Hypercholesterolemia Persisting After Distal Ileal Bypass: Response to Mevinolin

FAMILIAL HYPERCHOLESTEROLEMIA is an autosomal dominant disorder associated with lifelong hypercholes-terolemia and premature atherosclerosis (1). Treatment of patients heterozygous for this disorder has included diet, medications (colestipol, nicotinic acid, probucol) (2) , and in certain patients surgical bypass of the distal ileum (3). By selectively removing the site of bile acid reabsorption, distal ileal bypass surgery results in en-hanced fecal excretion of bile acids; an increased rate of hepatic conversion of cholesterol to bile acids; and, by depleting the hepatic pool of cholesterol, an increase in the number of high-affinity receptors for low-density lipo-proteins (LDL) on hepatocyte membranes with a con-comittant increase in the fractional rate of catabolism of LDL. Although reductions of 25 % to 40 % in the con