Fiber-multivitamin combination therapy: a beneficial influence on low-density lipoprotein and homocysteine.
Proven effective alternative and adjunctive therapies for lipid lowering could be beneficial for patients with hyperlipidemia. We evaluated a 90% soluble fiber for its ability to alter lipid, lipoprotein, and homocysteine levels in the setting of coadministered folate and B vitamins. Patients (n = 119) were randomized to either the fiber and vitamin combination, or placebo. Fasting lipid, glucose, and homocysteine concentrations, and body mass index (BMI) were obtained at baseline and weeks 4 and 8. Both between-group (Wilcoxon rank-sum test) and within-group (paired t test) comparisons were used to evaluate treatment effects. After 6 weeks of a diet therapy (National Cholesterol Education Program [NECP] Step I) run-in period, subjects in both groups had similar low-density lipoprotein cholesterol (LDL-C) levels (159 mg/dL v 158 mg/dL). The treated group showed a 7.1% +/- 11.6% reduction by 4 weeks, which was maintained at 8 weeks (7.9% +/- 11.0%). Placebo patients had a slight increase in LDL-C values over the same period (+2.4% +/- 11.7%), for a 10.3% difference between groups. The treatment effect was statistically significant both between groups (P <.001) and within the active-treatment group (P <.001) after the 8-week intervention. Apolipoprotein B (ApoB) levels in a representative subset of the treated group (n = 53) decreased by 20% (P =.004). The fiber blend neither raised triacylglycerol (TG) (P =.95) nor lowered high-density lipoprotein cholesterol (HDL-C) levels (P =.54), and lowered homocysteine (active, 9.8 to 8.7/micromol/L, P =.02; placebo, 9.4 to 9.2 /micromol/L, P =.98). Thus, a significant LDL-C lowering effect, with parallel Apo B reduction, was demonstrated for this fiber/vitamin combination. No adverse changes on TG or HDL-C levels were noted, and folate/B vitamin benefits attributed to homocysteine reduction were preserved. Concurrent administration of fiber and vitamins represents a preventive approach that may reduce the need for concomitant lipid-lowering therapies or serve as an adjunct therapy.
Preventive Cardiology Section, The Cleveland Clinic Foundation, OH, USA.
Dennis L
DL
Sprecher
Gregory L
GL
Pearce
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D008078:Cholesterol, LDL / Q000097:blood; D004043:Dietary Fiber / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D014280:Triglycerides / Q000097:blood; D014803:Vitamin B Complex / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use*
D001786:Blood Glucose; D008078:Cholesterol, LDL; D004043:Dietary Fiber; D004338:Drug Combinations; D008077:Lipoproteins, LDL; D014280:Triglycerides; D014815:Vitamins; D006710:Homocysteine; D014803:Vitamin B Complex; D005492:Folic Acid