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The study evaluates the efficacy of the inhibition of the intracellular enzyme acyle coenzyme, A:cholesterol acyltransferase (ACAT), with pactimibe in the prevention of atherosclerosis in patients with familial hypercholesterolemia. Results show pactimibe had no effect on atherosclerosis as measured by maximum changes in carotid intima-media thickness (CIMT), but was associated with an increase in mean CIMT and higher incidence of major cardiovascular events.

The new HMG-CoA reductase inhibitor, atorvastatin, appears to reduce elevated blood levels of triglycerides. Elevated triglyceride levels are associated with an increased risk of coronary artery disease. Researchers randomized 55 people with elevated triglycerides into one of four groups: groups that would take 5 milligrams (mg), 20 mg or 80 mg of atorvastatin and a group that would take a placebo. All of the volunteers were on a low-cholesterol diet. After two weeks, atorvastatin had lowered triglyceride levels from 26.5% to 45.8% on average, depending on the dose. Higher doses led to greater reductions. In addition, the drug lowered total cholesterol and LDL and VLDL cholesterol, all of which are risk factors for coronary artery disease when elevated. Ten percent of the people taking the drug experienced an adverse effect, which included headache, pain, diarrhea and flatulence. HMG-CoA reductase inhibitors are usually used to reduce elevated cholesterol levels.

A review of 19 studies of the effect of dietary oats on cholesterol levels found that people who eat three grams of oat fiber a day can reduce their cholesterol levels by five or six milligrams per deciliter. This is not as great a reduction as some individual studies have claimed. But researchers have found that a cholesterol reduction of one percent can cut deaths from heart disease in the US by two percent. Some of the studies found that those with the highest cholesterol levels experienced the greatest reduction in cholesterol levels. Others have shown that older women experience the greatest declines in cholesterol., Objectives.--To test the a priori hypothesis that consumption of oats will lower the blood total cholesterol level and to assess modifiers and confounders of this association. Data Sources.--A computerized literature (MEDLINE) search and the Quaker Oats Co identified published and unpublished trials as of March 1991. Raw data were requested for all trials. Study Selection.--Trials were included in summary effect size estimates if they were randomized and controlled, if a formal assessment of diet and body weight changes occurred, and, if raw data were not received, if there was enough information in the published report to perform calculations. Data Synthesis.--Twenty trials were identified. Using the methods of DerSimonian and Laird, a summary effect size for change in blood total cholesterol level of -0.13 mmol/L (-5.9 mg/dL) (95% confidence interval [Cl], -0.19 to -0.017 mmol/L [-8.4 to -3.3 mg/dL]) was calculated for the 10 trials meeting the inclusion criteria. The summary effect size for trials using wheat control groups was -0.11 mmol/L (-4.4 mg/dL) (95% Cl, -0.21 to -0.01 mmol/L [-8.3 to -0.38 mg/dL]). Calculation of Keys scores demonstrated that substituting carbohydrates for dietary fats and cholesterol did not account for the majority of blood cholesterol reduction. Larger reductions were seen in trials in which subjects had initially higher blood cholesterol levels ([is greater than or equal to]5.9 mmol/L[is greater than or equal to]229 mg/dL]), particularly when a dose of 3 g or more of soluble fiber was employed. Conclusion.--This analysis supports the hypothesis that incorporating oat products into the diet causes a modest reduction in blood cholesterol level. (JAMA. 1992;267:3317-3325)

High blood levels of cholesterol (hypercholesterolemia) affect one in four adults in the United States and are considered a risk factor for the development of coronary artery disease. Dietary modification to reduce fat intake is the first step in lowering cholesterol levels, but other aspects of the diet are also under investigation for fat-reducing effects. Water-soluble fibers, such as those found in fruits, dried beans, legumes, barley, psyllium and oats, may lower fats and cholesterol in the blood. Oat cereals rich in beta-glucan are a potential dietary therapy for high cholesterol levels. To test how well oatmeal and oat bran lowered cholesterol, 148 adults with elevated levels of low-density lipoprotein cholesterol (LDL-C) completed a study during which they were given either one, two, or three ounces of oatmeal meal or oat bran, or one ounce of farina each day for 12 weeks. Beta-glucan, the water-soluble fiber in oat cereals, lowered cholesterol levels when taken in conjunction with a low-fat diet. Two ounces of oat bran lowered cholesterol better than one ounce, but three ounces did not produce a greater reduction. (This observation may be related to the small size of the study.) Three ounces of oatmeal were needed to reduce cholesterol as much as two ounces of oat bran. Theories about how soluble fiber reduces cholesterol are reviewed. It is also possible that the cholesterol-lowering effect is not related to beta-glucan, but to the effects of a compound with vitamin E activity or the amino acid content of oats, especially the arginine-lysine ratio. (Consumer Summary produced by Reliance Medical Information, Inc.)

Importance: It remains uncertain whether the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) reduce cardiovascular risk.Objective: To determine the effects on cardiovascular outcomes of a carboxylic acid formulation of EPA and DHA (omega-3 CA) with documented favorable effects on lipid and inflammatory markers in patients with atherogenic dyslipidemia and high cardiovascular risk.Design, Setting, and Participants: A double-blind, randomized, multicenter trial (enrollment October 30, 2014, to June 14, 2017; study termination January 8, 2020; last patient visit May 14, 2020) comparing omega-3 CA with corn oil in statin-treated participants with high cardiovascular risk, hypertriglyceridemia, and low levels of high-density lipoprotein cholesterol (HDL-C). A total of 13 078 patients were randomized at 675 academic and community hospitals in 22 countries in North America, Europe, South America, Asia, Australia, New Zealand, and South Africa.Interventions: Participants were randomized to receive 4 g/d of omega-3 CA (n = 6539) or corn oil, which was intended to serve as an inert comparator (n = 6539), in addition to usual background therapies, including statins.Main Outcomes and Measures: The primary efficacy measure was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization.Results: When 1384 patients had experienced a primary end point event (of a planned 1600 events), the trial was prematurely halted based on an interim analysis that indicated a low probability of clinical benefit of omega-3 CA vs the corn oil comparator. Among the 13 078 treated patients (mean [SD] age, 62.5 [9.0] years; 35% women; 70% with diabetes; median low-density lipoprotein [LDL] cholesterol level, 75.0 mg/dL; median triglycerides level, 240 mg/dL; median HDL-C level, 36 mg/dL; and median high-sensitivity C-reactive protein level, 2.1 mg/L), 12 633 (96.6%) completed the trial with ascertainment of primary end point status. The primary end point occurred in 785 patients (12.0%) treated with omega-3 CA vs 795 (12.2%) treated with corn oil (hazard ratio, 0.99 [95% CI, 0.90-1.09]; P = .84). A greater rate of gastrointestinal adverse events was observed in the omega-3 CA group (24.7%) compared with corn oil-treated patients (14.7%).Conclusions and Relevance: Among statin-treated patients at high cardiovascular risk, the addition of omega-3 CA, compared with corn oil, to usual background therapies resulted in no significant difference in a composite outcome of major adverse cardiovascular events. These findings do not support use of this omega-3 fatty acid formulation to reduce major adverse cardiovascular events in high-risk patients.Trial Registration: ClinicalTrials.gov Identifier: NCT02104817. [ABSTRACT FROM AUTHOR]

The drug orlistat appears to be effective in promoting weight loss. This drug reduces fat absorption in the intestines by about 30%. Researchers randomly assigned 880 obese patients to take orlistat or a placebo in addition to a reducing diet. Two different dosages of orlistat were tested: 120 milligrams (mg) three times a day or 60 mg three times a day. More patients in the orlistat group lost weight in the first year compared to the placebo group. Patients taking the higher dose were less likely to regain the weight during the second year of the study.

Context: Carotid artery intima-media thickness (CIMT) is a marker of coronary atherosclerosis and independently predicts cardiovascular events, which are increased in type 2 diabetes mellitus (DM). While studies of relatively short duration have suggested that thiazolidinediones such as pioglitazone might reduce progression of CIMT in persons with diabetes, the results of longer studies have been less clear.Objective: To evaluate the effect of pioglitazone vs glimepiride on changes in CIMT of the common carotid artery in patients with type 2 DM.Design, Setting, and Participants: Randomized, double-blind, comparator-controlled, multicenter trial in patients with type 2 DM conducted at 28 clinical sites in the multiracial/ethnic Chicago metropolitan area between October 2003 and May 2006. The treatment period was 72 weeks (1-week follow-up). CIMT images were captured by a single ultrasonographer at 1 center and read by a single treatment-blinded reader using automated edge-detection technology. Participants were 462 adults (mean age, 60 [SD, 8.1] years; mean body mass index, 32 [SD, 5.1]) with type 2 DM (mean duration, 7.7 [SD, 7.2] years; mean glycosylated hemoglobin [HbA1c] value, 7.4% [SD, 1.0%]), either newly diagnosed or currently treated with diet and exercise, sulfonylurea, metformin, insulin, or a combination thereof.Interventions: Pioglitazone hydrochloride (15-45 mg/d) or glimepiride (1-4 mg/d) as an active comparator.Main Outcome Measure: Absolute change from baseline to final visit in mean posterior-wall CIMT of the left and right common carotid arteries.Results: Mean change in CIMT was less with pioglitazone vs glimepiride at all time points (weeks 24, 48, 72). At week 72, the primary end point of progression of mean CIMT was less with pioglitazone vs glimepiride (-0.001 mm vs +0.012 mm, respectively; difference, -0.013 mm; 95% confidence interval, -0.024 to -0.002; P = .02). Pioglitazone also slowed progression of maximum CIMT compared with glimepiride (0.002 mm vs 0.026 mm, respectively, at 72 weeks; difference, -0.024 mm; 95% confidence interval, -0.042 to -0.006; P = .008). The beneficial effect of pioglitazone on mean CIMT was similar across prespecified subgroups based on age, sex, systolic blood pressure, duration of DM, body mass index, HbA(1c) value, and statin use.Conclusion: Over an 18-month treatment period in patients with type 2 DM, pioglitazone slowed progression of CIMT compared with glimepiride.Trial Registration: clinicaltrials.gov Identifier: NCT00225264 [ABSTRACT FROM AUTHOR]

Investigates if a hypocholesterolemic dose-response relationship existed for β-glucan content in oatmeal and oat bran in hypercholesterolemic patients. Nutrient analysis regarding the dietary fat content between the treatment groups; Criteria for patients to be eligible for the treatment; Findings of a multivariate repeated-measures analysis of variance.

Focuses on possible differences between fibrates in pharmacokinetic interactions with statins. Concerns of physicians about prescribing fibrates and statins concomitantly; Risk of myopathy with statin therapy; Potential differences between fibrates in their ability to affect the glucuronidation pathway.

Presents a letter to the editor about Dr. Nissen's editorial on the benefits of statin therapy in ACS patients.