Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens

Article Abstract:

Deposition of fatty plaque on the walls of arteries, the characteristic pathophysiological change associated with atherosclerosis, is partly a function of circulating concentrations of low-density lipoproteins (LDLs), one component of the cholesterol-carrying system. Blood LDLs carry cholesterol and other substances into deeper layers of the blood vessel wall; thus, one treatment for atherosclerosis consists of reducing LDL levels. Results from a randomized, controlled study of 72 patients with heterozygous familial hypercholesterolemia (an inherited condition associated with excess cholesterol) are presented, in which atherosclerotic lesions of the coronary arteries (which supply blood to the heart itself) were evaluated with the aid of computerized programs. Patients received dietary counseling and were randomly assigned to take a combination of medications (colestipol plus niacin, and lovastatin, when that drug became available), or no drugs. Thirty-two control subjects took no drugs while 40 were treated with the drug regimen. However, the control group's regimen was expanded partway through the trial to include colestipol at half the treatment group's dose for 14 people. The study lasted 26 months, and patients underwent angiography (X-ray of the coronary vessels after filling them with a dye) at its beginning and end. From these examinations, the percent diameter and percent cross-sectional area affected by stenosis (constriction) for a total of 457 lesions were calculated. Results showed an average reduction in LDL cholesterol levels by 38 percent for the treatment group and 10.6 percent for the controls. The treatment group showed a strong trend toward regression of the coronary artery lesions (reduction of 1.53 in percent area stenosis), while controls showed a trend toward progression of the lesions (+0.80). Measurements showed that there was a 4.5 percent difference in the size of the average lesion between the groups, a figure that is consistent with the rate at which atherosclerosis develops. This is the first study to include women as subjects; the atherosclerotic regression was equally strong for both sexes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Low density lipoproteins, Blood cholesterol, Niacin, Colestipol

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Lovastatin efficacy in reducing low-density lipoprotein cholesterol levels on high- vs low-fat diets

Article Abstract:

The National Cholesterol Education Program (NCEP) developed a specific approach for treating hypercholesterolemia (elevated blood levels of cholesterol). Low-density lipoprotein (LDL) levels should be measured in patients with increased total cholesterol levels and used to plan treatment. LDL cholesterol levels should be reduced to less than 3.36 millimoles per liter. Therapy consists initially of a low-fat diet followed by drug treatment if diet therapy fails. However, drug therapy with LDL cholesterol-lowering agents is often started without attempting diet therapy, because physicians lack confidence in the effectiveness of diet therapy or patients do not comply with the diet. The most commonly used drug, lovastatin, works by blocking a step in the body's production of cholesterol and thereby decreases the liver supply of cholesterol. Low-cholesterol diets restrict the source of cholesterol from outside of the body, and thereby deplete the liver cholesterol stores. A decrease in liver stores of cholesterol either through restriction of supply or depletion increases the activity of LDL receptors, proteins that specifically bind and remove LDL from the blood. The combined effects of diet therapy and lovastatin treatment should produce greater decreases in blood cholesterol levels than either diet or drug therapy alone. In a study of 19 patients with hypercholesterolemia, lovastatin decreased total cholesterol by 23 percent and LDL cholesterol by 30 percent. Diet therapy increased high-density lipoprotein cholesterol by seven to eight percent. Eighty percent of patients achieved recommended cholesterol levels after addition of lovastatin to a low-fat diet, whereas only 50 percent of patients reached appropriate cholesterol levels after addition of lovastatin to a high-fat diet. These findings show that the recommended cholesterol levels can be effectively achieved with the addition of lovastatin to a low-fat diet. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diet therapy

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Intensive Lifestyle Changes for Reversal of Coronary Heart Disease

Article Abstract:

Intensive lifestyle changes including diet and exercise may reverse the progression of coronary artery disease. Researchers put 28 patients with moderate to severe coronary artery disease on a low-fat vegetarian diet plus aerobic exercise, stress management, smoking cessation and group social support. Twenty similar patients in the control group received usual care only. After five years, there was less plaque in the coronary arteries of those in the lifestyle change group whereas those in the control group had more plaque. Fewer people in the lifestyle change group had a heart attack compared to the control group.

United States, Care and treatment, Development and progression, Low-fat diet, Low fat diet, Life style, Lifestyles

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