Cholesterol Journal Articles

Record 5161 to 5180

Effect of vitamin E, phosphorus and sorbitol on growth performance and serum and tissue cholesterol concentrations in the pig
Lepine, A. J., B. E. Moore, et al. (1990), J Anim Sci 68(10): 3252-60.
Abstract: A total of 180 crossbred, weanling pigs were assigned to five dietary treatment groups: 1) a basal corn-soybean meal diet formulated to current NRC recommendations, 2) basal + monosodium phosphate (2 x NRC P recommendations; P), 3) basal + alpha-tocopheryl acetate (220 IU/kg; E), 4) basal + sorbitol (1% of the diet; S) and 5) basal + PES. Dietary treatments were continued until market weight (104 kg). Blood samples were obtained at 3-wk intervals for analysis of serum alpha-tocopherol, P and total cholesterol. Liver and muscle (semimembranosus) samples were obtained at the end of the starter, grower and finisher phases for determination of total cholesterol concentration. The Ca:P imbalance produced by the high-phosphorus diets (P and PES) increased feed intake during the finisher phase. Dietary treatment did not consistently affect total serum cholesterol at any phase of growth. A transient 21.5% (P less than.05) depression of liver cholesterol concentration was observed in the PES-fed pigs at the end of the starter phase but was not apparent at market weight. A similar trend (nonsignificant) was noted for muscle cholesterol concentration. The present study suggests that the PES diet can decrease tissue cholesterol concentration during the nursery phase, but it remains uncertain whether this transient response is a function of age and(or) diet transition at weaning. Further research is necessary to determine whether this response can be translated to the finishing phase, and thereby reduce carcass cholesterol.

Effect of weight loss on plasma high density lipoprotein cholesterol
Ghalaut, V. S., P. S. Ghalaut, et al. (2000), J Assoc Physicians India 48(8): 854-5.

Effect of Xue Zhi Kang on the formation of fatty liver in cholesterol-fed rabbits
Zhang, M., Y. Tong, et al. (2001), Zhonghua Gan Zang Bing Za Zhi 9 Suppl: 34-6.
Abstract: OBJECTIVE: To explore the effect of Xue Zhi Kang (XZhK) on the formation of fatty liver in cholesterol-fed rabbits. METHODS: XZhK was refined from Chinese traditional medicine Hong Qu and its main composition is HMG-CoA reductase inhibitor. Thirty New Zealand white rabbits were randomly assigned into 3 groups (control, hypercholesterol-fed, and XZhK groups) during the 12 week's experiment. The effects of XZhK (0.8g.kg(-1).d(-1)) were investigated in rabbits fed a l.5% cholesterol diet. The changes of serum TC, TG, HDL-C, and LDL-C concentrations and the histopathological changes of the liver were detected. RESULTS: The serum TC, LDL-C, and TG levels decreased in XZhK group compared with those in the cholesterol-fed control group (P<0.05). The serum HDL-C concentration slightly increased, but there was no statistical significance. The fatty degeneration of liver was ameliorated in XZhK group (P<0.05). CONCLUSIONS: XZhK can modulate the lipid metabolism and inhibit the formation of fatty liver in cholesterol-fed rabbits.

Effect of YM 9429, a potent teratogen, on cholesterol biosynthesis in cultured cells and rat liver microsomes
Honda, A., G. S. Tint, et al. (1996), Steroids 61(9): 544-8.
Abstract: YM 9429 (cis-1-4-(p-menthan-8-yloxy)phenylpiperidine) is a hypolipidemic agent with a potent and specific teratogenicity, inducing cleft palate and skeletal variations in rats. Since cleft palate is generally observed in the Smith-Lemli-Opitz syndrome, a common syndrome of multiple congenital anomalies caused by reduced activity of 7-dehydrocholesterol delta 7-reductase (3 beta-hydroxysteroid delta 7-reductase), the final enzyme in the cholesterol biosynthetic pathway, YM 9429 was suspected of being an inhibitor of this enzyme. To prove this hypothesis, YM 9429 was added to cultured human skin fibroblasts and to cultured Morris hepatoma cells and incubated with 5-3Hmevalonolactone. After 24 h, radiolabeled 7-dehydrocholesterol accumulated in the cells, whereas the formation of radiolabeled cholesterol was markedly reduced. The results indicate that YM 9429 inhibits the conversion of 7-dehydrocholesterol to cholesterol catalyzed by the microsomal enzyme 7-dehydrocholesterol delta 7-reductase. In rat liver microsomes, the mode of inhibition was found to be noncompetitive, with a Ki of 40 microM. These results suggest that YM 9429 induced developmental abnormalities in rats by the same mechanism as the Smith-Lemli-Opitz syndrome. This compound might be useful for studying the pathogenesis of anomalies in animal models of the Smith-Lemli-Opitz syndrome.

Effect of yogurt and bifidus yogurt fortified with skim milk powder, condensed whey and lactose-hydrolysed condensed whey on serum cholesterol and triacylglycerol levels in rats
Beena, A. and V. Prasad (1997), J Dairy Res 64(3): 453-7.
Abstract: The possible hypocholesterolaemic properties of milk and fermented milk products have been investigated in groups of albino rats given a basal diet, basal diet plus cholesterol, and basal diet plus cholesterol together with whole milk or standard or bifidus yogurt. The yogurts were fortified with skim milk powder, condensed whey or lactose-hydrolysed condensed whey. After 30 d, triacylglycerols, total cholesterol, HDL-cholesterol and LDL-cholesterol were measured in serum. Whole milk and ordinary yogurt had no hypocholesterolaemic effect, but standard yogurt containing lactose-hydrolysed condensed whey and all bifidus yogurts lowered serum cholesterol. In general, yogurts changed HDL-cholesterol little, but tended to raise triacylglycerols. There was marked lowering of LDL-cholesterol in rats given either type of yogurt fortified with whey proteins. This study has demonstrated in a rat model that bifidus yogurts and yogurts fortified with whey proteins can reduce total and LDL-cholesterol, and suggests that if they have the same effect in human subjects they have potential value in cholesterol-lowering diets.

Effect of zeta potential of cationic liposomes containing cationic cholesterol derivatives on gene transfection
Takeuchi, K., M. Ishihara, et al. (1996), FEBS Lett 397(2-3): 207-9.
Abstract: Cationic liposomes are known to be useful tools for gene transfection. However, the relation between transfection efficiency and physicochemical properties of liposomes has not been well understood. Here, we synthesized eight cationic derivatives of cholesterol which contain a tertiary amino head group with a different spacer arm. Transfection of plasmid pSV2CAT DNA into cells was done by cationic liposomes made of a mixture of dioleoylphosphatidylethanolamine (DOPE) and each cationic cholesterol derivative. At the same time we measured zeta potential of cationic liposomes by laser Doppler spectroscopy. The present results indicated that zeta potentials of cationic liposomes were well related to transfection activity of pSV2CAT DNA. This suggested that zeta potential of cationic liposomes is one of important factors which control gene transfection.

Effect on blood lipids of very high intakes of fiber in diets low in saturated fat and cholesterol
Jenkins, D. J., T. M. Wolever, et al. (1993), N Engl J Med 329(1): 21-6.
Abstract: BACKGROUND. It is known that soluble fiber in the diet can lower blood lipid levels. It is less certain, however, that eating foods with soluble fiber will further lower blood lipids when the intake of saturated fat and cholesterol has already been reduced to very low levels. Furthermore, the mechanism of the lipid-lowering effect of fiber has not been elucidated. METHODS. To address these questions, we studied 43 volunteers with hyperlipidemia in a crossover study involving two four-month dietary periods. The two metabolic diets contained foods high in either soluble or insoluble fiber and were separated by a two-month National Cholesterol Education Program Step 2 diet. The metabolic diets were low in saturated fat (< 4 percent of total calories) and cholesterol (< 25 mg per 1000 kcal), high in carbohydrate (> or = 60 percent of total calories), and very high in fiber (> 24 g per 1000 kcal). RESULTS. Blood lipids fell to their lowest levels by week 4 of both study diets. When the soluble-fiber period was compared with the insoluble-fiber period, the subjects' total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol levels were found to be lower by a mean (+/- SE) of 4.9 +/- 0.9 percent (P < 0.001), 4.8 +/- 1.3 percent (P < 0.001), and 3.4 +/- 1.3 percent (P = 0.014), respectively. In contrast, the ratio of total to HDL cholesterol was not significantly different during the two dietary periods. The loss of fecal bile acids was 83 +/- 14 percent greater during the soluble-fiber period than during the insoluble-fiber period (P < 0.001) and was related to the differences in total and LDL cholesterol and apolipoprotein B levels (r = 0.42, P = 0.005; r = 0.49, P < 0.001; and r = 0.33, P = 0.035, respectively). The difference in serum cholesterol levels between the two dietary periods was greater among the men (7.5 +/- 1.2 percent, P < 0.001) than among the women (3.4 +/- 1.2 percent, P = 0.008). CONCLUSIONS. Very high intakes of foods rich in soluble fiber lower blood cholesterol levels even when the main dietary modifiers of blood lipids--namely, saturated fat and cholesterol--are greatly reduced.

Effect on coronary atherosclerosis of decrease in plasma cholesterol concentrations in normocholesterolaemic patients. Harvard Atherosclerosis Reversibility Project (HARP) Group
Sacks, F. M., R. C. Pasternak, et al. (1994), Lancet 344(8931): 1182-6.
Abstract: Lipid-lowering therapy ameliorates coronary atherosclerosis in patients with raised concentrations of low-density-lipoprotein (LDL) cholesterol. We have investigated whether a similar benefit can be obtained in normocholesterolaemic patients. We studied 79 normocholesterolaemic patients with coronary heart disease (70 male, 9 female), mean age 58 years, all non-smokers, with mean total cholesterol concentration 5.5 mmol/L. All patients received diet therapy and were randomly assigned placebo (39) or active treatment (40) with pravastatin, nicotinic acid, cholestyramine, and gemfibrozil stepwise as needed to reach the specified goal (total cholesterol < or = 4.1 mmol/L, ratio of LDL/high-density-lipoprotein HDL cholesterol < or = 2.0). Coronary angiograms at baseline and after 2.5 years of treatment were analysed by computer-assisted quantitative techniques. There was no significant difference in coronary atherosclerosis during follow-up between the active treatment and placebo groups; the mean minimum diameter narrowed significantly but to the same extent in both groups (change baseline to 2.5 years 0.14 SD 0.42 and 0.15 0.42 mm, respectively, both p < 0.001). Similarly, the change in percentage stenosis did not differ between the groups (2.1 10.6 vs 2.4 10.3%). By multiple regression analysis, the adjusted difference between the groups was a 0.04 mm (95% CI -0.04 to 0.12 mm) increase in minimum diameter and a 0% (-1.7 to 1.7) change in percentage stenosis. The groups differed significantly in plasma lipids (% change in active minus % change in placebo group: -28% total cholesterol, -41% LDL-cholesterol, 13% HDL-cholesterol, -26% triglycerides, -31% apolipoprotein B, all p < 0.001). Thus, intensive pharmacological treatment of normocholesterolaemic patients has significant effects on plasma lipid concentrations but no angiographically measurable benefit on the coronary arteries.

Effect on curcumin on cholesterol gall-stone induction in mice
Hussain, M. S. and N. Chandrasekhara (1992), Indian J Med Res 96: 288-91.
Abstract: A study was carried out on the efficacy of curcumin in reducing the incidence of cholesterol gall-stones (CGS), induced by feeding a lithogenic diet in young male mice. Feeding a lithogenic diet supplemented with 0.5 per cent curcumin for 10 wk reduced the incidence of gall-stone formation to 26 per cent, as compared to 100 per cent incidence in the group fed with lithogenic diet alone. Biliary cholesterol concentration was also significantly reduced by curcumin feeding. The lithogenic index which was 1.09 in the cholesterol fed group was reduced to 0.43 in the 0.5 per cent curcumin supplemented group. Further, the cholesterol: phospholipid (C/PL) ratio of bile was also reduced significantly when 0.5 per cent curcumin supplemented diet was fed. A dose-response study with 0.2, 0.5 and 1.0 per cent curcumin supplemented lithogenic diets showed that 0.5 per cent curcumin was more effective than a diet with 0.2 or 1 per cent curcumin.

Effect on high-density lipoprotein cholesterol of maximum dose simvastatin and atorvastatin in patients with hypercholesterolemia: results of the Comparative HDL Efficacy and Safety Study (CHESS)
Ballantyne, C. M., M. A. Blazing, et al. (2003), Am Heart J 146(5): 862-9.
Abstract: BACKGROUND: Previous studies have shown that effects on high-density lipoprotein cholesterol (HDL-C) may differ among statins. METHODS: A multicenter, randomized, double-blind, parallel-dose study was conducted in 917 hypercholesterolemic patients to compare the efficacy of 80 mg/d simvastatin versus 80 mg/d atorvastatin on HDL-C and apolipoprotein (apo) A-I for 24 weeks. Efficacy was assessed as the means of weeks 6 and 12 and weeks 18 and 24. Prespecified subgroups analyzed were patients with low HDL-C levels and with the metabolic syndrome. RESULTS: Simvastatin increased HDL-C and apo A-I values significantly more than did atorvastatin for the mean of weeks 6 and 12 (8.9% vs 3.6% and 4.9% vs -0.9%, respectively) and the mean of weeks 18 and 24 (8.3% vs 4.2% and 3.7% vs -1.4%). These differences were observed across both baseline HDL-C subgroups (<40 mg/dL, > or =40 mg/dL) and in patients with the metabolic syndrome. Low-density lipoprotein cholesterol and triglyceride reductions were greater with atorvastatin. Consecutive elevations >3x the upper limit of normal in alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) occurred in significantly fewer patients treated with simvastatin than with atorvastatin (2/453 0.4% vs 13/464 2.8%), with most elevations observed in women taking atorvastatin (11/209 5.3% vs 1/199 0.5% for simvastatin). CONCLUSIONS: Simvastatin (80 mg) increased HDL-C and apo A-I significantly more than did atorvastatin (80 mg) in patients with hypercholesterolemia. This advantage was observed regardless of HDL-C level at baseline or the presence of the metabolic syndrome. Significantly fewer consecutive elevations >3x the upper limit of normal in ALT and/or AST occurred in patients receiving simvastatin.

Effective blood pressure treatment improves LDL-cholesterol susceptibility to oxidation in patients with essential hypertension
Quinones-Galvan, A., A. Pucciarelli, et al. (2001), J Intern Med 250(4): 322-6.
Abstract: OBJECTIVES: LDL-cholesterol particles from hypertensive patients exhibit enhanced susceptibility to in vitro oxidation, an abnormality thought to increase cardiovascular risk. We tested whether blood pressure (BP) normalization can reverse this abnormality. DESIGN: Double-blind, randomized pharmacological intervention trial. SETTING: Clinical research centre. Subjects. A total of 29 nondiabetic, normolipidaemic patients with essential hypertension (BP= 151 +/- 3/99 +/- 1 mmHg) and 11 normotensive controls (BP=125 +/- 3/85 +/- 1 mmHg) matched for gender, age, obesity, glucose tolerance and lipid profile. Intervention. Anti-hypertensive treatment for 3 months with a calcium-antagonist in randomized combination with either an ACE inhibitor or a beta-blocker. MAIN OUTCOME MEASURES: Lag phase of copper-induced LDL oxidation, cell-mediated (human umbilical vein endothelium) generation of malondialdehyde (MDA) by LDL and vitamin E content in LDL. RESULTS: At baseline in hypertensives versus controls, lag phase was shorter (89 +/- 3 vs. 107 +/- 6 min, P < 0.04), MDA generation was higher (5.8 +/- 0.1 vs. 5.1 +/- 0.2 nmol L(-1), P=0.002), and vitamin E was reduced (6.40 +/- 0.05 vs. 6.67 +/- 0.11 microg mg(-1), P=0.03). At 3 months, BP was normalized (124 +/- 3/81 +/- 1, P < 0.0001 vs. baseline, P=ns versus controls), lag phase was prolonged (to 98 +/- 3 min, P=0.0005), MDA generation was reduced (5.6 +/- 0.1 nmol L-1, P = 0.001), and vitamin E was increased (6.53 +/- 0.05 microg mg(-1), P=0.003), with no significant differences between the randomized groups. CONCLUSIONS: In nondiabetic, nonobese, normolipidaemic patients with essential hypertension, LDL susceptibility to copper- and cell-mediated oxidation is increased. BP normalization is associated with a significant improvement, but not a full reversal, of this abnormality.

Effective cholesterol lowering in children in a pediatric office setting
Kuehl, K. S., D. Slater, et al. (1991), Ann N Y Acad Sci 623: 476-9.

Effective lowering of plasma, LDL, and esterified cholesterol in LDL receptor-knockout mice by adenovirus-mediated gene delivery of ApoB mRNA editing enzyme (Apobec1)
Teng, B., B. Ishida, et al. (1997), Arterioscler Thromb Vasc Biol 17(5): 889-97.
Abstract: Adenovirus-mediated gene delivery of apolipoprotein (apo)B mRNA editing enzyme (AvApobec1) was used to study the effect of apoB mRNA editing on apoB production in homozygous LDL receptor-deficient (LDLR-/-) mice. Intravenous injection of AvApobec1 into these mice resulted in a >80% decrease in plasma apoB-100 with a concomitant increase in plasma apoB-48 level. The plasma apoE level also increased. In all cases, total plasma apoB (apoB-100 + apoB-48) decreased by 60% at day 5 and remained approximately 40% lower in AvApobec1-treated compared with control vector Av1LacZ4-treated animals at day 12. On day 12, total plasma cholesterol decreased by 29% in male mice and 18% in female mice that were transduced with AvApobec1. This was reflected in a reduction in apoB-containing lipoprotein cholesterol, which decreased by 34% and 27% in male and female mice, respectively. Apobec1 gene transfer also decreased the cholesteryl ester contents in the LDL fraction, which were 16%, 22%, and 22% in female and 20%, 20%, and 15% in male animals on days 5, 7, and 12, respectively, compared with Av1LacZ controls with 29%, 32%, and 33%, respectively, in female and 29%, 38%, and 36%, respectively, in male animals. Nondenaturing gradient gel electrophoresis indicated almost complete elimination of LDL particles of 29, 27, and 25 nm at days 7 and 12. We conclude that in the absence of a functioning LDL receptor, hepatic overexpression of Apobec1 is highly efficient in lowering plasma apoB-100 levels, leading to the almost complete elimination of LDL particles and a reduction in LDL cholesterol and cholesteryl ester content.

Effective reduction of LDL cholesterol by indigenous plant product
Bhardwaj, P. K., D. J. Dasgupta, et al. (1994), J Indian Med Assoc 92(3): 80-1.
Abstract: A herbal powder containing guar gum, methi, tundika and meshasringi was administered to 30 control and 30 type 2 (non-insulin dependent) diabetes mellitus patients for a month. Total serum cholesterol and its fractions eg, high density lipoprotein, low density lipoproteins, very low density lipoproteins and serum triglyceride were determined before and after the trial period. Total and low density lipoprotein (LDL) cholesterols were reduced significantly after the therapy. There were no significant changes in high density lipoproteins (HDL), very low density lipoproteins (VLDL) or triglyceride levels. Side-effects eg, mild flatulence and looseness of bowel were noticed in less than 40% cases.

Effectiveness and equity of serum cholesterol and blood pressure testing: a population-based study in Spain
Rodriguez-Artalejo, F., L. Diez-Ganan, et al. (2003), Prev Med 37(2): 82-91.
Abstract: BACKGROUND: This study examined the effectiveness and equity of serum cholesterol and blood pressure testing in Spain. METHODS: Data were taken from a household survey of 3680 persons of the Basque Country, a region in northern Spain. Analyses were performed using logistic regression, controlling for need, equity, and predisposing factors for serum cholesterol and blood pressure testing. Proxies for need were age, subjective health and cardiovascular risk factors, such as tobacco and alcohol consumption, physical activity at work and at leisure time, and body mass index. Proxies for equity were sex, educational level, and province of residence, and predisposing factors for testing were the marital status and the number of medical visits in the preceding year. RESULTS: The percentage of subjects that had their cholesterol measured rose with age and worse subjective health, but showed no association with any cardiovascular risk factor except body mass index, for which a positive association was observed (P for linear trend, 0.0351). The percentage of subjects with serum cholesterol checked also rose with educational level (P for linear trend, 0.0024). Moreover, women were less likely to have their cholesterolemia tested than men (OR, 0.79; 95% CI, 0.67-0.94). Educational and sex differences in cholesterol testing increased after adjustment for the number of medical visits. Similar results were obtained for blood pressure testing. CONCLUSIONS: Serum cholesterol and blood pressure testing are not performed according to cardiovascular risk, which compromise its effectiveness. Moreover, there are social inequalities in testing, to which healthcare professionals could be contributing.

Effectiveness and hazards of case finding for a high cholesterol concentration
Kinlay, S. and R. F. Heller (1990), Bmj 300(6739): 1545-7.
Abstract: OBJECTIVE--To see whether adults with high blood cholesterol concentrations (greater than 6.5 mmol/l) detected by case finding return to their doctor, receive appropriate advice, and report changes in their diet and whether adults found not to have high cholesterol concentrations on case finding are discouraged from changing their diet. DESIGN--Follow up study. SETTING--Seven general practices in the lower Hunter region of Australia. PARTICIPANTS--600 Men and women aged 25-65 who had their blood cholesterol concentrations measured three to four months earlier while attending their general practitioner. Analysis conducted on 552 (92%) who returned follow up postal questionnaires. MEASUREMENTS AND MAIN RESULTS--Of the 125 subjects found to have blood cholesterol concentrations greater than 6.5 mmol/l, 102 (82%) returned to their doctor and 83 of these recalled receiving dietary advice. 93 (75%) Subjects with high concentrations reported changing their diet compared with 72 (46%) subjects with concentrations of greater than 5.5-6.5 mmol/l and 44 (17%) subjects with lower concentrations. Overall 333 (61%) of all respondents who answered reported not changing their diet, the most common reason (nearly half the sample; n = 266) being that their cholesterol concentration was "all right." Adults without high cholesterol concentrations who returned to their doctor were also significantly more likely to recall their doctor saying that they did not need to lower their concentrations (less than or equal to 5.5 mmol/l = 61%; greater than 5.5-6.5 mmol/l = 12%; greater than 6.5 mmol/l = 5%) and significantly less likely to recall receiving dietary advice (less than or equal to 5.5 mmol/l = 13%; greater than 5.5-6.5 mmol/l = 60%; greater than 6.5 mmol/l = 82%). CONCLUSIONS--High risk strategies which require everyone to be tested for high cholesterol concentrations may interfere with population strategies designed to reduce everyone's dietary intake of fat.

Effectiveness and tolerability of a new lipid-altering agent, gemcabene, in patients with low levels of high-density lipoprotein cholesterol
Bays, H. E., J. M. McKenney, et al. (2003), Am J Cardiol 92(5): 538-43.
Abstract: This study evaluated the efficacy and tolerability of gemcabene, a new lipid-altering agent, in a double-blind, randomized, dose-response study of 161 patients with high-density lipoprotein (HDL) cholesterol of <35 mg/dl and serum triglyceride (TG) levels of either >/=200 (n = 94) or <200 mg/dl (n = 67). After a 6-week, placebo, dietary lead-in period, patients were administered either 150, 300, 600, or 900 mg of gemcabene or placebo once daily for 12 weeks. In the TG >/=200 mg/dl stratum, gemcabene significantly increased serum HDL cholesterol by 18% with corresponding significant increases of 6% in both apolipoprotein A-I and A-II levels at the 150-mg dose. HDL cholesterol levels also increased 12% at the 300-mg dose; however, this did not reach statistical significance. Also, in the TG >/=200 mg/dl stratum, serum TG levels were significantly reduced by 27% and 39% at the 150- and 300-mg doses of gemcabene, respectively. No significant differences were found in serum HDL cholesterol or TG levels in the TG >/=200 mg/dl groups that received 600 or 900 mg of gemcabene, or in TG <200 mg/dl groups administered any dose of gemcabene. However, at these higher 600- and 900-mg doses, gemcabene significantly reduced serum low-density lipoprotein (LDL) cholesterol levels by 15% to 25%, respectively, in both TG strata, with proportionate decreases in the levels of apolipoprotein B. Gemcabene was well tolerated with a frequency of adverse events similar to that of placebo. In conclusion, at the lower doses, gemcabene significantly increased HDL cholesterol and reduced TG serum levels in patients with low HDL cholesterol and TG >/=200 mg/dl. At the higher doses, gemcabene significantly reduced LDL cholesterol levels in all patients with low HDL cholesterol.

Effectiveness of a nurse-based intervention in a community practice on patients' dietary fat intake and total serum cholesterol level
Pine, D. A., D. J. Madlon-Kay, et al. (1997), Arch Fam Med 6(2): 129-34.
Abstract: OBJECTIVE: To evaluate the effect of a nurse-based intervention for patients with high total cholesterol (TC) levels in a community practice. DESIGN: Clinical trial without a control followed by a nonrandomized control trial. SETTING: Suburban primary care practice. PATIENTS: White patients with TC higher than 6.21 mmol/L (240 mg/dL). In the initial trial, 82 patients with a mean TC level of 6.80 mmol/L (263 mg/dL). Fifty-three preponderantly female patients in the nonrandomized control trial with a mean TC level of 6.83 mmol/L (264 mg/dL). INTERVENTION: Counseling by office nurses using the Eating Pattern Assessment Tool and handouts with brand-specific food advice. In the initial study, patients attended up to 5 nurse counseling visits. In a follow-up study, intervention patients attending 2 or more counseling sessions were matched with other patients in the practice. MAIN OUTCOME MEASURES: Eating Pattern Assessment Tool scores in the initial study and TC levels in both trials. RESULTS: Mean Eating Pattern Assessment Tool scores at baseline in both studies demonstrated that intervention patients were already following a diet consistent with the National Cholesterol Education Program Step I Diet. In the initial study, mean TC levels of the patients declined 2% (P <.05) and mean Eating Pattern Assessment Tool score improved from 23.4 to 20.4 (P <.001). In the follow-up study, the mean TC level of all patients improved significantly (P =.002). However, the improvement of the intervention patients was no better than that of the comparison patients. CONCLUSION: The nurse counseling intervention was not effective in patients already following a Step I Diet.

Effectiveness of atorvastatin for reducing low-density lipoprotein cholesterol to National Cholesterol Education Program treatment goals
Davidson, M. H., J. W. Nawrocki, et al. (1997), Am J Cardiol 80(3): 347-8.
Abstract: Atorvastatin is a highly efficacious hydroxymethylglutaryl-coenzyme A reductase inhibitor that has been shown to reduce low-density lipoprotein cholesterol by 40% to 60%. Monotherapy with atorvastatin (10 to 80 mg/day) is well-tolerated, convenient, and appears to be effective for achieving National Cholesterol Education Program treatment goals in most patients, regardless of risk status.

Effectiveness of colesevelam hydrochloride in decreasing LDL cholesterol in patients with primary hypercholesterolemia: a 24-week randomized controlled trial
Insull, W., Jr., P. Toth, et al. (2001), Mayo Clin Proc 76(10): 971-82.
Abstract: OBJECTIVE: To evaluate the efficacy, tolerability, and safety of colesevelam hydrochloride, a new nonsystemic lipid-lowering agent. PATIENTS AND METHODS: In this double-blind, placebo-controlled trial performed in 1998, 494 patients with primary hypercholesterolemia (low-density lipoprotein LDL cholesterol level > or = 130 mg/dL and < or = 220 mg/dL) were randomized to receive placebo or colesevelam (2.3 g/d, 3.0 g/d, 3.8 g/d, or 4.5 g/d) for 24 weeks. Fasting serum lipid profiles were measured to assess efficacy. Adverse events were monitored, and discontinuation rates and compliance rates were analyzed. The primary outcome measure was the mean absolute change of LDL cholesterol from baseline to the end of the 24-week treatment period. RESULTS: Colesevelam lowered mean LDL cholesterol levels 9% to 18% in a dose-dependent manner (P<.001), with a median LDL cholesterol reduction of 20% at 4.5 g/d. The reduction in LDL cholesterol levels was maximal after 2 weeks and sustained throughout the study. Mean total cholesterol levels decreased 4% to 10% (P<.001), while median high-density lipoprotein cholesterol levels increased 3% to 4% (P<.001). Median triglyceride levels increased by 5% to 10% in placebo and colesevelam treatment groups relative to baseline (P<.05), but none of these differences were significantly different from placebo. Mean apolipoprotein B levels decreased 6% to 12% in an apparent dose-dependent manner (P<.001). No significant differences occurred in adverse events or discontinuation rates between groups, and compliance rates were between 88% and 92% for all groups. CONCLUSIONS: Colesevelam was efficacious, decreasing mean LDL cholesterol levels by up to 18%, and well tolerated without serious adverse events.

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