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23-05-2010 | Cardiometabolic | Article

Combination therapy improves LDL cholesterol lowering in patients on low-carbohydrate diet


Free abstract

MedWire News: Adding a cholesterol absorption inhibitor to statin therapy improves low-density lipoprotein (LDL) cholesterol lowering in patients on a low-carbohydrate diet, findings from a randomized study show.

Low-carbohydrate diets have been shown to have beneficial effects on triglyceride and high-density lipoprotein cholesterol levels; however, such diets do not usually reduce levels of LDL cholesterol.

Julio Chirinos (University of Pennsylvania, Philadelphia, USA) and colleagues note that because patients following a low-carbohydrate diet typically consume, in addition to greater quantities of protein, greater quantities of saturated fat and cholesterol, it is likely that statin monotherapy will not achieve optimal LDL cholesterol reduction.

It follows that inhibition of cholesterol absorption could improve LDL cholesterol lowering in patients on a low-carbohydrate diet, they say.

Accordingly, 65 individuals who were overweight or obese, had moderately elevated levels of LDL cholesterol, and were eating less than 30 g/day of carbohydrates were randomly assigned to receive treatment with simvastatin 20 mg/day alone or simvastatin plus the cholesterol absorption inhibitor ezetimibe 10 mg/day, for 8 weeks.

As reported in the American Heart Journal, the average weight loss among the patients was 3.1% by the end of the end of the study, regardless of treatment prescribed.

In patients who took simvastatin alone, 8 weeks of treatment was associated with a significant decrease in levels of LDL cholesterol of 32 mg/dl (0.8 mmol/l, 20.9%). In patients taking simvastatin plus ezetimibe, LDL cholesterol levels were typically reduced by a significant 60 mg/dl (1.5 mmol/l, 37.4%).

The patients also showed an average 15.8% decrease in triglyceride levels that did not differ significantly by treatment.

The authors note that their study results are limited because 97% of participants were male.

But they conclude: “Among patients who follow a low-carbohydrate diet in whom aggressive LDL cholesterol lowering is required, combined cholesterol synthesis and absorption inhibition appears to be an effective strategy for lowering LDL cholesterol.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Philip Ford