Plasma 25-Hydroxy-vitamin D in Familial Hypercholesterolemic Children Receiving Colestipol Resin

Abstract

Pediat. Res. 12: 980-982 (1978) Bile acid sequestrant resins (colestipol) 25-hydroxy-vitamin D SummaryIn this study we have assessed effects of Colestipol, a synthetic organic bile sequestrant polymer, on vitamin D metabolism over a 2-year period in children with familial hypercholesterolemia. In the 15 children, mean (+SE) low density lipoprotein (LDL) cholesterol decreased from 221 + 9 mg/dl (baseline), to 181 +-7 after 12-14 months of Colestipol resin, P < 0.01. Thereafter, LDL cholesterol remained in the 170-190 mg/dl range. Mean plasma 25-hydroxyvitamin D (25-OHD) levels appeared to fall slightly and progressively from 32.6 + 4 ng/ml (baseline) to 29.8 + 3.5 at 12-14 months, to 25.6 & 3.3 at 16-18 months, and to 18.5 + 2.7 at 18-20 months. The decrease in plasma 25-OHD was not significant until 18-20 months (paired t, P < 0.01). After 20 months, plasma 25-OHD levels appeared to increase again and were not significantly different from baseline. Seasonal effects on plasma 25-OHD were not demonstrable. Mean plasma Ca values were mildly increased after Colestipol therapy was begun and were significantly elevated at 18-20 months (10.04 vs. 9.71 mg/dl at baseline). Mean plasma PO4 levels were not significantly different on Colestipol therapy, with the single exception that at 20-22 months plasma Po4 was 3.82 vs. 4.05 mg/dl at baseline ( P< 0.05). In no subject was serum Ca <9 mg/dl or serum PO4 <2.5 mg/dl at any time during the study.

Drug–Vitamin D Interactions

“…One of the RCTs reported a statistically significant decrease in serum 25(OH)D concentrations among children with familial hypercholesterolemia taking 8 g cholestyramine/day for one year compared to controls 30 . In contrast, the time series and before-and-after studies reported no significant change from baseline circulating 25(OH)D levels among children taking colestipol for 2–24 months 32, 33 . Similarly, two of the RCTs both reported no significant differences in circulating 25(OH)D concentrations between adults taking 24 g cholestyramine/day and a control group after 24 weeks 31 or 7–10 years 29 .…”

“…Three RCTs (Class A; two neutral quality 29, 30 , one negative quality 31 ), one time series (Class C, negative quality 32 ), and one before-and-after study (Class D, negative quality 33 ) evaluated the effect of bile acid sequestrants on vitamin D status. One of the RCTs reported a statistically significant decrease in serum 25(OH)D concentrations among children with familial hypercholesterolemia taking 8 g cholestyramine/day for one year compared to controls 30 .…”

Feasibility study of colestipol as an oral phosphate binder in hemodialysis patients

“…28 A previous small study of colestipol in hypercholesterolaemic children with normal renal function did not demonstrate changes in phosphate, though the dif-ferences in patient population perhaps limit applicability to dialysis patients. 28 The treatment period was short, and the sample size was also limited. Overall, however, our results suggest that a larger and longer trial of colestipol as a phosphate-binding medication is feasible.…”

“…Further physiological studies measuring gut and/or urinary phosphate excretion as well as vitamin D status with colestipol treatment may be useful to clarify the effects of this drug on phosphate and also the mechanisms of action . A previous small study of colestipol in hypercholesterolaemic children with normal renal function did not demonstrate changes in phosphate, though the differences in patient population perhaps limit applicability to dialysis patients . The treatment period was short, and the sample size was also limited.…”

Drug and Hormone Effects on Vitamin D Metabolism

“…However, a large double-blind randomized trial of patients treated with cholestyramine (24 g/day) for 4 months showed similar levels of vitamin D metabolites, PTH, and serum calcium and phosphate compared with placebo-treated patients [486]. Ismail et al showed equivalent findings after 6 months of therapy [464], as did long-term studies using another bile acid sequestrant, colestipol, for the treatment of children with familial hypercholesterolemia [487,488].…”