Angiographic progression of coronary atherosclerosis in patients with familial hypercholesterolaemia treated with non-statin therapy: Impact of a fat-modified diet and a resin

被引:11
作者
Watts, Gerald F. [1 ,2 ]
Pang, Jing [1 ]
Chan, Dick C. [1 ]
Brunt, John N. H. [3 ]
Lewis, Barry [4 ]
机构
[1] Univ Western Australia, Sch Med & Pharmacol, Perth, WA 6009, Australia
[2] Royal Perth Hosp, Dept Cardiol, Cardiometab Serv, Lipid Disorders Clin, Perth, WA, Australia
[3] Clatterbridge Canc Ctr NHS Fdn Trust, Wirral, Cheshire, England
[4] Univ London, Kings Coll, Malet St, London, England
关键词
Familial hypercholesterolaemia; Treatment; Diet; Bile-acid sequestrant; DENSITY-LIPOPROTEIN CHOLESTEROL; LIPID-LOWERING THERAPY; ARTERY-DISEASE; HEART-DISEASE; PLAQUE REGRESSION; PCSK9; INHIBITION; RANDOMIZED-TRIAL; SURGICAL CONTROL; MORTALITY; GUIDANCE;
D O I
10.1016/j.atherosclerosis.2016.07.923
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background and aims: Familial hypercholesterolaemia (FH) profoundly increases the risk of coronary artery disease (CAD). We investigated whether diet and a bile-acid sequestrant decrease coronary atherosclerosis in patients with FH. Methods: We identified 26 men with FH and CAD, participating in the St Thomas' Atherosclerosis Regression Study, who had been randomized to receive a fat-modified diet plus cholestyramine (8 g twice daily) (DC, n = 12) or usual care (UC, n = 14), and investigated the relative effects of these treatments on the angiographic progression of coronary atherosclerosis over 39 months. FH was defined as probable/definite according to Dutch Lipid Clinic Network criteria; mean FH score was 8.7 (range 6 - 15) and mean baseline low-density lipoprotein cholesterol (LDL-Ch) concentration was 5.4 (SD 1.4) mmol/L. Coronary atherosclerosis was assessed by serial quantitative angiography as the global changes in mean and minimum absolute width of segments (MAWS and MinAWS, respectively). Results: Mean plasma LDL-Ch concentration fell by 35% with DC and remained significantly (p < 0.001) lower during the trial at 3.78 (SD 0.98) mmol/L compared with UC at 4.89 (1.04). MAWS decreased by 0.252 (SEM 0.072) mm in the UC group and by 0.001 (0.065) mm in the DC group (p = 0.007), with corresponding reductions in MinAWS of 0.290 (0.087) mm and 0.013 (0.058) mm (p = 0.009); these changes were significant after adjusting for baseline variables, including coronary luminal dimensions and lipoprotein(a). Progression was observed in 7 patients (50%) on UC and 3 (25%) on DC (p = 0.19), with regression in no patients (0%) and 3 patients (25%) (p < 0.05), respectively. Conclusions: This investigation, carried out in the pre-statin era, demonstrates that a prudent diet and cholestyramine could improve the course of coronary atherosclerosis in men with phenotypic FH through sustained reductions in LDL-Ch. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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页码:82 / 87
页数:6
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