RECIPE study: daily phytosterol supplementation helps to improve lifestyle in dyslipidemic patients

- 79th EAS Congress, Gothenburg, Sweden – Guidelines place renewed focus on lifestyle as the fundamental first step in managing dyslipidemia to prevent cardiovascular risk. More controversially, the proposed new Joint British Societies guidelines in the UK (JBS3) have taken a completely new approach with the adoption of the concept of ‘lifetime risk’ – heart age’ overturning the conventional approach of using 10-year cardiovascular risk scores. According to Professor John Deanfield, Professor of Cardiology and Head of Cardiovascular Prevention, University College London, UK who is chair of JBS3: ‘Small changes early on can make even greater leveraged gains in the longer-term. You don’t have to do very much to obtain the same magnitude of benefit as seen in clinical intervention studies. However, tackling the overweight patient, many of whom have dyslipidemia, is much more difficult. We need to change patient, clinician and societal views and make a healthy diet as aspirational as a wealthy lifestyle.’

However, the biggest challenge in implementing lifestyle change is poor compliance. Self-monitoring of other risk factors such as blood glucose and blood pressure has been shown to be beneficial in empowering patients to change. Drivers that help to reinforce the value of lifestyle, such as self-assessment, clearly help. However, this is often difficult for implementing changes in nutritional behaviour.

With these points in mind, new data from the RECIPE study,¹ discussed at EAS 2011 are especially pertinent. The RECIPE study was an international, prospective observational study conducted in general practice. Each general practitioner provided advice on lifestyle modification, including daily intake of phytosterol-supplemented yogurt to consecutive patients with moderate hypercholesterolemia. Patients both already treated with cholesterol-lowering therapy and untreated patients were enrolled. The study used an innovative food frequency self-report questionnaire (the Nutritional lifestyle questionnaire), specifically adapted to dyslipidemic patients to assess nutritional behaviour.

This first report of the RECPE study included data from 1,048 patients (57 percent women, mean age 56 years) enrolled in Spain. About 25% were overweight or obese, 47% had a high waist circumference, 20% were smokers and 13% had type 2 diabetes. With respect to lifestyle behaviours at baseline, only 57% reported exercising occasionally and even less (25%) exercising regularly. This was a predominantly primary prevention population (90%). Mean lipids at baseline were 160 mg/dL for LDL cholesterol, 150 mg/dL for triglycerides and 50 mg/dL for HDL cholesterol.

The reasons given by general practitioners for selecting patients included the desire to avoid the use of hypercholesterolemic drugs due to side effects, or preference for a non-drug approach in patients at borderline LDL cholesterol levels. A daily drink of phytosterol-supplemented yogurt helped dyslipidemic patients comply with lifestyle advice. After 4 months, LDL cholesterol was reduced by about 7%, and was also associated with significant improvement in the Nutritional Lifestyle score. The proportion of patients achieving a good diet increased from 28% to 75% over 4 months. There was also significant reduction in body mass index (p<0.0001) and waist circumference (p<0.0005) in the study population. The proportion of patients exercising regularly also increased to 80%. The results of the RECIPE study were presented at an Educational symposium at EAS Congress 2011, Monday.

Professor Luis Masana, Professor of Medicine and Head of the Internal Medicine Department and Lipid and Cardiovascular Risk Unit, University Hospital Sant Joan, Reus, Spain who was lead author highlighted motivation as a key obstacle for hypercholesterolemic patients to adopt a healthy diet. ‘These findings from the RECIPE study, in a real-life clinical setting, show that daily dietary phytosterol supplementation, as part of comprehensive lifestyle modification, can help patients to adopt a healthier lifestyle and also positively impacts lipids.’ He added, that in a recent study published in this week’s issue of The New England of Medicine yogurt was one of the foods associated with weight reduction in a cohort of 120,877 U.S. women and men free of chronic diseases and not obese at baseline.²

References

1. Masana L, Descamps O, Bosi E, Allaert FA, Chapman MJ, Bruckert E. Lifestyle behaviour and cardiovascular risk in hypercholesterolemia: Impact of consumption of phytosterol-supplemented yogurt. EAS 2011, Abstract 1380.

2. Mozaffarian D, Tao Hao, MPH, Rimm EB et al. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011; 364:2392-240.