BILE ACID SEQUESTRANTS


















  • References [1,2,3,4,5,10,11,13,14]
Effect of BAS on lipids in clinical trials
Medication Total chol
(% decrease)
LDL
(% decrease)
Triglycerides
(% increase)
Cholestyramine (Questran®) 13 - 23% 20 - 31% 11 - 18%
Colesevelam (Welchol™) 10 - 17% 17 - 23% may increase
Colestipol (Colestid®) 7% 15 - 21% may increase
up to 21%




Cholestyramine vs Placebo for Prevention of CAD Events, JAMA (1984) [PubMed abstract]
  • The LRC-CPPT enrolled 3806 men with no history of heart disease
Main inclusion criteria
  • Male sex
  • Age 35 - 59
  • Total cholesterol > 265 mg/dl
  • No history of heart disease
Randomized treatment groups
  • Group 1 - Cholestyramine daily
  • Group 2 - Placebo daily
Primary outcome: Definite coronary heart disease death and/or definite nonfatal myocardial infarction
Results

Duration: Average of 7.4 years
Outcome Cholestyramine Placebo Comparisons
Primary outcome 7% 8.6% p<0.05
  • There was no significant difference in overall mortality between the 2 groups

Findings: The LRC-CPPT findings show that reducing total cholesterol by lowering LDL-C levels can diminish the incidence of CHD morbidity and mortality in men at high risk for CHD because of raised LDL-C levels. This clinical trial provides strong evidence for a causal role for these lipids in the pathogenesis of CHD.





  • Baseline A1C was 8.2% in both trials
  • N=357 for monotherapy trial and N=159 in the metformin trial
  • Reference [14]
Effect of Colesevelam (Col) on diabetes in trials lasting 24 - 26 weeks
Col 3.8 g/day
(monotherapy)
Col 3.8 g/day
(added to metformin)
% A1C reduction
(colesevelam - placebo)
-0.27% -0.5%