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Bakgrunn: Diabetes er assosiert med koronarsykdom, og kardiovaskulær sykdom er viktigste dødsårsak hos mennesker med sykdommen. I denne studien har vi undersøkt forekomsten av kjent diabetes og ikke-erkjent diabetes hos pasienter ved første gangs hjerteinfarkt, perkutan koronar intervensjon eller koronar bypasskirurgi samt forekomsten av nye kardiovaskulære hendelser i inntil fem år etterpå., Materiale Og Metode: Alle pasienter < 80 år uten tidligere kjent koronarsykdom innlagt ved Sørlandet sykehus Arendal i forbindelse med første gangs hjerteinfarkt, perkutan koronar intervensjon eller koronar bypasskirurgi i perioden 2007-16 ble fortløpende inkludert i studien og fulgt i inntil fem år (median oppfølgingstid tre år)., Resultater: Av totalt 1 259 inkluderte pasienter hadde 178 (14 %) kjent diabetes ved innleggelsestidspunktet og 49 (4 %) ikke-erkjent diabetes. I løpet av oppfølgingsperioden utviklet ytterligere 102 pasienter (8 %) diabetes. Omtrent halvparten av dem med diabetes hadde en HbA1c-verdi ≤ 7 %. Risikoen for utvikling av nye kardiovaskulære hendelser var høyere hos pasienter med diabetes enn hos pasienter uten diabetes (alders- og kjønnsjustert hasardratio 1,5; 95 % konfidensintervall: 1,1-2,1, p = 0,005)., Fortolkning: Studien viser at det er høy forekomst av diabetes hos pasienter med første gangs koronarsykdom og høy risiko for nye kardiovaskulære hendelser hos pasienter med diabetes. Regelmessig undersøkelse med tanke på utvikling av diabetes og god forebyggende behandling av pasienter med diabetes og koronarsykdom er viktig.

In 2015, more than 530 000 people were prescribed statins in Norway. Adverse effects from the musculoskeletal system as well as less specific side effects are frequently reported. The extent of these contrasts with observations made in randomised controlled studies which report the prevalence of such adverse effects as being in line with placebo. Breaks from drug treatment, low doses, switching medication and use of other lipid-lowering drugs are the most relevant approaches to dealing with adverse effects.

Background: We have investigated the significance of a single measurement of risk factors for cardiovascular disease and total mortality for different time periods., Material and Methods: The 14 846 men (without disease) who were screened in the Oslo Health Study in 1972-73 have been followed for 33 years. Cox and logistic regression analyses were used to estimate associations between risk factors and mortality for the four time periods 0-12, 12-24, 24-33 and 0-33 years. The predictivity of Westlund's score was compared to risk score functions based on three classical and some other risk factors., Results: In a multivariate analysis the following there factors were the best predictors of total mortality in the period 0-12 years: total cholesterol, blood pressure and smoking. Triglycerides, glucose, body mass index, physical activity at work and little physical activity at leisure were more weakly, but consistently associated with mortality. With longer follow-up, predictivity decreased for total cholesterol and blood pressure in contrast to smoking (hazard ratio 1.41; 95% confidence interval 1.38-1.45), which also was the best discriminator between survival and death. Westlund's score performed worse than the 3-factor score. Use of a score based on eight factors did not result in a clinically significant increase in predictivity., Interpretation: The classical risk factors predicted mortality over all follow-up periods. Smoking was the most important discriminator between survival and death. The 3- factor score resulted in adequate predictivity in comparison with the 8-factor score.

Background: The metabolic syndrome is a widely prevalent constellation of risk factors for cardiovascular disease. We examined the prevalence and determinants of the metabolic syndrome in overweight/obese patients requesting treatment., Material and Methods: We conducted a retrospective journal search for patients with a diagnosis of obesity that were examined at the Department of Preventive Cardiology, Ullevaal University Hospital between 1999 - 2002. The patients were self-referred (14 %) or referred from primary (55 %) or secondary care (27 %). We compared the definition of the metabolic syndrome modified by the National Cholesterol Education Program with that used by the International Diabetes Federation (IDF)., Results: Of 162 women and 116 men (mean body mass index of 39 kg/m 2 ), 71 % (95 % CI 66 % - 77 %) met both sets of criteria. Only 16 women and two men had no other components of the metabolic syndrome than an elevated waist circumference. Patients with the metabolic syndrome were older (47 years versus 43 years; p = 0.005) and had more prevalent cardiovascular disease (16 % versus 6 %; p = 0.05) than those without the syndrome. Men had a higher prevalence of the metabolic syndrome than women (81 % versus 66 %, p = 0.007) and higher systolic blood pressure and triglyceride levels., Interpretation: We conclude that both definitions identify nearly the same populations among obese patients. Men should be encouraged more strongly to enrol in obesity treatment programs because of their metabolic risk profile.

Background: Biliopancreatic bypass with duodenal switch is a treatment for morbid obesity that combines restriction of dietary intake with a high degree of malabsorption. The operation involves the risk of losing important nutritional elements., Material and Methods: 64 women and 14 men who had a biliopancreatic bypass with duodenal switch performed in 2002 - 2005 and were followed up at least once, six months or later after surgery, were examined with 3 to 6-month intervals for the following; body weight, clinical status, haematological variables, ferritin, folate, albumin, creatinine, retinol, alpha-tocopherol/lipids, vitamin D metabolites, parathyroid hormone, vitamin B1, lipids, glucose and other clinical chemical variables., Results: Weight loss after surgery was substantial and rapid, from a mean of 153.8 kg (SD 30.2) to 92.7 kg (SD 21.6) after one year (n = 74). Low values of serum albumin, creatinine, retinol, 25-OH vitamin D and elevated parathyroid hormone were very common. Four women and three men (9 % of all) with common channels of < 100 cm, required a surgical revision mainly due to hypoalbuminemia. Two women became pregnant before the recommended 18 months after surgery., Interpretation: Biliopancreatic bypass with duodenal switch in patients with common channels < 100 cm, has a high rate of complications and nutritional deficiencies. This surgery should be used restrictively.

Background: The men invited to participate in the Oslo Study in 1972/3 were invited again to participate in the Oslo II study in 2000. We examined whether self-reported lifestyle habits were associated with biological markers, a range of symptoms and several illnesses in 2000., Material and Methods: In addition to data from Oslo II, were data from those men of the Oslo-cohort who participated in 5 other studies between 1998 and 2001. The total material is named The second screening of the Oslo-study. Levels of lipids and glucose, height, weight, waist and hip circumferences and blood pressure were measured in 6,410 men born in 1923-32 that participated in both surveys. Participants were divided into four groups according to their lifestyle habits in both surveys, as follows: unhealthy, somewhat unhealthy, somewhat healthy and healthy lifestyle., Results: Participants with a healthy lifestyle had a lower number of symptoms and illnesses, prevalence of the metabolic syndrome and waist-hip ratio, compared to those with a less healthy lifestyle. The number of men with psychological distress leading to treatment, was inversely associated with an increasingly healthy lifestyle. After adjustment for level of education and smoking in both 1972/3 and in 2000, the relationship between health profile and lifestyle became more linear., Interpretation: A healthy lifestyle was associated with protective levels of risk factors and lower prevalences of a wide range of illnesses.

Background: Overweight and obesity represent an increasing health problem. Both genetic and environmental factors contribute to the development of obesity. This article summarises the genetic aspects of these conditions., Material and Methods: A literature search was conducted using PubMed and OMIM. Both original and review articles were included., Results and Interpretation: The genetic influence on body weight is shown by twin and family studies. Environmental changes in recent decades have promoted the development of obesity in individuals at risk because of their genetic composition. Our understanding of the molecular pathways underlying common obesity is limited. During the last decade a handful of monogenic disorders leading to early, severe obesity in humans have been identified. All affect the central regulation of appetite. These conditions are rare, except for mutations in the melanocortin 4 receptor that account for about 5% of morbidly obese patients (BMI > 40 kg/m). The identification of monogenic forms of obesity has contributed valuable insight into the regulation of appetite and development of obesity, although causal treatment only exists for leptin deficiency. In addition, several well defined Mendelian syndromes are associated with overweight and obesity. The molecular genetic cause is known for some of these syndromes, but how appetite and energy balance are affected is still unclear.

Background: Between 1981 and 1991, the City of Oslo offered all its 40-year-old citizens screening for risk factors for cardiovascular disease. We describe changes in risk factors over this period., Material and Methods: Between 1981 and 1999, a total of 104,482 men and women born between 1941 and 1959 were invited to undergo screening., Results: The attendance rate was slightly above 55% in the initial years when the City of Oslo had a centralised administration. After a decentralisation to 25 city districts in 1988, attendance dropped considerably. Body weight, triglycerides, physical inactivity, prevalence of metabolic syndrome and diabetes all increased over the period. The classic risk factors, including total serum cholesterol, high blood pressure and cigarette smoking, were all gradually reduced., Interpretation: With regard to the classic risk factors, the findings are consistent with other investigations. The increase in body weight and some other characteristics of the metabolic syndrome are causes for concern.

In spite of a substantial decline in the morbidity and the mortality from coronary heart disease in Norway since 1970-1975, cardiovascular disease remains the leading cause of death. The prevention of premature cardiovascular disease includes a mass strategy as well an individual strategy. While the first aims at changing life habits in the whole population, the latter is directed towards individuals with elevated cardiovascular risk. Non-pharmacological and pharmacological modes of treatment have been demonstrated to be effective in reducing cardiovascular events. However, the value of such measures depends on our ability to identify high-risk individuals. This paper describes different approaches in preventive medicine, from population screening to the screening of relatives of patients with premature disease. While doctors previously focused on whether blood pressure or cholesterol levels were above the defined limits, a global risk assessment is now recommended. Information regarding family history, smoking and exercise habits, lipid values, blood pressure, and the presence of diabetes must be obtained in a proper risk assessment. In some individuals with intermediate risk, additionally non-invasive tests may be of value in order to ensure that sufficient information has been obtained for a recommendation of preventive measures.

Background: Previous studies of treatment with statins have included few subjects aged 70 years or above. While the absolute risk of cardiovascular disease in the elderly is very high, the benefits of treatment may be reduced by adverse events, polypharmacy and competing risks., Material and Methods: A statistician and a clinician reviewed the Pravastatin in elderly individuals at risk of vascular disease (PROSPER) study and compared the results with subgroup analyses of previous studies., Results: Subgroup analyses of previous studies showed that treatment with statins reduces cardiovascular events among patients with coronary heart disease aged > or = 65 years. The Heart Protection Study (HPS) included elderly with known atherosclerotic disease, while only 44% of subjects in the PROSPER study had such disease. Among subjects aged 70 or above the difference in events between the groups that received a statin or placebo was 6.1% in the HPS study and 2.1% in the PROSPER study (numbers needed to treat were 6 and 48, respectively). The studies gave conflicting results with regard to stroke and cancer., Interpretation: Elderly people with cardiovascular disease may benefit from treatment with statins. We do not have data that show that statins reduce total mortality among the elderly.

Background: Statins have been shown to reduce cardiovascular disease in subjects with coronary heart disease, in men with high cholesterol levels and in men and postmenopausal women with low high-density lipoprotein cholesterol levels. In meta-analysis, reduction in events is associated with reduction in serum low-density lipoprotein (LDL) cholesterol levels, however, some studies have proposed a threshold level for the effect., Material and Methods: A clinician and a statistician reviewed the Heart Protection Study in the context of previous similar studies., Results: High-risk men and women (n = 20,536) aged 40-80 years with coronary heart disease, peripheral artery disease or diabetes and a cholesterol level of at least 3.5 mmol/l were randomised to simvastatin 40 mg or placebo. After 5.5 years, the incidence of nonfatal myocardial infarction or coronary death was reduced from 11.8% in the placebo group to 8.7% in the simvastatin group, and a similar reduction was seen in subjects with diabetes but no cardiovascular disease. There was no threshold of LDL cholesterol below which lowering it did not reduce risk., Interpretation: The study adds to the body of evidence indicating that cholesterol lowering with statins is indicated for subjects with high risk and that LDL cholesterol reduction explains the reduction in events.

Background: Quitting smoking is a primary lifestyle option for reducing the risk of a number of diseases. Effective therapies include counselling, nicotine replacement and bupropion, a dopamine and noradrenaline reuptake inhibitor., Material and Methods: Double-blind, placebo-controlled studies with > or = 100 subjects identified through the Cochrane database or presented by the author at a congress are reviewed., Results: Bupropion initially increased quit rates in a dose-dependent manner among healthy smokers treated at specialist clinics. Recent trials have included smokers treated in a wider range of settings and in subgroups who often experience difficulties in quitting, including smokers with pulmonary or cardiovascular disease and smokers who relapsed after previous treatment with bupropion. In three studies reporting twelve-month results, quit rates were 27-30% for bupropion compared to 12-16% for placebo and continuous abstinence rates were 18-22% compared to 6-11% for placebo. In meta-analysis the odds ratio for smoking cessation of bupropion versus placebo was 2.16 (95% confidence interval 1.51-3.10) with combined data for six and twelve months of continuous abstinence. Bupropion was well tolerated in all the trials and is recommended in US and UK guidelines., Interpretation: Physicians should recommend medication for smoking cessation for patients with no contraindications because of the enormous benefits of quitting.

Background: Dietary treatment plays an important role in prevention of coronary heart disease. In Norway as in other European countries, patients with established coronary heart disease are advised to follow a cholesterol-lowering diet. However, epidemiological observations have suggested that Mediterranean and other diets may have cardioprotective characteristics beyond their effects on serum total and LDL cholesterol levels., Material and Methods: We describe the results of randomised, controlled clinical trials that have investigated the effect of diet on secondary prevention of coronary heart disease., Results: Diets characterised by high contents of oleic acid (18: 1n-9), alpha-linolenic acid (18: 3n-3) and fish or fish oil and near-vegetarian diets have reduced cardiovascular morbidity and mortality in patients with coronary heart disease., Interpretation: Several characteristics of the Mediterranean diet seem to have additional anti-atherothrombogenic effects beyond those observed with the usually recommended cholesterol-lowering diet. We ask whether Norwegian dietary recommendations for secondary prevention, should emphasise more strongly the type of fat used and fruit and vegetable intake, in line with the principles of the Mediterranean diet. Such dietary advice should be incorporated into the medical treatment given to all patients with coronary heart disease, regardless of their lipid profile.

Background: Many experts consider obesity a chronic disease that may require long-term therapy. A loss of 5-15% of body weight is associated with improvements in cardiovascular risk factors and morbidity. However, most studies show that the majority of patients who lose weight relapse. Patients may be unable to maintain a low energy intake when confronted with an almost limitless supply of food. Moreover, a number of physiological mechanisms favour a set point for body weight, that may be altered with anti-obesity drugs., Material and Results: In the current paper we describe actions and effects of current anti-obesity drugs. The centrally acting drug, sibutramine, is an adrenaline and serotonine re-uptake inhibitor which was recently approved in the USA for obesity. The USA, the European Union and Norway have approved orlistat, a pancreatic lipase inhibitor for weight reduction for up to two years. Patients must maintain a low fat intake in order to avoid gastrointestinal discomfort. In recent studies, orlistat and diet reduced body weight by 9% versus 6% on placebo and diet. No studies have documented long-term safety of anti-obesity drugs., Interpretation: Treatment of a lifestyle-related disease like obesity with medications is controversial, however, such treatment may not differ substantially from treatment of type II diabetes, hyperlipidaemia or hypertension.

Postmenopausal women experience increases in total cholesterol, triglyceride and lipoprotein (a) levels, decreased HDL cholesterol level and a shift in the LDL particle distribution toward a more dense subtype. Postmenopausal hormone substitution lowers LDL cholesterol level by 12-13%, also in women with hyperlipidaemia, and lowers lipoprotein (a) level. The effect on subtype of LDL has been variable in studies to date. The type, dose and mode of administration of the gestagen as well as the choice of oestrogen (conjugated equine oestrogen versus oestradiol) may affect triglyceride and/or HDL cholesterol levels. The first randomised study of postmenopausal hormone substitution in women with cardiovascular disease (Heart and Estrogen/progestin Replacement Study) showed an increase in cardiovascular events during the first year of therapy with a decrease by the fourth year, thus, there was no overall effect. Several new studies including the Women's Health Initiative and the Women's International Study of long Duration Oestrogen after Menopause should have the power to show the effect of postmenopausal hormone substitution on cardiovascular endpoints in primary prevention, however, the results of these studies will not be available for several years.

Nicotine replacement therapy doubles quit rates in smoking cessation with or without adjunct behavioural therapy; however, absolute quit rates are higher with adjunct therapy. Effective therapies include the nicotine gum, transdermal preparations, inhaler and spray. Highly dependent smokers should be offered high dose gum (4 mg) or nicotine spray. The nicotine inhaler offers more habit replacement than any of the other forms of nicotine administration and is appropriate for smokers who are moderately addicted and need something to do with their hands. Use of nicotine replacement therapy is safe for most patients with cardiovascular disease, but should probably be restricted in pregnancy to heavy smokers who are unable to quit. Bupropion, a modest dopamine and noradrenaline reuptake inhibitor, increases quit rates compared with placebo. Future therapies will include combinations of nicotine replacement products, and combinations of nicotine products with other medications. Some smokers may benefit from longer treatment and more gradual withdrawal than present treatment regimens imply.

Consensus groups have recommended using the baseline absolute risk of disease over five to ten years rather than relative risk when treatment with lipid-lowering or antihypertensive drugs is considered. Targeting patients with a coronary event rate of 20% over ten years ensures that society's investment in drugs yields substantial benefits by reducing the incidence of premature disease. However, the use of absolute risk is most appropriate among the middle-aged. Because all elderly persons have a high absolute risk of disease, almost all may be eligible for drug treatment. The costs of postponing death after the age of 70 are therefore substantial. Among young persons with familial hypercholesterolemia on the other hand, the consequences of a death before middle-age are so enormous that most patients are treated with drugs even though absolute risk is very low. An additional problem with using absolute risk is that the risk of atherosclerotic disease accumulates over time. Calculation of benefit on the basis of short-term trials might underestimate long-term benefit. In the future, non-invasive measures of atherosclerosis and new markers of risk may provide valuable information on risk stratification in primary prevention.

Familial hypercholesterolemia causes premature cardiovascular disease. Genetic screening of patients' relatives who have already been diagnosed has proved to be more efficient than screening in a general population. Privacy laws in Norway forbid physicians to directly contact persons with genetic disorders who are not their own patients. We examined attitudes towards this type of screening in a representative sample of the Norwegian population and a group of patients with familial hypercholesterolaemia. In both groups the majority showed a positive attitude towards physicians contacting relatives directly to detect individuals with familial hypercholesterolaemia. In both groups the majority wanted to know whether, based on the diagnosis of relatives, they might also be affected. Both groups wanted this information regardless of the risk of their being affected. We conclude that the privacy laws should be amended to conform with the attitudes of the population and the patients, thus enabling physicians to contact relatives directly.

Though women have a lower absolute risk of disease than men at all ages, almost all the risk factors for cardiovascular disease carry the same or higher relative risk for women as for men. Moreover, the attributable risk is higher in older women than in men. Epidemiologic studies show that recent decreases in coronary heart disease mortality are in some cases greater among women than men. Interventional studies show that women appear to have as good or better a response than men to cholesterol-lowering in secondary prevention. Antihypertensive drug therapy is effective in preventing clinical endpoints in elderly women. These observations imply that an overall estimation of cardiovascular risk in women needs careful consideration. Because established therapies appear to be effective in high risk women, postmenopausal and probably also elderly women are important target groups for preventive efforts. The value of prevention for premenopausal women should not be underestimated, but should on the whole be approached through population-based strategies.

We examined 199 consecutive referrals to the Lipid Clinic at the National hospital in 1995 in order to compare referral- and chart data on familial hyperlipidaemia, familial cardiovascular disease, diagnosis, and lifestyle. 78% of referrals were from general practitioners. Most of the referrals included information on familial hyperlipidaemia and cardiovascular disease and on diet, but did not specify a lipid diagnosis. Less than half of the referrals included information on smoking habits (which was almost always specified in the chart). Up to 80% did not include information on alcohol, body mass index and physical activity, which was also often missing in the chart. We conclude that the referring doctors, and to some extent the clinic physicians, identified patients with a familial risk of cardiovascular disease, but they did not appear to characterise important lifestyle habits related to cardiovascular risk.

Though severe hyperlipidaemia (total cholesterol level > or = 13 mmol/l in this study) is uncommon, it is important to make a precise diagnosis. We examined 57 patients with isolated severe hypercholesterolaemia. Of these, four were homozygotes for familial hypercholesterolaemia, 48 were heterozygotes for familial hypercholesterolacmia and one had sitosterolemia. The heterozygotes carried 15 different LDL receptor mutations, with no one mutation predominating. When the diagnosis is made, relatives should be given the opportunity to be tested. Combined severe hyperlipidaemia is usually due to a secondary cause, at our clinic, the most common cause is diabetes mellitus. The underlying disease should be treated first. However, many patients will require additional lipid-lowering drugs because the underlying disease may be associated with an increased risk of cardiovascular disease. With the exception of fish oil capsules, drugs that reduce serum triglyceride levels substantially are not registered in Norway at present.

107 patients with primary hypercholesterolaemia participated for five years in a clinical trial with dietary and drug treatment (a statin) at the Lipid Clinic. At the end of the study the patients were referred back to their own physicians, with written advice on diet and drug therapy. At a recall two years later we studied to what extent recommended therapy and follow-up had been implemented. 15% had no follow-up after participating in the study and 18% had not measured their cholesterol for one year or more. The majority of the patients did not follow the recommended diet and level of physical activity satisfactorily, and 20% had stopped their lipid-lowering medication. In general they had been prescribed too low doses of the lipid-lowering agent, and 70% of the patients had not reached the target of the LDL-cholesterol. In conclusion, adequate treatment and a five-year follow-up is not sufficient to keep the patient compliant when the follow-up becomes less intensive. When a clinical trial is terminated, greater efforts should be made to secure better compliance to therapy.

The use of lipid-lowering drugs is now established clinical practice. However, not all patient categories have been covered in the landmark studies (4S, WOSCOPS and CARE), leaving the arena open for widely differing opinions. Dyslipidoemia in patients with diabetes mellitus and arteriosclerotic disease of the aorta, limb arteries or carotid arteries should be corrected. The benefit remains unproven for patients with coronary artery disease and normal lipid levels, and for the elderly. Omega-3 supplements are approved in Norway for hypertriglyceridoemia, but clinical benefit has not been established for this treatment, in contrast to treatment with gemfibrosil. Hormone replacement therapy for postmenopausal women effectively lowers LDL cholesterol levels and the results of randomised studies with clinical endpoints are awaited. The rapid effect (within six months) of lowered cholesterol on coronary events suggests that starting treatment during middle age is adequate for many patients, except for those with familial hyperlipidemias.

Familial hypercholesterolaemia is an autosomal dominant disorder characterized by hypercholesterolaemia, xanthomas and premature coronary heart disease. Treatment of hypercholesterolemia is effective and consists of dietary changes and lipid lowering drugs. Only a minor proportion of familial hypercholesterolaemia patients are adequately treated, however. One explanation for this is assumed to be the relatively vague clinical diagnostic criteria applied. Because familial hypercholesterolaemia is caused by a mutation in the gene encoding the low density lipoprotein (LDL) receptor, mutation analysis of this gene could form the basis for specific diagnosis. 29 different mutations in the LDL receptor gene have been found to cause familial hypercholesterolaemia among Norwegian patients, and a total of 681 patients from 322 unrelated families have been provided with a molecular genetic diagnosis. We conclude that the use of molecular genetic analysis is feasible, and should be used clinically.

The identification and management of hyperlipidemias in children are currently limited to persons regarded as being at very high risk, such as those with familial hypercholesterolemia. Universal screening of children is not recommended, but it is important to screen the subset of children and adolescents at highest risk, i.e. those with a family history of premature cardiovascular disease or familial hypercholesterolemia. Treatment of children and adolescents with hypercholesterolemia requires a multidisciplinary approach. Cholesterol-lowering medication may be required in addition to dietary therapy in children with a history of premature coronary heart disease among close relatives.

Dietary antioxidants such as vitamin E, vitamin C, beta carotene and flavonoids may retard atherosclerosis by preventing low density lipoprotein oxidation. Observational epidemiological studies, including ecological correlations, case control and prospective studies, indicate that high vitamin E levels may be associated with decreased cardiovascular disease. Beta carotene may be protective among smokers and the elderly. Few studies have been able to show that vitamin C has a protective effect. A handful of intervention studies have examined the effects of vitamin E and beta carotene with mixed results. While few side effects of antioxidant supplementation are known, the results of current, large-scale studies in primary intervention must be awaited before recommendations can be made. Increased intake of fruits and vegetables that are rich in antioxidants is recommended.

The efficacy and safety of treatment with recommended doses of lovastatin (20, 40 and 80 mg/day) and pravastatin (10, 20 and 40 mg/day) were compared in 48 men and women with primary hyperlipidemia and LDL-cholesterol > or = 4.1 mmol/l following dietary intervention. Each dose was taken for six weeks in this double-blind, parallel, randomized study. Lovastatin was found to reduce LDL-cholesterol by 22-37% and pravastatin by 18-26%. HDL-cholesterol levels increased and triglyceride levels decreased to the same extent in both groups. The number of patients who reported adverse events in the course of the study was small. No clinically significant changes occurred in laboratory tests, nor in sleep scores obtained from a standardized questionnaire. Neither drug had any effect on the responses to a quality of life screening questionnaire, nor were any significant changes in depressive symptoms seen during the 18 weeks of treatment.

While dietary and pharmacological therapies are the mainstay of treatment of hyperlipidemia, there has been a surge of interest for nonpharmacological treatments such as dietary fibre and food flavourings. In placebo-controlled studies, oat bran in relatively large doses of 56-95 grams per day have been shown to reduce serum cholesterol by 5-9%. Psyllium has caused a 5-15% reduction of serum cholesterol with doses of 10.2 grams per day, and guar gum a reduction of 5-17% with doses of 15 grams per day. Documentation of long-term effects is inadequate. Fresh garlic contains over 70 compounds containing sulphur, which may be biologically active. In animal experiments cholesterol is reduced by supplementing the diet with large doses of fresh, boiled, or dried products. Human studies are poor methodologically, and none has documented constancy of diet during the study.