Tags

Type your tag names separated by a space and hit enter

The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia.
N Engl J Med 1993; 328(17):1213-9NEJM

Abstract

BACKGROUND

A diet low in saturated fat and cholesterol is the standard initial treatment for hypercholesterolemia. However, little quantitative information is available about the efficacy of dietary therapy in clinical practice or about the combined effects of diet and drug therapy.

METHODS

One hundred eleven outpatients with moderate hypercholesterolemia were treated at five lipid clinics with the National Cholesterol Education Program Step 2 diet (which is low in fat and cholesterol) and lovastatin (20 mg once daily), both alone and together. A diet high in fat and cholesterol and a placebo identical in appearance to the lovastatin were used as the respective controls. Each of the 97 patients completing the study (58 men and 39 women) underwent four consecutive nine-week periods of treatment according to a randomized, balanced design: a high-fat diet-placebo period, a low-fat diet-placebo period, a high-fat diet-lovastatin period, and a low-fat diet-lovastatin period.

RESULTS

The level of low-density lipoprotein (LDL) cholesterol was a mean of 5 percent (95 percent confidence interval, 3 to 7 percent) lower during the low-fat diet than during the high-fat diet (P < 0.001). With lovastatin therapy as compared with placebo, the reduction was 27 percent. Together, the low-fat diet and lovastatin led to a mean reduction of 32 percent in the level of LDL cholesterol. The level of high-density lipoprotein (HDL) cholesterol fell by 6 percent (95 percent confidence interval, 4 to 8 percent) during the low-fat diet (P < 0.001) and rose by 4 percent during treatment with lovastatin (P < 0.001). The ratio of LDL to HDL cholesterol and the level of total triglycerides were reduced by lovastatin (P < 0.001), but not by the low-fat diet.

CONCLUSIONS

The effects of the low-fat-low-cholesterol diet and lovastatin on lipoprotein levels were independent and additive. However, the reduction in LDL cholesterol produced by the diet was small, and its benefit was possibly offset by the accompanying reduction in the level of HDL cholesterol.

Authors+Show Affiliations

Heart Disease Prevention Clinic, Minneapolis, MN 55455.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

8464431

Citation

Hunninghake, D B., et al. "The Efficacy of Intensive Dietary Therapy Alone or Combined With Lovastatin in Outpatients With Hypercholesterolemia." The New England Journal of Medicine, vol. 328, no. 17, 1993, pp. 1213-9.
Hunninghake DB, Stein EA, Dujovne CA, et al. The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia. N Engl J Med. 1993;328(17):1213-9.
Hunninghake, D. B., Stein, E. A., Dujovne, C. A., Harris, W. S., Feldman, E. B., Miller, V. T., ... Held, J. (1993). The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia. The New England Journal of Medicine, 328(17), pp. 1213-9.
Hunninghake DB, et al. The Efficacy of Intensive Dietary Therapy Alone or Combined With Lovastatin in Outpatients With Hypercholesterolemia. N Engl J Med. 1993 Apr 29;328(17):1213-9. PubMed PMID: 8464431.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia. A1 - Hunninghake,D B, AU - Stein,E A, AU - Dujovne,C A, AU - Harris,W S, AU - Feldman,E B, AU - Miller,V T, AU - Tobert,J A, AU - Laskarzewski,P M, AU - Quiter,E, AU - Held,J, PY - 1993/4/29/pubmed PY - 1993/4/29/medline PY - 1993/4/29/entrez SP - 1213 EP - 9 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 328 IS - 17 N2 - BACKGROUND: A diet low in saturated fat and cholesterol is the standard initial treatment for hypercholesterolemia. However, little quantitative information is available about the efficacy of dietary therapy in clinical practice or about the combined effects of diet and drug therapy. METHODS: One hundred eleven outpatients with moderate hypercholesterolemia were treated at five lipid clinics with the National Cholesterol Education Program Step 2 diet (which is low in fat and cholesterol) and lovastatin (20 mg once daily), both alone and together. A diet high in fat and cholesterol and a placebo identical in appearance to the lovastatin were used as the respective controls. Each of the 97 patients completing the study (58 men and 39 women) underwent four consecutive nine-week periods of treatment according to a randomized, balanced design: a high-fat diet-placebo period, a low-fat diet-placebo period, a high-fat diet-lovastatin period, and a low-fat diet-lovastatin period. RESULTS: The level of low-density lipoprotein (LDL) cholesterol was a mean of 5 percent (95 percent confidence interval, 3 to 7 percent) lower during the low-fat diet than during the high-fat diet (P < 0.001). With lovastatin therapy as compared with placebo, the reduction was 27 percent. Together, the low-fat diet and lovastatin led to a mean reduction of 32 percent in the level of LDL cholesterol. The level of high-density lipoprotein (HDL) cholesterol fell by 6 percent (95 percent confidence interval, 4 to 8 percent) during the low-fat diet (P < 0.001) and rose by 4 percent during treatment with lovastatin (P < 0.001). The ratio of LDL to HDL cholesterol and the level of total triglycerides were reduced by lovastatin (P < 0.001), but not by the low-fat diet. CONCLUSIONS: The effects of the low-fat-low-cholesterol diet and lovastatin on lipoprotein levels were independent and additive. However, the reduction in LDL cholesterol produced by the diet was small, and its benefit was possibly offset by the accompanying reduction in the level of HDL cholesterol. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/8464431/full_citation L2 - http://www.nejm.org/doi/full/10.1056/NEJM199304293281701?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -