Hypercholesterolemia diet therapy

Anderson, J. W., Allgood, L. D., Laurence, A., Altringer, L. A., Jerdack, G. R., Hengehold, D. A., and Morel, J. G. (2000a). Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia Metaanalysis of 8 controlled trials. Am. J. Clin. Nutr. 71, 472 79. 

Hypercholesterolemia Adjunctive therapy to diet for the reduction of LDL-C, total-C, triglycerides, and apolipoprotein B (apo B) and to increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia (Fredrickson Types lla and Mb). 

Primary hypercholesterolemia Adjunctive therapy to diet for reducing elevated total-C, LDL-C, Apo B, TG, and non-HDL-C, and increasing HDL-C in patients with... 

Denke, M. A., 1995. Lack of efficacy of low-dose sitostanol therapy as an adjunct to a cholesterol-lowering diet in men widi moderate hypercholesterolemia. American Journal of Clinical Nutrition 61 392—396. 

Hyperlipoproteinemia Adjunctive therapy for the reduction of elevated serum cholesterol in patients with primary hypercholesterolemia (elevated LDL) who do not respond adequately to diet. 

Diet Before instituting therapy, attempt to control hypercholesterolemia with diet, exercise, and weight reduction in obese patients. 

Monotherapy - Administered alone as adjunctive therapy to diet for the reduction of elevated total cholesterol (total-C), low density lipoprotein cholesterol (LDL-C), and apolipoprotein B (Apo B) in patients with primary (heterozygous familial and nonfamilial) hypercholesterolemia. 

Dietary measures are always initiated first and may obviate the need for drugs. Exceptions are patients with familial hypercholesterolemia or familial combined hyperlipidemia in whom diet and drug therapy should be started simultaneously. Cholesterol, saturated fats, and trans fats are the principal factors that influence LDL levels, whereas total fat and calorie restriction is important in management of triglycerides. 

Probucol is a lipid-lowering agent, but the results are not consistent with respect to LDL cholesterol. It lowers HDL cholesterol hence it is not the first drug of choice in therapy. The ability of probucol to correct atherosclerosis has been attributed to its antioxidant properties.77 The usual oral dose is 500 mg twice daily and is administered after food. Many experts use it as adjuvant therapy in familial hypercholesterolemia. The drug is well tolerated but causes GI side effects such as nausea and flatulence, headache, and dizziness. Patients taking probucol must be on a low-fat diet. Probucol should not be used in patients with recent myocardial infarction, and it should not be given to children or pregnant women. 

Baycol was indicated as an adjunct to diet to reduce elevated total-cholesterol, low-density lipoprotein cholesterol (LDL-C), apo B, and triglycerides (TG) and to increase high-density lipoprotein cholesterol (HDL-C) levels in patients with primary hypercholesterolemia and mixed dyslipidemia (Fredrickson types Ila and Ilb) when the response to dietary restriction of saturated fat and cholesterol and other nonpharmacological measures alone had been inadequate. Therapy with lipid altering drugs should bea component of multiple risk factor intervention in those patients at significantly high risk for atherosclerotic vascular disease due to hypercholesterolemia. 

Bell LP, Hectome K, Re)molds H, Balm TK, Hunninghake DB. Cholesterol-lowering effects of psyllium hydrophilic muciUoid. Adjunct therapy to a prudent diet for patients with mild to moderate hypercholesterolemia. JAMA 1989 261 3419-3423. 

The manufacturer does not recommend use of the fixed combination as initial therapy of primary hypercholesterolemia or mixed dyslipidemia. It is specifically Indicated in patients receiving lovastatin alone plus diet who require an additional reduction in triglyceride levels or increase in HDL cholesterol levels it is also Indicated In those treated with niacin alone who require additional decreases in LDL cholesterol. 

Cholestyramine is indicated as adjunctive therapy to diet for the reduction of elevated serum cholesterol in patients with primary hypercholesterolemia (elevated low-density lipoprotein [LDL] cholesterol) who do not respond adequately to diet. Similarly, it is indicated for the relief of pruritus associated with partial biliary obstruction. Cholestyramine is not absorbed but binds to bile acids in the intestine, whereupon it is eliminated. To replenish the lost bile acid, cholesterol is then converted to bile acid, and this lowers the level of cholesterol (see Figure 34). Cholestyramine has also been used in the treatment of cholestasis to control the intense pruritis. It reduces the LDL level in 4 to 7 days, and the maximum effect is seen in 14 days. 

Colesevelam is a bile acid sequestrant that increases removal of bile acids from the body by binding them in the intestine, impeding their reabsorption. As the bile acid pool becomes depleted, the conversion of cholesterol to bile acids is increased, which decreases serum cholesterol. Colesevelam is indicated as an adjunctive therapy to diet and exercise given alone or with an HMG-CoA reductase inhibitor for the reduction of elevated LDL cholesterol in patients with primary hypercholesterolemia (Fredrickson type 11a). 

Ezetimibe is an antihyperlipidemic agent that inhibits absorption of cholesterol by the small intestine. It is indicated to be administered alone or with HMG-CoA reductase inhibitors as adjnnctive therapy to diet for reduction of elevated total cholesterol, LDL, and apolipoprotein (Apo) in patients with primary hypercholesterolemia with atorv-astatin or simvastatin for the reduction of elevated total cholesterol and LDL levels in patients with homozygous familial hypercholesterolemia as an adjunct to other lipidlowering treatments or if such treatments are unavailable and as adjnnctive therapy to diet for the reduction of elevated sitosterol and campesterol levels in patients with homozygons familial sitosterolemia. 

Both of Ms. Jeina s younger brothers had very high serum cholesterol levels, and both had suffered heart attacks in their mid-forties. With this information, a tentative diagnosis of familial hypercholesterolemia, type IIA was made, and the patient was started on a step I diet as recommended by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. This panel recommends that decisions with regard to when dietary and drug therapy are initiated based on the serum LDL cholesterol level, as depicted in Table 34.1. 

The serum cholesterol-lowering effect of plant sterols and stanols has been proven in several clinical studies. The hypocholesterolemic effects have been verified in normocholesterolemic individuals, in individuals with mild to moderate hypercholesterolemia or with familial hypercholesterolemia, in women with coronary heart disease, and in men with non-insulin-dependent diabetes -in conjunction with cholesterol-lowering statin therapy and irrespective of the background diet. In addition, studies have been conducted with normocholesterolemic children and with children with slightly elevated cholesterol levels, or with familial hypercholesterolemia. 

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