title: Angiographic progression of coronary atherosclerosis in patients with familial hypercholesterolaemia treated with non-statin therapy: Impact of a fat-modified diet and a resin.
abstract: Familial hypercholesterolaemia (FH) profoundly increases the risk of coronary artery disease (CAD). We investigated whether diet and a bile-acid sequestrant decrease coronary atherosclerosis in patients with FH.
  
  
  
  We identified 26 men with FH and CAD, participating in the St Thomas' Atherosclerosis Regression Study, who had been randomized to receive a fat-modified diet plus cholestyramine (8 g twice daily) (DC, n = 12) or usual care (UC, n = 14), and investigated the relative effects of these treatments on the angiographic progression of coronary atherosclerosis over 39 months. FH was defined as probable/definite according to Dutch Lipid Clinic Network criteria; mean FH score was 8.7 (range 6-15) and mean baseline low-density lipoprotein cholesterol (LDL-Ch) concentration was 5.4 (SD 1.4) mmol/L. Coronary atherosclerosis was assessed by serial quantitative angiography as the global changes in mean and minimum absolute width of segments (MAWS and MinAWS, respectively).
  
  
  
  Mean plasma LDL-Ch concentration fell by 35% with DC and remained significantly (p < 0.001) lower during the trial at 3.78 (SD 0.98) mmol/L compared with UC at 4.89 (1.04). MAWS decreased by 0.252 (SEM 0.072) mm in the UC group and by 0.001 (0.065) mm in the DC group (p = 0.007), with corresponding reductions in MinAWS of 0.290 (0.087) mm and 0.013 (0.058) mm (p = 0.009); these changes were significant after adjusting for baseline variables, including coronary luminal dimensions and lipoprotein(a). Progression was observed in 7 patients (50%) on UC and 3 (25%) on DC (p = 0.19), with regression in no patients (0%) and 3 patients (25%) (p < 0.05), respectively.
  
  
  
  This investigation, carried out in the pre-statin era, demonstrates that a prudent diet and cholestyramine could improve the course of coronary atherosclerosis in men with phenotypic FH through sustained reductions in LDL-Ch.
authors: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia. Electronic address: gerald.watts@uwa.edu.au.
authors: Gerald F
authors: GF
authors: Watts
authors: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
authors: Jing
authors: J
authors: Pang
authors: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
authors: Dick C
authors: DC
authors: Chan
authors: The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, Cheshire, United Kingdom.
authors: John N H
authors: JNH
authors: Brunt
authors: King's College, University of London, Malet Street, London, United Kingdom.
authors: Barry
authors: B
authors: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D002792:Cholestyramine Resin / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003627:Data Interpretation, Statistical; D004032:Diet; D018450:Disease Progression; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D002792:Cholestyramine Resin
keywords: Bile-acid sequestrant; Diet; Familial hypercholesterolaemia; Treatment