Benecol - Healthcare Professionals

Case 1: Elevated LDL-C in a Young Adult

Routine checkup:

• Age: 33 years
• Sex: male
• Status: Except for hypercholesterolaemia when fasting, the patient was in excellent health
• Fasting analysis (lipid profile):
• TC: 280 mg/dl (7.2 mmol/l)
• HDL-C: 60 mg/dl (1.6 mmol/l)
• TG: 140 mg/dl (1.6 mmol/l)
• Calculated LDL-C: 192 mg/dl (4.9 mmol/l)
• Lp(a): 13 mg/dl
• Repeated blood sampling confirmed the lipid profile

Other parameters:

• Thyroid, renal and hepatic values: normal
• Blood pressure: 110/70 mmHg
• There were no clinical signs of atherosclerosis

Family history:

• negative for hypertension, diabetes mellitus and premature CVD
• the patient said that his parents and older brother had normal lipid values

The patient:

• never smoked
• was not overweight: 173 cm and 64 kg, or 5 ft 8 in and 140 lb, BMI 21.4 kg/m²
• vigorously played tennis on weekends in addition to jogging 5-6 km (3-4 miles) 2-3 times a week

Dietary recommendations:

• The patient was advised to follow the general cholesterol-lowering diet (NCEP Step I Diet), including:
• total fat not exceeding 30% of energy intake
• saturated fat not exceeding 10% of energy intake
• not more than 300 mg/day dietary cholesterol
• Lipid values were checked over a period of several months, and LDL-C stabilised at
  about 170 mg/dl (4.4 mmol/l)

What do you recommend to the patient?

Answer:

LDL-C remained elevated (>160 mg/dl, or >4.1 mmol/l) despite exercise and maximum efforts towards dietary control. However, given the patient's relative youth, otherwise acceptable lipid profile, including high HDL-C and the absence of other risk for CHD, it would be best to defer lipid-lowering pharmacotherapy, which is usually a lifelong therapy.

The patient's LDL-C:HDL-C ratio (2.8) is now at a desirable level (<3) for primary prevention. Still, it would be best to reduce his LDL-C to <130 mg/dl (<3.4 mmol/l).

PLANTsterol characteristics:

Plantsterol-containing foods are a dietary supplement which lowers the mean LDL-C levels
by 10-15% in addition to any other treatment previously followed.

Study results from patients similar to this case:

(Miettinen T et al. N Engl J Med. 1995;333:1308-12). Long-term LDL lowering could be shown.

Evidence:

• Phytosterol therapy is in line with the updated NCEP ATPIII guidelines. The patient's absolute
  10-year CHD risk according to Framingham is below 5%, placing the patient in the low-risk group.
  The recommended LDL-C treatment goal in this risk category is <160 mg/dl (4.1 mmol/l), and the threshold level for considering drug therapy is ≥190 mg/dl (≥5.0 mmol/l).
• Two large studies on asymptomatic persons at risk of coronary heart disease (WOSCOPS, AFCAPS/TexCAPS) have shown that lifestyle changes and lowering LDL-C can substantially reduce the risk of a heart attack (myocardial infarction) in patients with moderately elevated LDL-C.

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