Treatment guidelines for hypercholesterolaemia: time to consider soluble fibre

Lowering raised serum cholesterol levels is firmly established as an effective intervention for reducing the mortality and morbidity due to coronary heart disease (CHD). Recent European and British guidelines for the management of hypercholesterolaemia recommend dietary modification as first-line therapy. However, dietary measures alone do not significantly reduce cholesterol levels. There is ample evidence that soluble fibre, such as ispaghula, lowers cholesterol and could therefore potentially reduce the risk of CHD. As CHD management costs spiral upwards, prescribing lipid-lowering drugs for all indicated patients is not sustainable within current NHS resources. It is suggested that treatment guidelines be revised to include a soluble fibre product, such as ispaghula, as an adjunct to diet for patients where diet alone has failed and where lifelong therapy with lipid-lowering drugs is inappropriate.