Fat-soluble vitamin concentrations in hypercholesterolemic children treated with colestipol

Twenty-three children with heterozygous familial hypercholesterolemia were studied to determine whether long-term administration of colestipol hydrochloride in conjunction with a low-cholesterol diet would be effective in reducing plasma total and low density lipoprotein cholesterol and would affect the plasma concentrations of vitamins A, D, E, K or folic acid. Effect of the drug on calcium metabolism was studied by sequential determination of serum total and ionized calcium, phosphorus, alkaline phosphatase, and parathyroid hormone. Mean decrease in plasma cholesterol of children previously on ad libitum diets was 6% after 3 mth of diet. After 2 mth of colestipol therapy and diet in the 11 children with good drug adherence, total cholesterol decreased 19±3% (SEM) from drug baseline; after 2 yr of therapy in 5 of these children, mean decrease from drug baseline was 13±5%. Diet did not significantly decrease serum concentration of any of the vitamins but during 24 mth of colestipol therapy serum vitamin A and E concentrations did decrease in the 5 patients with good drug adherence (vitamin A, 68±11 vs 35±4 μg/100 ml, P<.005; vitamin E, 14±1 vs 11±1 μg/100 ml, P<0.05). However, all vitamin concentrations remained within normal limits; calcium metabolism was not affected. Annual monitoring of serum concentrations of fat-soluble vitamins and folate in children receiving colestipol for more than 2 yr is recommended but may prove unnecessary.