Combination Therapy with Colestipol and Psyllium Mucilloid in Patients with Hyperlipidemia

Spence, J. David; Huff, M W; Heidenheim, Paul; Viswanatha, A; Muñoz, Carmen; Lindsay, R. M.; Wolfe, Benjamin; Mills, Dean

doi:10.7326/0003-4819-123-7-199510010-00003

Cited by 47 publications

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“…It is derived from the seed husk of Plantago ovata (11) and is considered a useful supplement to dietary therapy (National Cholesterol Education Program (NCEP) Step 1 and 2 diets) for the treatment of hypercholesterolaemic patients. Despite this, Haney et al (12) and Spence et al (13) have expressed certain doubts with regard to the dose -response relationship and long-term efficacy of the treatment.Although these positive effects have been clearly demonstrated in hypercholesterolaemic adults (7) , there are few, mostly old, published studies on the use of psyllium or other fibre mixtures in children or adolescents (9,10) and some (13,14) have reported inconclusive results.We hypothesised that psyllium supplementation exerts an additional lipid-lowering effect on serum LDL-C concentrations in dyslipidaemic paediatric subjects treated with the NCEP Step 2 diet. * Corresponding author: Professor S. A. Ribas, fax þ55 21 2587 6494, email ribasnut@yahoo.com.br…”

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Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial

et al. 2014

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The present study investigated the LDL-cholesterol (LDL-C)-lowering effects of psyllium in Brazilian dyslipidaemic children and adolescents. A total of fifty-one individuals (6 -19 years) with mild-to-moderate hypercholesterolaemia were evaluated by conducting a randomised, double-blind, placebo-controlled, parallel clinical trial. Over an 8-week trial period, the participants were randomly allocated to one of two groups (control: n 25 and psyllium: n 26) using a computer-generated random number sequence. Fasting blood samples, dietary records and anthropometric data were collected. Both groups were treated with the National Cholesterol Education Program Step 2 diet for 6 weeks before randomisation. After this run-in period, a daily supplement of 7·0 g psyllium was given to the intervention group, while an equivalent amount of cellulose was given to the control group. Statistically significant changes between the control and intervention groups over time were observed for total cholesterol (7·7 %; 20·39 mmol/l; P ¼ 0·003) and LDL-C (10·7 %; 20·36 mmol/l; P ¼ 0·01). None of the participants reported any aversion to the smell, taste, appearance or texture of psyllium. No serious adverse effects were reported during the study. In addition to causing a significant reduction in LDL-C concentrations, psyllium therapy was found to be both safe and acceptable for the treatment of hypercholesterolaemic children and adolescents.Key words: Dyslipidaemia: Psyllium: Children: Adolescents Atherosclerotic CVD is a leading cause of morbidity and premature mortality in Western countries and hypercholesterolaemia is recognised as a major cardiovascular risk factor (1) . Available data indicate that 28 -40 % of Brazilian children and adolescents are dyslipidaemic (2,3) .According to current Brazilian and American guidelines (4,5) , the best way to reduce LDL-cholesterol (LDL-C) concentrations is to follow a low-fat diet supplemented with water-soluble fibres and plant stanols and sterols, combined with weight control and exercise (6) . Alternative dietary therapies have been proposed and efforts have been made to enhance the efficacy of conventional dietary therapy (low-fat diet) to reduce serum cholesterol concentrations through the inclusion of specific foods or food components with known cholesterol-lowering properties (4,6) .A recent systematic review (7) has demonstrated the cholesterol-lowering capacity of the soluble dietary fibre extracted from psyllium husk in adults. Psyllium has been found to lead to reductions ranging from 2·78 to 2 22·8 % in the serum LDL-C concentrations of children and adolescents (8 -10) . The wide range of effects observed in these studies may be related to the quality of the dietary intervention or to the different methods of randomisation, blinding, dietary intake assessment and laboratory measurement.Psyllium is one of the richest known sources of soluble mucilaginous dietary fibre. It is derived from the seed husk of Plantago ovata (11) and is considered a useful supplement to dietary...

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Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial

et al. 2014

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“…In all 22 of 39 studies were selected for special review. Two studies (Stoy et al, 1993;Spence et al, 1995), which met above criteria, were excluded because they did not provide enough data to compute the effect size and one was excluded because subjects in the study were already represented in another published study by the same group. As two research reports (Sprecher et al, 1993;Jenkins et al, 1997) involved two sub-groups, the data were treated as two separate studies.…”

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Time- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: a meta-analysis of controlled clinical trials

Wei

Wang

et al. 2008

Eur J Clin Nutr

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Objectives: Evidences from randomized clinical trials and meta-analysis have claimed an association between the use of soluble dietary fiber from psyllium and a cholesterol-lowering effect. However, there is still uncertainty as to the dose-response relationship and its long-term lipid-lowering efficacy. This meta-analysis was primarily conducted to address the dose-response relationship between psyllium and serum cholesterol level and time-dependent effect of psyllium in mild-to-moderate hypercholesterolemic subjects. Methods: Twenty-one studies, which enrolled a total of 1030 and 687 subjects receiving psyllium or placebo, respectively, were included in the meta-analysis. The studies were randomized placebo-controlled trials, double blinded or open label, on subjects with mild-to-moderate hypercholesterolemia. The dose of psyllium was between 3.0 and 20.4 g per day and intervention period was more than 2 weeks. Any type of diet background was permitted. Diet lead-in period was between 0 and 8 weeks.Results: Compared with placebo, consumption of psyllium lowered serum total cholesterol by 0.375 mmol/l (95% CI: 0.257-0.494 mmol/l), and LDL cholesterol by 0.278 mmol/l (95% CI: 0.213-0.312 mmol/l). With random-effect meta-regression, a significant dose-response relationship were found between doses (3-20.4 g/day) and total cholesterol or LDL cholesterol changes. Regression model of total cholesterol was À0.0222 þ 0.2061 Â log (dose þ 1), and that of LDL cholesterol was 0.0485 þ 0.1390 Â log (dose þ 1). There was a time effect of psyllium on total cholesterol (equation: 6.3640-0.0316 Â treatment period) and on LDL cholesterol (equation: 4.3134-0.0162 Â treatment period), suggesting that psyllium reduced serum total cholesterol more quickly than LDL cholesterol. Conclusions: Psyllium could produce dose-and time-dependent serum cholesterol-lowering effect in mild and moderate hypercholesterolemic patients and would be useful as an adjunct to dietary therapy for the treatment of hypercholesterolemia. (2009) 63, 821-827; doi:10.1038/ejcn.2008 published online 5 November 2008 Keywords: hypercholesterolemia; total cholesterol; LDL cholesterol; meta-analysis; randomized controlled trials European Journal of Clinical Nutrition IntroductionIn recent years, there has been growing interest in the use of dietary fibers in health maintenance and disease prevention (Petchetti et al., 2007). It has been speculated that a deficiency of soluble fibers in the Western diet might be contributing to the epidemics of coronary heart disease (CHD), diabetes mellitus and colonic cancer. Hypercholesterolemia has been identified as a prominent independent risk factor in the development of CHD. Soluble fibers, including those from psyllium husk, have been shown to augment the cholesterol-lowering effects of a low-fat diet in persons with hypercholesterolemia. Increasing dietary fiber has been recommended as a safe and practical approach for cholesterol reduction (NCEP ATPIII, 2001 andBrunner et al., 2007). Psyllium is one of the highest so...

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“…36 Jenkins et al compared the cholesterol-lowering probability of a dietary portfolio with that of a statin in 34 hyperlipidemic patients. [37][38][39] The study participants were randomized to receive 1-month treatment with the control diet, which was a very low saturated fat diet; the statin diet (the control diet plus 20 mg of lovastatin); and a portfolio diet, which is high in viscous fibers from oats, barley, and psyllium.…”

Section: Psyllium Supplementation With a Modified Diet And Other Drugmentioning

confidence: 98%

Nutriceuticals in Cardiovascular Disease

Petchetti¹,

Frishman²,

Petrillo³

et al. 2007

Cardiology in Review

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In recent years, there has been a growing interest in the use of dietary fiber in health maintenance and disease prevention. A deficiency of fiber in the Western diet may be contributing to the current epidemics of diabetes mellitus, coronary artery disease (CAD), and colonic cancer. The awareness of fiber as a dietary supplement may have contributed to the reported 30% decline in death rate from CAD observed over the past 15 years. Psyllium is a soluble gel-forming fiber that has been shown to bind to the bile acids in the gut and prevent their normal reabsorption, similar to the bile acid sequestrant drugs. Psyllium is useful as an adjunct to dietary therapy (step 1 or step 2 American Heart Association [AHA] diet) in the treatment of patients with mild-to-moderate hypercholesterolemia. In combination with other cholesterol-lowering drugs, such as statins, psyllium provides an added benefit on cholesterol lowering, and is well tolerated and cost-effective.

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Combination Therapy with Colestipol and Psyllium Mucilloid in Patients with Hyperlipidemia

Abstract: These findings suggest that adding psyllium to half the usual dose of bile acid sequestrant resins maintains the efficacy and improves the tolerability of these resins.

Cited by 47 publications

References 0 publications

Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial

Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial

Time- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: a meta-analysis of controlled clinical trials

Nutriceuticals in Cardiovascular Disease

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