Hypercholesterolemia management

Some patients, in particular those with genetic forms of hypercholesterolemia (Table 9-2), will require three or more drugs to manage their disorder. Regimens using a statin, resin, and niacin were found to reduce LDL cholesterol up to 75%.42 These early studies were conducted with lovastatin, so larger reductions would be expected with the more potent statins available today. 

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. 

It has been suggested that milk thistle may be beneficial in the management of hypercholesterolemia and gallstones. A small trial in humans showed a reduction in bile saturation index and biliary cholesterol concentration. The latter may reflect a reduction in liver cholesterol synthesis. To date, however, there is insufficient evidence to warrant the use of milk thistle for either of these disorders. 

Sibutramine is an appetite suppressant that inhibits the re-uptake of noradrenaline and serotonin. It is used in the adjunctive management of obesity in individuals with a body mass index (BMI) of 30kg/m or more (and no associated co-morbidity) or in individuals with a BMI of 27 kg/m or more in the presence of other risk factors such as type 2 diabetes or hypercholesterolemia. 

Jensen, C.D., Haskell, W. and Whittam, J.H. 1997. Long-term effects of water-soluble dietary fiber in the management of hypercholesterolemia in healthy men and women, Am. J. Cardiol., 79(l) 34-37. 

The initial step in management is to modify the major risk factors for HID—hypertension, hypercholesterolemia, and smoking— and data from the Multiple Risk Factor Intervention Trial (MRFIT) show these interventions to be useful in patients with silent ischemia. In a subset of the study population that had abnormal baseline exercise ECG responses, the special intervention group had a 57% reduction in coronary heart disease death (22.2 of 1000 versus 51.8 of 1000) and a reduction in sudden death resulting from cessation of smoking and lowering of blood pressure and cholesterol when compared with the usual-care group. 

Schectman G, Wolff N, Byrd JC, et al. Physician extenders for cost-effective management of hypercholesterolemia. J Gen Intern Med 1996 11 277-286. 

Management of some symptoms of menopause and as an alternative to hormone replacement therapy may be beneficial for hypercholesterolemia or peripheral vascular disease As a tea for gastrointestinal disturbances, as a sedative, and as an anti-inflammatory agent Arthritis... 

The work of Brown and Goldstein got serendipitous support from the discovery, a Japanese veterinarian had made at Kobe University. In 1973, Yoshio Watanabe (1927-2008) noticed incidentally that a rabbit from his colony showed a tenfold increased blood cholesterol level. By appropriate breeding, he managed to establish a strain of rabbits with this characteristic dysregulation. AH of them developed a coronary heart disease, closely resembling its human variant. Thus, suddenly there was an animal model available to investigate familial hypercholesterolemia much better than with the elaborate method of Brown and Goldstein, who had used tissue cultures of skin cells, in lack of sufficient access to human hepatocytes (fiver cells). [360]... 

Parhofer, K.G., 2009. Review of extended-release niacin/laropiprant fixed combination in the treatment of mixed dyslipidemia and primary hypercholesterolemia. Journal of Vascular Health and Risk Management. 5 901-908. 

Table 1. Diet, rich in polyunsaturated fatty acids and low in cholesterol, for management of hypercholesterolemia (with kind permission of L. W. Kinsell, Oakland, Calif.)...

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