Abstract 18696: Berberine as a Supplement to Guideline-Based Lipid Management of a Patient With Heterozygous Familial Hypercholesterolemia: A Case Presentation

Abstract

Description of Case: A 62-year-old female presented for a lipidology consult. Labs revealed total cholesterol >450 mg/dL, Lp(a) 42 mg/dL, and LDL-P 2938. She was not on any lipid lowering therapy. A clinical diagnosis of heterozygous familial hypercholesterolemia (HeFH) was made. She reported occasional chest pain with both cardiac and noncardiac features. She had no personal history of CAD, and her family history revealed a mother and maternal grandfather with CAD in their 50s. A CCTA was performed, which revealed mild-moderate plaque in the ostial left circumflex (25-49%) and a CAC score of 124 (90-95th percentile). She was started on rosuvastatin 10mg daily and alirocumab with reduction of her LDL-C to 247 mg/dL. Given documented CAD, LDL-C <55 mg/dL was targeted. She had intolerable side effects to combination ezetemibe plus bempadoic acid and lomitapide. Evinacumab or LDL pheresis were offered, and the patient preferred to start evinacumab. Alirocumab was stopped. With rosuvastatin plus evinacumab, her LDL-C improved to 198 mg/dL. Berberine 1000mg was added to her regimen and resulted in further reduction of her LDL-C to 117 mg/dL. Discussion: Long used in Traditional Chinese and Ayurvedic medicine, Berberine is an alkaloid found in plants such as barberry and tree turmeric. Berberine suppresses PCSK9 transcription by regulating hepatocyte nuclear factor 1 alpha, a binding site located upstream from the PCSK9 gene promoter. The role of supplements in lipid management remains unknown. We describe a case of HeFH in which berberine yielded an 81 mg/dL absolute reduction (41% relative reduction) in LDL-C when added to guideline-based therapy. In a dedicated integrative lipidology practice, berberine may be an effective supplement to the pharmaceutical management of severe hyperlipidemia.