LDL-C and endothelial function

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Children with heterozygous familial hypercholesterolemia have substantial elevation of LDL-cholesterol (LDL-C) and also have endothelial dysfunction. This dysfunction of the endothelium is thought to be an important first step in the atherosclerotic process. There is a variety of potential treatments for lowering LDL-C in these patients. One non-pharmacologic treatment strategy is to use foods rich in plant sterols or stanols which reduce absorption of cholesterol in the diet. Jakulj et al studied the effect of plant sterols provided in a low fat yogurt to children with familial hypercholesterolemia; this preparation was associated with reduced LDL-C, but was not associated with improved endothelial function. Thus, treatment over 4 weeks may not improve all aspects of heterozygous familial hypercholesterolemia and may be inadequate to reduce the atherosclerotic process. Further studies will be needed to determine if longer term treatment will be more effective.