-C, HDL particle concentration, and serum HDL cholesterol efflux in postmenopausal women. However, on a per particle basis, the efflux capacity of serum HDL increased. These observations support the concept that a decrease in HDL-C may not represent proportional impairment of HDL function.

Original languageEnglish (US)
Pages (from-to)1598-1605
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number5
DOIs
StatePublished - May 2012

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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