ω-3 Fatty Acid Ethyl Esters Diminish Postprandial Lipemia in Familial Hypercholesterolemia

Background: Although a cholesterol-lowering diet and the addition of plant sterols and stanols are suggested for the lipid management of children and adults with familial hypercholesterolemia, there is limited evidence evaluating such interventions in this population. Objectives: To investigate the impact of cholesterol-lowering diet and other dietary interventions on the incidence or mortality of cardiovascular disease and lipid profile of patients with familial hypercholesterolemia. Search methods: Relevant trials were identified by searching US National Library of Medicine National Institutes of Health Metabolism Trials Register and clinicaltrials.gov.gr using the following terms: diet, dietary, plant sterols, stanols, omega-3 fatty acids, fiber and familial hypercholesterolemia. Selection criteria: Randomized controlled trials evaluating the effect of cholesterol-lowering diet or other dietary interventions in children and adults with familial hypercholesterolemia were included. Data collection and analysis: Two authors independently assessed the trial eligibility and bias risk and one extracted the data, with independent verification of data extraction by a colleague. Results: A total of 17 trials were finally included, with a total of 376 participants across 8 comparison groups. The included trials had either a low or unclear bias risk for most of the parameters used for risk assessment. Cardiovascular incidence or mortality were not evaluated in any of the included trials. Among the planned comparisons regarding patients’ lipidemic profile, a significant difference was noticed for the following comparisons and outcomes: omega-3 fatty acids reduced triglycerides (mean difference [MD]: -0.27 mmol/L, 95% confidence interval [CI]: -0.47 to -0.07, p<0.01) when compared with placebo. A non-significant trend towards a reduction in subjects’ total cholesterol (MD: -0.34, 95% CI: -0.68 to 0, mmol/L, p=0.05) and low-density lipoprotein cholesterol (MD: -0.31, 95% CI: -0.61 to 0, mmol/L, p=0.05) was noticed. In comparison with cholesterol-lowering diet, the additional consumption of plant stanols decreased total cholesterol (MD: -0.62 mmol/l, 95% CI: -1.13 to -0.11, p=0.02) and low-density lipoprotein cholesterol (MD: -0.58 mmol/l, 95% CI: -1.08 to -0.09, p=0.02). The same was by plant sterols (MD: -0.46 mmol/l, 95% CI: -0.76 to -0.17, p<0.01 for cholesterol, and MD: -0.45 mmol/l, 95% CI: -0.74 to -0.16, p<0.01 for low-density lipoprotein cholesterol). No heterogeneity was noticed among the studies included in these analyses. Conclusions: Available trials confirm that the addition of plant sterols or stanols has a cholesterol-lowering effect on such individuals. On the other hand, supplementation with omega-3 fatty acids effectively reduces triglycerides and might have a role in lowering the cholesterol of patients with familial hypercholesterolemia. Additional studies are needed to investigate the effectiveness of a cholesterol-lowering diet or the addition of soya protein and dietary fibers to a cholesterol-lowering diet in familial hypercholesterolemia.

One of the limitations for ranking foods and meals for healthiness on the basis of the glycaemic index (GI) is that the GI is subject to manipulation by addition of fat. Postprandial lipemia, defined as a rise in circulating triglyceride containing lipoproteins following consumption of a meal, has been recognised as a risk factor for the development of cardiovascular disease and other chronic diseases. Many non-modifiable factors (pathological conditions, genetic background, age, sex and menopausal status) and life-style factors (physical activity, smoking, alcohol and medication use, dietary choices) may modulate postprandial lipemia. The structure and the composition of a food or a meal consumed also plays an important role in the rate of postprandial appearance and clearance of triglycerides in the blood. However, a major difficulty in grading foods, meals and diets according to their potential to elevate postprandial triglyceride levels has been the lack of a standardised marker that takes into consideration both the general characteristics of the food and the food’s fat composition and quantity. The release rate of lipids from the food matrix during digestion also has an important role in determining the postprandial lipemic effects of a food product. This article reviews the factors that have been shown to influence postprandial lipemia with a view to develop a novel index for ranking foods according to their healthiness. This index should take into consideration not only the glycaemic but also lipemic responses.

Introducción: Las dislipemias son alteraciones de las lipoproteínas que transportan el colesterol y los triglicéridos, siendo consideradas factor de riesgo de enfermedades cardiovasculares. La eficacia de la utilización de productos vegetales cono el ajo (Allium sativum) para prevenir y tratar dislipemias es discutida. Hay pocos estudios publicados sobre el efecto de estos productos en el ámbito de la farmacia comunitaria. Objetivos: Estudiar la variación de los valores de colesterol total en pacientes tratados con un complemento alimenticio a base de ajo en cápsulas. Relacionar dichos valores con factores demográficos y con la toma o no de medicamentos hipocolesterolemiantes de prescripción médica (MHPM). Comprobar si los resultados obtenidos concuerdan con los encontrados en la bibliografía. Material y métodos: Estudio experimental y controlado realizado en una farmacia comunitaria. Los pacientes que aceptaron participar se dividieron aleatoriamente en dos grupos, grupo intervención (GI) que tomaba complemento alimenticio de ajo y grupo control (GC) que no lo tomaba. Resultados: 59 sujetos, 29 pertenecientes al GC y 30 al GI. Mayor descenso del colesterol total en los que no tomaban MHPM, pero no puede atribuirse al efecto del complemento alimenticio administrado ya que el descenso se produce en los dos grupos. No se encontraron diferencias significativas entre los grupos. En los que ya tomaban MHP, el efecto del complemento alimenticio fue prácticamente inapreciable. Conclusiones: En las condiciones del estudio realizado, el efecto del complemento alimenticio de ajo no parece ser lo suficientemente efectivo como para reducir los niveles de colesterol de forma significativa. PALABRAS CLAVE Farmacia comunitaria, hipercolesterolemia, colesterol total, complemento alimenticio hipocolesterolemiante de ajo Financiación: ninguna. Conflicto de intereses: ninguno. Contribución a la autoría: AES participó en el diseño del estudio, el desarrollo de la investigación, el análisis de los resultados, el tratamiento estadístico, la redacción del manuscrito y la revisión del contenido final. AEE en el desarrollo de la investigación, el análisis de los resultados y la redacción del manuscrito. MEE en el desarrollo de la investigación, la redacción del manuscrito y la revisión del contenido final. Cite este artículo como: Espinosa-Suances A, Espinosa-Estévez A, Espinosa M. Estudio experimental y controlado en farmacia comunitaria: influencia de la administración de un complemento alimenticio de ajo en la evolución de la hipercolesterolemia.