Cholestyramine, Stanol and Statin Combination

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jay1000 - 21 Apr 2007 21:14 GMT

I am a high risk patient and have been fighting to lower cholesterol
since developing severe myalgia with Lipitor, then Zocor and finally
with Zetia. Only the very mild Pravachol is tolerable with a slight
myalgia. CK is normal.

With Pravachol 20 mg and chlolestyramine 8 gm, my TC is 200, LDL 120 &
HDL 50. I don't want to give up on lowering my cholesterol. So I am
considering adding Benecol margarine or chews with about 2.5 gm stanol
esters per day.

Pravachol, cholestyramine & stanols work with different mechanisms. It
is not unexpected that there does not appear to be any information on
possible interactions.

Any thoughs? My doctor has no data on this triple combination
therapy.

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The Wellness Gurus - 22 Apr 2007 02:26 GMT

> I am a high risk patient and have been fighting to lower cholesterol
> since developing severe myalgia withLipitor, then Zocor and finally
[quoted text clipped - 12 lines]
> Any thoughs? My doctor has no data on this triple combination
> therapy.

Here's my suggestion: Forget taking those medications"

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MarilynMann - 22 Apr 2007 16:35 GMT

Suggest you search Google Scholar for relevant studies. You may not
be able to find any that combine those three interventions, but you
should be able to find something on combining statins with resins
(bile acid sequestrants).

I haven't heard about any trials showing that stanols actually reduce
CVD, although I haven't heard about any that say they don't either.

Are you eating lots of fish and/or taking fish oil? There is pretty
good evidence for benefits of omega-3 fatty acids.

Marilyn

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William Wagner - 22 Apr 2007 16:55 GMT

> Suggest you search Google Scholar for relevant studies. You may not
> be able to find any that combine those three interventions, but you
> should be able to find something on combining statins with resins
> (bile acid sequestrants).

> Marilyn

Google Scholar is new to me. Thanks

http://scholar.google.com/

I look about here.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&tool=toolbar

Question is there a world wide equivalent to PubMed I should look at?

Bill about to work on his pond in about 80 degrees this after putting
away my winter stuff. Yahoo!

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This article is posted under fair use rules in accordance with
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jay1000 - 22 Apr 2007 19:30 GMT

>Suggest you search Google Scholar for relevant studies. You may not
>be able to find any that combine those three interventions, but you
[quoted text clipped - 8 lines]
>
>Marilyn

Thanks, FYI there is information on cholestyramine plus statins and
there are no adverse effects from the combo. However, the consensus
is if you are on statins you do not need cholestyramine as it is not
nearly as effective as statins. I am taking it because all I can take
is a "weak" statin and it helps with that.

As far as stanols, there have been no trials with CVD endpoints. The
trials do show an approx 10% reduction in chloresterol.

I'll check google scholar and see if I can find any interaction info.

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MarilynMann - 23 Apr 2007 11:54 GMT

You might also try eating certain foods that are thought to lower
LDL: psyllium (you can buy capsules in drugstore), almonds, okra,
eggplant, oat bran, etc.

I'm wary about plant sterols because I have seen discussions about
whether or not they are atherogenic. There is a genetic disease where
you end up with huge quantities in your bloodstream and it leads to
early CVD. I think they need to do some studies to know for sure.
Small amounts are probably not dangerous.

Soy only works if you eat huge amounts, and then only has a slight
effect.

Marilyn

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jay1000 - 23 Apr 2007 20:46 GMT

>Suggest you search Google Scholar for relevant studies. You may not
>be able to find any that combine those three interventions, but you
[quoted text clipped - 8 lines]
>
>Marilyn

Google Scholar did it! Found a triple therapy article. As expected,
it has no CVD end points but shows the effect of the individual agents
and some combinations on cholesterol.

Nutr Metab Cardiovasc Dis. 2002 Feb;12(1):19-23. Links

LDL cholesterol lowering by bile acid malabsorption during inhibited
synthesis and absorption of cholesterol in hypercholesterolemic
coronary subjects.

* Gylling H,
* Miettinen TA.

Department of Clinical Nutrition, University of Kuopio, Kuopio
University Hospital, Kuopio, Finland.

BACKGROUND AND AIMS: Recent large-scale trials have consistently
documented the fact that a 25-35% reduction in low-density lipoprotein
cholesterol (LDL-C) can delay the progression of atherosclerosis. This
raises the question as to how much it is possible to reduce serum
cholesterol using feasible therapies. The aim of this study was to
investigate the cholesterol-lowering efficacy of a triple therapy
combining bile acid malabsorption with the inhibition of cholesterol
synthesis and absorption.

METHODS AND RESULTS: Eleven consecutive hypercholesterolemic coronary
patients from Lipid Clinics on a low-fat, low-cholesterol baseline
diet added simvastatin (20 mg/day) for three months, and then dietary
plant stanol ester margarine (2.25 g of stanols/day) for eight weeks;
finally, cholestyramine 8 g/day was added for another eight weeks.
This was a before-after trial, in which the results of each period
were compared with baseline and those of the previous period. Serum
lipids were quantitated using commercial kits, and serum sterols by
means of gas-liquid chromatography. Simvastatin lowered LDL-C by 39%
(p < 0.001), and additional stanol ester margarine by a further 13% (p
< 0.05). The triple treatment led to 67% reduction from baseline (p <
0.001), with all LDL-C values being < 2.6 mmol/L, and increased
high-density lipoprotein cholesterol (HDL-C) by 15% (p < 0.01). It
also increased the serum lathosterol/cholesterol ratio (p < 0.01),
thus indicating an upregulation of cholesterol synthesis, and
increased the serum sitosterol ratio (p < 0.01) despite the
simultaneous consumption of plant stanols.

CONCLUSIONS: The massive reduction in LDL and increase in HDL-C
obtained using our triple therapy suggests that the combination of
stanol ester with only moderate doses of statin and resin makes it
possible to control LDL-C levels effectively in hypercholesterolemic
subjects.

PMID: 12125225 [PubMed - indexed for MEDLINE]

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