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PURPOSE: To evaluate the hypocholesterolemic effects of long-term treatment (36 to 51 weeks) with a mixture of dietary fibers (guar gum, pectin, soy, pea, corn bran) administered twice a day. PATIENTS AND METHODS: Fifty-nine subjects with moderate hypercholesterolemia who completed a 15-week, placebo-controlled study with the dietary fiber were treated for an additional 36 weeks with 20 g/day of fiber. Subjects were counseled and monitored on a National Cholesterol Education Program (NCEP) Step-One Diet before starting and during treatment. Analyses of changes in lipoprotein values during the additional 36 weeks of treatment took into account changes in weight, diet, and other variables that might have affected the response to treatment. RESULTS: There were no significant effects on the levels of either triglycerides or high-density lipoprotein cholesterol (HDL-C). Levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and the LDL/HDL ratio were significantly reduced during treatment. The mean percentage reductions from baseline after 51 weeks of treatment were approximately 5% for TC, 9% for LDL-C, and 11% for the LDL/HDL ratio. Changes were apparent after 3 weeks of treatment, with the maximum reductions occurring by the 15th week of treatment. CONCLUSIONS: For subjects on a Step-One Diet who complied with the treatment regimen, the moderate cholesterol-lowering effects of the fiber persisted throughout the 36-to-51 week treatment period.

The cholesterol-lowering effects of a fiber supplement were evaluated in patients with mild to moderate hypercholesterolemia. After a 9-wk diet stabilization period, patients were randomly assigned to treatment with 10 or 20 g/d of the fiber supplement or with a matching placebo. Among patients who completed the 15-wk treatment period, total cholesterol, LDL cholesterol, and the ratio of LDL to HDL (LDL/HDL) were significantly reduced (P < 0.05) for the 10- (n = 40) and 20-g/d (n = 39) groups compared with the placebo group (n = 48). In the placebo group and 10- and 20-g/d groups, the percent changes in total cholesterol were 0.4%, -5.8%, and -4.9%, in LDL cholesterol were -0.4%, -8.1%, and -7.3%, and in LDL/HDL were 1.0%, -5.6%, and -8.7%, respectively. The fiber supplement had no significant effects (P> 0.05) on HDL cholesterol or triglycerides. The changes in lipoproptein concentrations could not be attributed to changes in diet or body weight because there were no significant changes in these variables during the 15-wk treatment period.

Studies show that hypercholesterolemia (elevated blood cholesterol) increases the risk of coronary heart disease, a build-up of fatty plaques inside the major blood vessels supplying the heart. As many as 36 percent of adult Americans who are 20 to 74 years old have blood cholesterol levels above 200 milligrams per deciliter, a recently proposed definition for hypercholesterolemia. Public awareness of appropriate diets to reduce blood cholesterol levels is increasing. Several drugs have been developed to treat hypercholesterolemia, although many have unfavorable side effects. Foods containing soluble fiber, such as oat bran and certain legumes, can reduce cholesterol levels without adverse effects on health. Early studies showed that consumption of a form of water-soluble fiber called psyllium hydrophilic mucilloid may reduce blood cholesterol. In the current study, the effects of psyllium were compared with those of cellulose (an insoluble fiber, used as a placebo). Ninety-six men and women with mild to moderate hypercholesterolemia participated; all followed a diet designed to lower cholesterol, and half the subjects used psyllium while the other half took cellulose as a dietary supplement. The substances were given in doses of 5.1 grams (g) twice daily for 16 weeks. As compared with the placebo (cellulose), psyllium decreased average levels of total cholesterol by 5.6 percent and average levels of low-density-lipoprotein (LDL) cholesterol by 8.6 percent. The levels of total cholesterol and LDL cholesterol were not changed by the placebo. Levels of high-density-lipoprotein (HDL) cholesterol dropped during the period of adjustment to the diet but returned to close to the original level by the end of the 16 weeks. Blood levels of triglycerides were not altered in patients treated with psyllium or placebo. Ninety-five percent of patients adhered to their diet requirements. These findings suggest that psyllium hydrophilic mucilloid given twice daily is both safe and effective as a supplement to diets used to treat hypercholesterolemia. (Consumer Summary produced by Reliance Medical Information, Inc.)

ERT: Weighing the risks and benefits Among commonly employed therapeutic modalities, few have undergone as many shifts in and out of favor as estrogen replacement therapy (ERT). While ERT is [...]

To the Editor.—About a year ago, we reported in these pages that lovastatin, an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase that is now available for prescription in the United States, was well tolerated and very effective as a lipid-lowering drug.1 However, among the 101 patients in our 18-week study, 13 were found to have lens opacities at the poststudy examination that had not been reported at baseline. As we commented in our article, these data were difficult to interpret because of the subjective nature of slit-lamp examination for the detection of small opacities and the fact that all patients took lovastatin at some point during the study, so that there was no parallel control group. We are now able to provide further information.Study.—On completion of the double-blind part of the study, most patients continued taking lovastatin in an open extension of the study, which is ongoing.

In Reply.—Dr Cenedella is correct in pointing out the potential for inhibitors of cholesterol synthesis to induce cataracts, particularly in young individuals. Pediatric use of lovastatin has been limited to patients with serious genetic disorders, mainly children with homozygous familial hypercholesterolemia. One of us (J. A.T.) has analyzed results of all the ophthalmologic examinations in patients taking lovastatin. Slit-lamp examination of the lens was performed at the baseline examination and during treatment in over 500 patients. The mean age of the patients studied was 50 years; 60% of them had heterozygous familial hypercholesterolemia and 50% had ischemic heart disease. The prevalence of lens opacities in these patients was 27% at the baseline examination and 31% at the last available examination during treatment with lovastatin. Interpretation of these data is complicated by the subjective nature of slit-lamp examination, uncertainty regarding the natural incidence of lens opacities in patients with severe