PubMed · 550485
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1979-08-25. Panic and clofibrate.. https://pubmed.ncbi.nlm.nih.gov/550485/
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Changes in plasma concentrations of high density lipoproteins (HDL) and triglycerides may partly explain the ability of cholesterol-lowering drugs to decrease the incidence of coronary heart disease. We measured the response of fasting plasma lipids, lipoproteins, and apolipoproteins in 46 subjects with Type IIa hypercholesterolemia treated with simvastatin for 3 months. The initial dose of simvastatin (10 mg/day) was subsequently increased up to 40 mg/day if the plasma cholesterol concentration had not fallen below 5.2 mmol/l. Plasma concentrations of HDL cholesterol and of the apolipoproteins AI and AII were increased by simvastatin. The increase in HDL cholesterol (9%) was due to increases in both subfractions (HDL2 17%; HDL3 7%), changes that would be consistent with a beneficial effect on cardiovascular risk. Simvastatin decreased plasma triglyceride concentrations by 25%. Plasma total cholesterol concentrations fell by 35% after 3 months of treatment; this fall was proportional to the initial concentration and was due almost entirely to a 45% fall in low density lipoprotein cholesterol. In contrast, plasma concentrations of lipoprotein Lp(a) were not affected by simvastatin.
Psyllium hydrophilic mucilloid, rich in soluble fiber, significantly lowers serum cholesterol concentrations. To investigate the lipid-lowering effects of a ready-to-eat cereal enriched with psyllium, we studied 44 hypercholesterolemic ambulatory individuals for 7 wk, using a randomized, double-blind, parallel design. After a 1-wk baseline period, subjects were randomly assigned to consume 114 g/d of a psyllium-flake or wheat-bran-flake cerearl for 6 wk adjunctive to an American Heart Association Step I diet. Serum high-density-lipoprotein cholesterol and triglycerides remained unchanged throughout the study; however, serum cholesterol and low-density lipoprotein (LDL) concentrations were significantly lower on psyllium than on wheat-bran cereal. Additionally, serum total and LDL cholesterol values were significantly lower than baseline values in the psyllium group. The dietary nutrient intake of the two groups did not differ except for soluble fiber. Adding psyllium-enriched cereal to a prudent low-fat diet may enhance dietary management of hypercholesterolemia.
The prevention of lipid-related coronary risk by lipid lowering drugs or diet has been the object of several therapeutic trials. This meta-analysis comprises the 6 available primary prevention trials (representing 30,695 subjects). There was an overall reduction of non-lethal infarcts (-26%) and coronary events (-18%) in the treatment groups. There was a tendency to less coronary deaths (-10%), though not statistically significant, and no difference in mortality due to all causes was observed. Some questions remain unanswered about the fact that the reduced incidence of ischaemic heart disease did not affect global mortality. This fact could be explained by an inadequate duration of treatment or follow-up, to an effect limited to chronic infarction or to eventual unidentified adverse effects (the meta-analysis does not show any significant differences in mortality due to cancer or accidental death).