22 March 2009

Lovastatin versus cholestyramine for familial hypercholesterolemia

Along with the recommendation of exercise and a healthy diet (including a bit of red wine daily), both lovastatin and cholestyramine can be used in the treatment of familial hypercholesterolemia (1;2).

While lovastatin works as a HMG CoA reductase inhibitor to reduce cholesterol synthesis in the liver, cholestyramine acts as a bile acid-binding resin that increases fecal removal of cholesterol (1p152;3-4).

Reference List
1. Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism. Belmont, CA: Thomson Wadsworth, 2009.
2. Netdoctor.co.uk. Familial hypercholesterolemia. Available at: http://www.netdoctor.co.uk/diseases/facts/familialhypercholesterolaemia.htm.
3. Netdoctor.co.uk. Questran (colestyramine). Available at: http://www.netdoctor.co.uk/medicines/100002209.html.
4. Medicine.net. Lovastatin (oral). Available at: http://www.medicinenet.com/lovastatin-oral/article.htm.


MarilynMann said...


Because I have family members who have heterozygous familial hypercholesterolemia, I have a Google Alert for "familial hypercholesterolemia." Google sent me the link to your post.

First, I think it would be helpful to your readers if you explain to them what familial hypercholesterolemia (FH) is. I know from experience that laypersons usually are not familiar with the term. Briefly, familial hypercholesterolemia is a genetic disease that causes very high LDL ("bad") cholesterol levels. There are two forms: heterozygous and homozygous. Heterozygous FH occurs in approximately 1 out of 500 people, while homozygous FH occurs in 1 out of a million. The disease is linked to premature heart disease.

The primary treatment for heterozygous FH is statin therapy. Although lovastatin is a statin, it is one of the weaker statins. One of the more potent statins, such as atorvastatin or rosuvastatin, would be a more effective treatment for people with FH than lovastatin.

Cholestyramine is a very ineffective medication in reducing the incidence of heart attacks as compared with statins. Using cholestyramine to treat someone with FH would not be a very effective strategy. If someone had tried every statin and could not tolerate any of them, using cholestyramine would be an option. Not a good option, but an option. Some doctors might use cholestyramine or another bile acid sequestrant as an additional drug if someone's LDL was still high after being on the maximum dose of a statin. However, I am not aware of any evidence in the form of clinical trials that this strategy is effective in reducing the risk of heart disease.

Homozygous FH is also treated with statins, but generally requires LDL apheresis also. LDL apheresis involves removing LDL from the blood and then replacing the blood, similar to kidney dialysis.


David Despain said...

Congrats, Marilyn! On being the first person to have ever commented on this blog. Glad someone is reading it. David