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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1996;16:517-522.)
© 1996 American Heart Association, Inc.

Articles

Hypercholesterolemia With Cholesterol-Enriched LDL and Normal Levels of LDL–Apolipoprotein B

Effects of the Step I Diet and Bile Acid Sequestrants on the Cholesterol Content of LDL

Gloria Lena Vega; Scott M. Grundy

From the Center for Human Nutrition and the Departments of Clinical Nutrition, Internal Medicine, and Biochemistry of the University of Texas Southwestern Medical Center at Dallas and the Veterans Affairs Medical Center, Dallas, Tex.

Abstract One form of hypercholesterolemia is characterized by high levels of LDL cholesterol and normal levels of LDL–apolipoprotein (apo) B. The reason for hypercholesterolemia, therefore, is enrichment of LDL particles with cholesterol. We have reported previously that about one third of patients with primary moderate hypercholesterolemia have this lipoprotein pattern and have no apparent abnormality in LDL–apo B metabolism. The current study was designed to determine whether the combination of the Step I Diet (30% of total calories as fat, <10% saturated fatty acids, and <300 mg per day cholesterol) with or without cholestyramine therapy will correct the hypercholesterolemia in patients of this type. Ten hypercholesterolemic men of this type were identified and recruited into the study. Their LDL cholesterol levels were 160 mg/dL and LDL–apo B levels were <120 mg/dL (LDL cholesterol/apo B ratio >1.60). For patient selection, subjects were challenged with a high fat diet (40% of total calories as fat, 18% saturated fatty acids, and 400 mg per day cholesterol) for 6 weeks to confirm persistence of a high LDL cholesterol/apo B ratio. Thereafter, they were started on a Step I Diet, and lipoprotein analyses were repeated. Finally, cholestyramine (16 g per day) was added to the Step I Diet. The Step I Diet alone significantly reduced the LDL cholesterol/apo B ratios and produced a trend toward lowering LDL cholesterol levels. Cholestyramine therapy further reduced LDL cholesterol levels and maintained a normal LDL cholesterol/apo B ratio. The present investigation thus confirms the existence of a form of moderate hypercholesterolemia that arises from a defect in LDL composition. In addition, it demonstrates that the combination of the Step I Diet and cholestyramine therapy corrects this defect and normalizes LDL levels and LDL composition.

Key Words: cholesterol-enriched LDL • high fat diet • low fat diet • bile acid sequestrant • hypercholesterolemia