Effectiveness of low-dose colestipol therapy in patients with moderate hypercholesterolemia

Recommended doses of bile-acid binding resins have an established hypocholesterolemic effect, but data on responses to low doses, especially in women and subjects with moderate hypercholesterolemia, are sparse. A double-blind, placebo-controlled, randomized trial of 3 low doses of colestipol hydrochloride was conducted in women and men with moderate hypercholesterolemia. Men and women with plasma low-density lipoprotein (LDL) cholesterol concentrations >4 mmol/ liter (155 mg/dl) and triglyceride concentrations <2.82 mmol/liter (250 mg/dl) were recruited for the study. Eligible patients (54 women and 98 men) were placed on the American Heart Association step I diet 6 weeks before randomization. Participants were subsequently assigned to 1 of 4 drug treatment groups (placebo, and 5, 10 and 15 g/day of colestipol in 2 divided doses) for an additional 12 weeks. Of the 152 patients randomized, 141 completed all aspects of the study. For the treatment groups-placebo, and 5, 10 and 15 g of colestipol-LDL cholesterol reductions (mmol/ liter) were observed respectively (n = 141): 0.10 ±0.49 (2.7%), 0.65 ± 0.41 (16.3%), 0.98 ± 0.36 (22.8%) and 1.17 ± 0.47 (27.2%) (p < 0.001). Similar changes were observed in total cholesterol and apolipoprotein B concentrations. The apolipoprotein B LDL cholesterol ratio increased significantly with increasing colestipol dosage. Modest but insignificant changes in plasma triglyceride levels occurred, and high-density lipoprotein cholesterol levels remained unchanged. A dose of 5 g/day of colestipol achieved 51% of the LDL cholesterol reduction noted with 15 g/day. Low-dose colestipol therapy is effective in the treatment of patients with moderate hypercholesterolemia. The proportionally greater LDL cholesterol reduction in moderate compared with severe hypercholesterolemia was confirmed by examination of the Lipid Research Clinics' Coronary Primary Prevention Trial data set.