Author + information
- Livia N. Matos,
- Valeria A. Machado,
- Silvio A. Barbosa,
- Marilia I. Fonseca,
- Francisco A. Fonseca,
- Ney C. Borges and
- Maria C. Izar
Familial hypercholesterolemia (FH) is a severe form of inherited dyslipidemia, whose treatment requires lipid-lowering therapy in high doses or associations. Phytosterol supplementation (PS) may improve achieving goals, but the effect of these therapies on absorption and synthesis of sterols is not well described.
To evaluate the effects of the addition of phytosterols to lipid-lowering therapy, alone or combined, on lipids, markers of sterol synthesis and absorption.
A prospective randomized open label study with blinded endpoints analysis included 42 individuals of both sexes with clinical (Dutch MedPed, Simon Broome) and/or genetic diagnosis of FH. After discontinuation of prior lipid-lowering therapy, and under nutrition counselling according to NCEP/ATPIII guidelines, patients were randomized to receive 12 weeks of simvastatin 80 mg (S) or simvastatin 80 mg/ezetimibe 10 mg (SE). In the next phase it was associated 2 g/day of free phytosterol (Vegapure) encapsulated to prior treatments for another 12s. Lipids, apolipoproteins, absorption markers (campesterol and beta-sitosterol) and endogenous cholesterol synthesis markers (desmosterol), all by UPLC/MS/MS were evaluated at baseline, 12 and 24 weeks.
The groups were comparable at baseline. In the first phase, both therapies reduced total cholesterol (TC), LDL-C, triglycerides and Apo B (p<0.001 vs. Baseline), but the changes were greater with SE (p<0.05 vs. S). The addition of 2g of phytosterols further reduced TC, LDL-C and ApoB only in the group SE (p <0.05). S alone or associated with PS did not change the sterols, but the relations of markers absorption / sterol levels increased in group S (p<0.05). SE reduced campesterol and beta-sitosterol in both phases (p<0.001). In addition, these markers were lower in SE group (p<0.001 vs. S), with no differences between groups in the values [[Unable to Display Character: ​]][[Unable to Display Character: ​]]obtained for desmosterol levels.
Supplementation of PS in FH promotes additional benefits on lipids and Apo B only when treatment include the sterol absorption inhibitor, ezetimibe. Changes in the synthesis and absorption of sterols can influence the outcome of lipid-lowering interventions.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Prevention: Treatment of Hyperlipidemia
Abstract Category: 24. Prevention: Clinical
Presentation Number: 1275-15
- 2013 American College of Cardiology Foundation