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Effectiveness of a group dietary intervention on hypercholesterolemia: a randomized, controlled clinical trial
Tuesday 1 I October 1994: Poster Abstracts Clinical trials
The aim was to compare the effect on atherogenesis of dietary monounsaturated and saturated fatty acids in cholesterol-clamped rabbits. To obtain an average plasma cholesterol concentration of 20 mmol/l in each rabbit during the 13-week cholesterol-feeding period, dietary cholesterol was adjusted weekly. The amount of fat fed daily was 10 g/rabbit in experiment A (n = 23), B (n = 24). and D (n = 58) and 5 g/rabbit in experiment C (n = 36). The source of monounsaturated fatty acids was olive oil in all four experiments. The source of saturated fatty acids was butter in experiment A, lard in experiment B, coconut oil in experiment C, and butter or lard in experiment D. Generally, olive oil groups were fed more cholesterol and tended to have more cholesterol in
CLINICAL
12261Effectiveness w,
of a group dietary intervention on hypercholesterolemia: a randomized, controlled clinical trial Chemiak D, Faucher J, USC SOC, Dipartement de
midecine de ,fmille, Jl H 5N4
Universite’de Sherbrooke, Quibec, Canada
This study evaluated the effect of a supervised group dietary intervention on hypercholesterolemia. The distribution of serum cholesterol values in our clinic, based on 371 consecutive lipid work-ups, was 49.2% <5.2mmolil, 31.5% 5.2-6.2mmolfl and 19.4% 26.2 mmol/l. Eligible participants had serum cholesterol >5.2 mmolll. Exclusion criteria were pregnancy, diabetes, familial hypercholesterolemia type I or V, age ~18 or >65 years, and use of hypocholesteroiemic medication. They were randomized into two groups, with physicians blind to the distribution, one group being offered collective intervention in which a psychologist and a dietitian supervised seven meetings over 9 months, and both groups continuing usual care by their family physician. Serum cholesterol results (in mmol/l) were as follows:
Initial After 6 months After 12 months Average decrease
Intervention
Control
6.00 f 0.87 5.53 + 0.13 5.73kO.19 0.38 (P = 0.008)
6.06f0.11 5.52 + 0.13 5.90+0.15 0.17(P=O.24)
The differences between the groups are not statistically significant. Family physicians’ care reduced serum cholesterol regardless of the addition of the collective intervention. There was a rebound after 6 months in both groups, but to a lesser extent in the intervention group. Garlic reduces atherogenicity of low density lipopro12271 tein Qp&ov AN, Tertov VV, Pivovarova EM, Inst. of Experimental Cardiol., 3rd Cherepkovskaya Street ISA. 121552 Moscow, Russia
According to folk medicine, garlic is effective as an antiatherosclerotic agent. The effect of garlic powder tablets, Sapec, on atherogenic potential of whole blood serum and low density lipoprotein (LDL) was investigated. 2 and 4 h after a single dose of Sapec (1 tablet containing 300 mg garlic powder) the atherogenicity of patients’ sera was markedly decreased: the sera induced much lesser cholesterol accumulation in cultured human aortic smooth muscle cells compared with the sera obtained prior to the drug administration. After 4 weeks of long-term Sapec therapy (300 mg, 3 times daily) blood serum athemgenicity was 2-fold lower compared with the initial level. 4-week therapy lowered the atherogenicity of LDL isolated from patients’ plasma. However, the atherogenicity of LDL remained unchanged during
149
VLDL and less in LDL compared to groups receiving saturated fat. Analysis of variance of the combined results of all four experiments showed that olive oil, relative to saturated fat, lowered aortic cholesterol by 13% (95% CI -9% to 30%) in the aortic arch, and by 10% (-10% to 26%) in the thoracic aorta, neither of which was significant. In the comparison with olive oil, no differences in effects on aortic cholesterol content were detected between butter, lard, and coconut oil. These results do not support the notion that replacement of dietary saturated fat with olive oil has a major impact on the development of atherosclerosis in addidon to that accounted for by changes in plasma cholesterol levels.
TRIALS the first 7 days of the treatment. This indicates that reduction of lipoprotein atherogenicity is an indirect and relatively long process. The alteration in LDL athemgenicity correlated with the increase of sialic acid content in LDL particle but not with the decrease of LDL susceptibility to oxidation. 12281 m,
Algorithm for choice of hypolipidemic drugs in cardiovascular patients Perova NV, Vartanova OA, Clinical Pharmacol-
ogy Chair, Medical Sechenov Academy, 216 B. Pirogovskaya, Moscow 119881, Russia
Morbidity and mortality of cardiovascular patients can be reduced by adequate hypolipidemic therapy. The problem is to make the optimum choice for individual patients from the wide variety of drugs and regimens available. We have attempted to develop an algorithm for this choice according to type of hyperlipidemia. We examined the lipid profile (total cholesterol, triglycerides, HDL and LDL lipoproteins) of 149 type II-IV hyperlipidemic patients before and after 1 month of dietary treatment and during 2-3 months’ treatment with cholestyramine, gemfibrozil, bezafibrate, fenofibrate, lovastatin, lipostabil or probucol, alone or in combination. All drugs decreased LDL, lovastatin being the most effective and probucol and bezafibrate the least. Gemfibrosil and fenofibrate decreased Tg by more than 50%. Lipostabil increased HDL most, and this drug was the best tolerated and free from aftereffects. Probucol decreased HDL by 40%, but despite this was amongst the best treatments in familial hypercholesterolemia. In type IIa patients the first-line drugs were fatty acid sequestrants, HMG-CoA rcductase inhibitors, pmbucol and LDH apheresis; in type IIb, fatty acid sequestrants in combination with fibrates, HMG-CoA reductase inhibitors plus fibrates or nicotinic acid or probucol, or LDH apheresis plus fibrates; in type IV, nicotinic acid, fibrates, or n-3 fatty acids; for low HDL, lipostabil as monotherapy or in combination with other hypolipidemic drugs. Influence of fluvastatin on lipid and apolipoprotein levels in Muscovites with hypercholesterolemia and hypertension Perova NV, Olferiev AM, Metelskaya VA, Aronov DM, Volchkova TM, Pizh MV, Vartanova OA, National Centre for 12291
Preventive Med., IO, Petroverigsky str., 101953 Moscow, Russia
The aim of this study was to determine the efficacy of a new fully synthetic HMG-CoA-reductase inhibitor, fluvastatin (Lescol, Sandoz Pharma Ltd) in patients receiving concomitant antihypertensive drug treatment (calcium antagonists and/or beta-blockers) and diet recommendations. 70 Moscow residents with controlled hypertension and LDL-C level greater than 4.1 mmol/l were included in a IZweek fluvastatin trial. The plasma lipid levels were measured enzymatically, apo A-I and apo B by immunonephelo-
Atherosclerosis X, Montreal, October 1994
The aim was to compare the effect on atherogenesis of dietary monounsaturated and saturated fatty acids in cholesterol-clamped rabbits. To obtain an average plasma cholesterol concentration of 20 mmol/l in each rabbit during the 13-week cholesterol-feeding period, dietary cholesterol was adjusted weekly. The amount of fat fed daily was 10 g/rabbit in experiment A (n = 23), B (n = 24). and D (n = 58) and 5 g/rabbit in experiment C (n = 36). The source of monounsaturated fatty acids was olive oil in all four experiments. The source of saturated fatty acids was butter in experiment A, lard in experiment B, coconut oil in experiment C, and butter or lard in experiment D. Generally, olive oil groups were fed more cholesterol and tended to have more cholesterol in
CLINICAL
12261Effectiveness w,
of a group dietary intervention on hypercholesterolemia: a randomized, controlled clinical trial Chemiak D, Faucher J, USC SOC, Dipartement de
midecine de ,fmille, Jl H 5N4
Universite’de Sherbrooke, Quibec, Canada
This study evaluated the effect of a supervised group dietary intervention on hypercholesterolemia. The distribution of serum cholesterol values in our clinic, based on 371 consecutive lipid work-ups, was 49.2% <5.2mmolil, 31.5% 5.2-6.2mmolfl and 19.4% 26.2 mmol/l. Eligible participants had serum cholesterol >5.2 mmolll. Exclusion criteria were pregnancy, diabetes, familial hypercholesterolemia type I or V, age ~18 or >65 years, and use of hypocholesteroiemic medication. They were randomized into two groups, with physicians blind to the distribution, one group being offered collective intervention in which a psychologist and a dietitian supervised seven meetings over 9 months, and both groups continuing usual care by their family physician. Serum cholesterol results (in mmol/l) were as follows:
Initial After 6 months After 12 months Average decrease
Intervention
Control
6.00 f 0.87 5.53 + 0.13 5.73kO.19 0.38 (P = 0.008)
6.06f0.11 5.52 + 0.13 5.90+0.15 0.17(P=O.24)
The differences between the groups are not statistically significant. Family physicians’ care reduced serum cholesterol regardless of the addition of the collective intervention. There was a rebound after 6 months in both groups, but to a lesser extent in the intervention group. Garlic reduces atherogenicity of low density lipopro12271 tein Qp&ov AN, Tertov VV, Pivovarova EM, Inst. of Experimental Cardiol., 3rd Cherepkovskaya Street ISA. 121552 Moscow, Russia
According to folk medicine, garlic is effective as an antiatherosclerotic agent. The effect of garlic powder tablets, Sapec, on atherogenic potential of whole blood serum and low density lipoprotein (LDL) was investigated. 2 and 4 h after a single dose of Sapec (1 tablet containing 300 mg garlic powder) the atherogenicity of patients’ sera was markedly decreased: the sera induced much lesser cholesterol accumulation in cultured human aortic smooth muscle cells compared with the sera obtained prior to the drug administration. After 4 weeks of long-term Sapec therapy (300 mg, 3 times daily) blood serum athemgenicity was 2-fold lower compared with the initial level. 4-week therapy lowered the atherogenicity of LDL isolated from patients’ plasma. However, the atherogenicity of LDL remained unchanged during
149
VLDL and less in LDL compared to groups receiving saturated fat. Analysis of variance of the combined results of all four experiments showed that olive oil, relative to saturated fat, lowered aortic cholesterol by 13% (95% CI -9% to 30%) in the aortic arch, and by 10% (-10% to 26%) in the thoracic aorta, neither of which was significant. In the comparison with olive oil, no differences in effects on aortic cholesterol content were detected between butter, lard, and coconut oil. These results do not support the notion that replacement of dietary saturated fat with olive oil has a major impact on the development of atherosclerosis in addidon to that accounted for by changes in plasma cholesterol levels.
TRIALS the first 7 days of the treatment. This indicates that reduction of lipoprotein atherogenicity is an indirect and relatively long process. The alteration in LDL athemgenicity correlated with the increase of sialic acid content in LDL particle but not with the decrease of LDL susceptibility to oxidation. 12281 m,
Algorithm for choice of hypolipidemic drugs in cardiovascular patients Perova NV, Vartanova OA, Clinical Pharmacol-
ogy Chair, Medical Sechenov Academy, 216 B. Pirogovskaya, Moscow 119881, Russia
Morbidity and mortality of cardiovascular patients can be reduced by adequate hypolipidemic therapy. The problem is to make the optimum choice for individual patients from the wide variety of drugs and regimens available. We have attempted to develop an algorithm for this choice according to type of hyperlipidemia. We examined the lipid profile (total cholesterol, triglycerides, HDL and LDL lipoproteins) of 149 type II-IV hyperlipidemic patients before and after 1 month of dietary treatment and during 2-3 months’ treatment with cholestyramine, gemfibrozil, bezafibrate, fenofibrate, lovastatin, lipostabil or probucol, alone or in combination. All drugs decreased LDL, lovastatin being the most effective and probucol and bezafibrate the least. Gemfibrosil and fenofibrate decreased Tg by more than 50%. Lipostabil increased HDL most, and this drug was the best tolerated and free from aftereffects. Probucol decreased HDL by 40%, but despite this was amongst the best treatments in familial hypercholesterolemia. In type IIa patients the first-line drugs were fatty acid sequestrants, HMG-CoA rcductase inhibitors, pmbucol and LDH apheresis; in type IIb, fatty acid sequestrants in combination with fibrates, HMG-CoA reductase inhibitors plus fibrates or nicotinic acid or probucol, or LDH apheresis plus fibrates; in type IV, nicotinic acid, fibrates, or n-3 fatty acids; for low HDL, lipostabil as monotherapy or in combination with other hypolipidemic drugs. Influence of fluvastatin on lipid and apolipoprotein levels in Muscovites with hypercholesterolemia and hypertension Perova NV, Olferiev AM, Metelskaya VA, Aronov DM, Volchkova TM, Pizh MV, Vartanova OA, National Centre for 12291
Preventive Med., IO, Petroverigsky str., 101953 Moscow, Russia
The aim of this study was to determine the efficacy of a new fully synthetic HMG-CoA-reductase inhibitor, fluvastatin (Lescol, Sandoz Pharma Ltd) in patients receiving concomitant antihypertensive drug treatment (calcium antagonists and/or beta-blockers) and diet recommendations. 70 Moscow residents with controlled hypertension and LDL-C level greater than 4.1 mmol/l were included in a IZweek fluvastatin trial. The plasma lipid levels were measured enzymatically, apo A-I and apo B by immunonephelo-
Atherosclerosis X, Montreal, October 1994