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A Trial to Evaluate the Efficacy of AB-Life Probiotic Product on LDL-Cholesterol Reduction in Moderate Hypercholesterolemia

Primary Purpose

Moderate Hypercholesterolemia

Status
Completed
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Probiotics bacterial strains
Placebo
Sponsored by
AB Biotics, SA
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Moderate Hypercholesterolemia focused on measuring Probiotics, AB-Life, LDL-cholesterol, Hypercholesterolemia

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

To be eligible to the study, male and female volunteers will have to fulfill the following criteria (assessment based on the medical examination performed at V1 with a checking at V3):

  • Age between 18 and 65 years (limits included).
  • BMI between 18,5 and 30 kg/m² ((limits excluded).
  • For women : Non menopausal with reliable contraception since at least two cycles before the beginning of the study and agreeing to keep it during the entire duration of the study (condom alone without spermicide gel and oestrogenic contraceptive excluded) or menopausal without oestrogenic replacement therapy.
  • Good general and mental health with in the opinion of the investigator: no clinically significant and relevant abnormalities of medical history or physical examination.
  • Able and willing to participate to the study by complying with the protocol procedures as evidenced by his dated and signed informed consent form.
  • Affiliated with a social security scheme.
  • Agree to be registered on the volunteers in biomedical research file.

After V1 biological analysis the subjects will be eligible to the visit V2 on the following criteria:

- Fasting plasma LDLc level (Friedewald estimation method) between 1,3 and 1,89 g/L (3,35 - 4,92 mmol/L, limits included with ± 2% tolerated around).

After V2 biological analysis the subjects will be eligible to the study on the following criteria:

- Fasting plasma LDLc level (Friedewald estimation method) between 1,3 and 1,89 g/L (3,35 - 4,92 mmol/L, limits included with ± 2% tolerated around).

A re-screening can occur from 2 months after the exit of study for failure to comply with the one or more of the eligibility criteria listed above.

Exclusion Criteria:

Volunteers with the following criteria will be considered as non eligible to the study (assessment based on the medical examination performed at V1 with a checking at V3):

  • Suffering from a metabolic disorder such as diabetes, uncontrolled thyroidal trouble or other chronic severe disease.
  • Suffering from a severe chronic disease (e.g. cancer, HIV, renal failure, hepatic or biliary disorders ongoing, chronic inflammatory digestive disease, arthritis or other chronic respiratory trouble, etc.) or gastrointestinal disorders found to be inconsistent with the conduct of the study by the investigator (e.g. celiac disease).
  • With a history of ischemic cardiovascular event or, during the previous 6 months a surgical procedure.
  • With a known or suspected food allergy or intolerance or hypersensitivity to any of the study products' ingredient.
  • Suffering from an uncontrolled hypertension (systolic blood pressure ≥ 160 mmHg and diastolic blood pressure ≥ 100 mmHg).
  • Pregnant or lactating women or intending to become pregnant within 5 months ahead.
  • Under lipid-lowering treatment (e.g. statins, fibrates, ezetimibe, bile acid sequestrants, niacin, etc.) or stopped less than 4 months before the randomization.
  • Under medication which could affect blood lipid parameters (e.g. long-term corticosteroid systemic drug, systemic antibodies, androgens or phenytoin, etc.) or stopped less than 1 month before the randomization (stable long-term treatment with beta blocker or thiazide diuretics tolerated).
  • Regular intake of dietary supplements or "functional foods" which may interfere with lipid absorption and/or metabolism (e.g. rich in plant stanol or sterol like PRO-ACTIV or DANACOL products, red yeast rice, policosanol, omega-3 fatty acids like fish oils, ST HUBERT OMEGA 3 or PRIMEVERE products, soya protein, oat fiber like QUAKER OATS, psyllium, chitosan, guar gum, inulin, etc.) or stopped less than 3 months before the randomization.
  • Under treatment which could disturb microbiota balance or stopped in a too short period before the randomization (e.g. less than one month for laxatives, less than 6 weeks for antibiotics).
  • Regular intake of dietary supplements or "functional foods" containing prebiotics, probiotics or symbiotics (e.g. BION 3, LACTIBIANE, ACTIMEL, ACTIVIA, etc.) or stopped less than 1 month before the randomization.
  • Under treatment or dietary supplement which could significantly affect parameter(s) followed during the study according to the investigator or stopped in a too short period before the randomization.
  • With significant change in food habits or in physical activity in the 3 months before randomization or not agreeing to keep them unchanged throughout the study.
  • With reported body weight variation > 5% in the 3 months prior the randomization or with a hyper or hypocaloric diet planned in the next 5 months.
  • With a personal history of anorexia nervosa, bulimia or significant eating disorders according to the investigator.
  • Consuming more than 3 standard drinks of alcoholic beverage daily for men or 2 standard drinks daily for women or not agreeing to keep his alcohol consumption habits unchanged throughout the study.
  • Smoking more than 10 cigarettes daily or not agreeing to keep his smoking habits unchanged throughout the study.
  • Recent history of chronic alcohol or drug abuse (in the last 2 years).
  • Having a lifestyle deemed incompatible with the study according to the investigator including high level physical activity (defined as more than 10 hours of significant physical activity a week, walking excluded).
  • Who made a blood donation in the 3 months before the randomization or intending to make it within 4 months ahead.
  • Taking part in another clinical trial or being in the exclusion period of a previous clinical trial.
  • Having received, during the last 12 months, indemnities for clinical trial higher or equal to 4500 Euros.
  • Under legal protection (guardianship, wardship) or deprived from his rights following administrative or judicial decision.
  • Presenting a psychological or linguistic incapability to sign the informed consent.
  • Impossible to contact in case of emergency.

After V1 biological analysis the subjects will be considered as non eligible to the study on the following criteria :

  • Fasting plasma glucose level > 1,26 g/L (6,99 mmol/L).
  • Fasting plasma triglycerides > 3,5 g/L (3,95 mmol/L).
  • Fasting plasma TC, HDLc or insulin with an abnormality judged as clinically significant according to the investigator.

After V2 biological analysis the subjects will be considered as non eligible to the study on the following criteria:

  • Fasting plasma TC, HDL or TG with an abnormality judged as clinically significant according to the investigator.
  • Serum AST, ALT, GGT, ALP or bilirubin with an abnormality judged as clinically significant according to the investigator.
  • Serum urea or creatinine with an abnormality judged as clinically significant according to the investigator.
  • Complete blood count with clinically significant abnormality according to the investigator.

Volunteers with the following criteria at the V3 will be considered as non eligible to the study:

  • Capsules' consumption less than 80% of capsules during the run-in period (since V1) according to the quantities returned.
  • Gastroenteritis history finished less than 2 weeks before the randomization.

The included subjects who cannot be randomized at V3 because of a too short wash out period related to the non inclusion criteria E8, E10, E12 or E34 can delay their visit V3 without to exceed 28 days from the visit V2.

A re-screening can occur from 2 months after the exit of study for failure to comply with the one or more of the eligibility criteria listed above (except for E33 criteria).

Sites / Locations

  • Naturalpha
  • Biofortis

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

AB-Life

Placebo

Arm Description

1 capsule of AB-Life daily during 12 weeks consumed immediately before, after or during the breakfast. The daily dose corresponds to the intake of 1.8E+10 CFU. According to the product's stability and the duration of the experiment, all participants receive at least 1.2E+09 CFU/capsule/day by the end of the study.

1 capsule of placebo daily during 12 weeks consumed immediately before, after or during the breakfast.

Outcomes

Primary Outcome Measures

Change of the fasting blood LDL cholesterol concentration

Secondary Outcome Measures

Change in fasting blood total cholesterol concentration
Change in fasting blood total cholesterol concentration
Change in fasting blood LDLc concentration
Change in fasting blood HDLc concentration
Change in fasting blood HDLc concentration
Change in fasting blood ratio total cholesterol / HDLc concentrations
Change in fasting blood ratio total cholesterol / HDLc concentrations
Change in fasting blood ratio LDLc / HDLc concentrations
Change in fasting blood ratio LDLc / HDLc concentrations
Change in fasting blood triglycerides concentration
Change in fasting blood triglycerides concentration
Change in fasting blood Apo A1 concentration
Change in fasting blood Apo A1 concentration
Change in fasting blood Apo B100 concentration
Change in fasting blood Apo B100 concentration
Change in fasting blood insulin concentration
Change in fasting blood insulin concentration
Change in fasting blood glucose concentration
Change in fasting blood glucose concentration
Change in fasting blood acetate concentration
Change in fasting blood propionate concentration
Change in fasting blood acetate / propionate concentrations
Change in SCORE - European Low Risk Chart of fatal cardiovascular disease
Change in SCORE - European Low Risk Chart of fatal cardiovascular disease
Change in fasting blood hsCRP concentration
Complete blood count
Blood Alkaline Phosphatase
Blood Alanine Amino Transferase
Blood Aspartate Amino Transferase
Blood Gamma Glutamyl Transpeptidase
Blood total bilirubin
Blood urea
Blood creatinine
Heart rate
Heart rate
Systolic Blood Pressure
Diastolic Blood Pressure
Diastolic Blood Pressure
Systolic Blood Pressure
Body weight
Body weight
Physical Activity Score
Total energy intake
Percentage of energy intake from fat
Dietary fiber intake
Saturated Fatty Acids intake

Full Information

First Posted
July 23, 2014
Last Updated
May 29, 2018
Sponsor
AB Biotics, SA
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1. Study Identification

Unique Protocol Identification Number
NCT02198703
Brief Title
A Trial to Evaluate the Efficacy of AB-Life Probiotic Product on LDL-Cholesterol Reduction in Moderate Hypercholesterolemia
Official Title
RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED CLINICAL TRIAL FOR EVALUATING THE EFFICACY OF AB-LIFE PROBIOTIC PRODUCT ON THE LDL-CHOLESTEROL REDUCTION IN THE MODERATE HYPERCHOLESTEROLEMIA
Study Type
Interventional

2. Study Status

Record Verification Date
September 2015
Overall Recruitment Status
Completed
Study Start Date
September 2014 (undefined)
Primary Completion Date
July 2015 (Actual)
Study Completion Date
July 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
AB Biotics, SA

4. Oversight

5. Study Description

Brief Summary
This study aims to demonstrate the effect of the chronic consumption of AB-Life probiotic blend on blood LDL cholesterol level in volunteers with moderate hypercholesterolemia.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Moderate Hypercholesterolemia
Keywords
Probiotics, AB-Life, LDL-cholesterol, Hypercholesterolemia

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
104 (Actual)

8. Arms, Groups, and Interventions

Arm Title
AB-Life
Arm Type
Experimental
Arm Description
1 capsule of AB-Life daily during 12 weeks consumed immediately before, after or during the breakfast. The daily dose corresponds to the intake of 1.8E+10 CFU. According to the product's stability and the duration of the experiment, all participants receive at least 1.2E+09 CFU/capsule/day by the end of the study.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
1 capsule of placebo daily during 12 weeks consumed immediately before, after or during the breakfast.
Intervention Type
Dietary Supplement
Intervention Name(s)
Probiotics bacterial strains
Other Intervention Name(s)
AB-Life
Intervention Type
Dietary Supplement
Intervention Name(s)
Placebo
Other Intervention Name(s)
AB-life
Primary Outcome Measure Information:
Title
Change of the fasting blood LDL cholesterol concentration
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Change in fasting blood total cholesterol concentration
Time Frame
4 weeks
Title
Change in fasting blood total cholesterol concentration
Time Frame
12 weeks
Title
Change in fasting blood LDLc concentration
Time Frame
4 weeks
Title
Change in fasting blood HDLc concentration
Time Frame
4 weeks
Title
Change in fasting blood HDLc concentration
Time Frame
12 weeks
Title
Change in fasting blood ratio total cholesterol / HDLc concentrations
Time Frame
4 weeks
Title
Change in fasting blood ratio total cholesterol / HDLc concentrations
Time Frame
12 weeks
Title
Change in fasting blood ratio LDLc / HDLc concentrations
Time Frame
4 weeks
Title
Change in fasting blood ratio LDLc / HDLc concentrations
Time Frame
12 weeks
Title
Change in fasting blood triglycerides concentration
Time Frame
4 weeks
Title
Change in fasting blood triglycerides concentration
Time Frame
12 weeks
Title
Change in fasting blood Apo A1 concentration
Time Frame
4 weeks
Title
Change in fasting blood Apo A1 concentration
Time Frame
12 weeks
Title
Change in fasting blood Apo B100 concentration
Time Frame
4 weeks
Title
Change in fasting blood Apo B100 concentration
Time Frame
12 weeks
Title
Change in fasting blood insulin concentration
Time Frame
4 weeks
Title
Change in fasting blood insulin concentration
Time Frame
12 weeks
Title
Change in fasting blood glucose concentration
Time Frame
12 weeks
Title
Change in fasting blood glucose concentration
Time Frame
4 weeks
Title
Change in fasting blood acetate concentration
Time Frame
12 weeks
Title
Change in fasting blood propionate concentration
Time Frame
12 weeks
Title
Change in fasting blood acetate / propionate concentrations
Time Frame
12 weeks
Title
Change in SCORE - European Low Risk Chart of fatal cardiovascular disease
Time Frame
4 weeks
Title
Change in SCORE - European Low Risk Chart of fatal cardiovascular disease
Time Frame
12 weeks
Title
Change in fasting blood hsCRP concentration
Time Frame
12 weeks
Title
Complete blood count
Time Frame
12 weeks
Title
Blood Alkaline Phosphatase
Time Frame
12 weeks
Title
Blood Alanine Amino Transferase
Time Frame
12 weeks
Title
Blood Aspartate Amino Transferase
Time Frame
12 weeks
Title
Blood Gamma Glutamyl Transpeptidase
Time Frame
12 weeks
Title
Blood total bilirubin
Time Frame
12 weeks
Title
Blood urea
Time Frame
12 weeks
Title
Blood creatinine
Time Frame
12 weeks
Title
Heart rate
Time Frame
4 weeks
Title
Heart rate
Time Frame
12 weeks
Title
Systolic Blood Pressure
Time Frame
4 weeks
Title
Diastolic Blood Pressure
Time Frame
4 weeks
Title
Diastolic Blood Pressure
Time Frame
12 weeks
Title
Systolic Blood Pressure
Time Frame
12 weeks
Title
Body weight
Time Frame
4 weeks
Title
Body weight
Time Frame
12 weeks
Title
Physical Activity Score
Time Frame
12 weeks
Title
Total energy intake
Time Frame
12 weeks
Title
Percentage of energy intake from fat
Time Frame
12 weeks
Title
Dietary fiber intake
Time Frame
12 weeks
Title
Saturated Fatty Acids intake
Time Frame
12 weeks
Other Pre-specified Outcome Measures:
Title
Fasting blood PCSK9 concentration
Time Frame
12 weeks
Title
Fasting blood FGF-19 concentration
Time Frame
12 weeks
Title
Fasting blood LDLox concentration
Time Frame
12 weeks
Title
Fasting blood fibrinogen concentration
Time Frame
12 weeks
Title
Fasting blood biliary acids concentrations
Time Frame
12 weeks
Title
Fecal concentrations of neutral sterol including cholesterol and its secondary metabolites
Time Frame
12 weeks
Title
Fecal concentrations of phytosterols
Time Frame
12 weeks
Title
Fecal concentrations of volatil fatty acids
Time Frame
12 weeks
Title
Fecal concentrations of branched chain fatty acids
Time Frame
12 weeks
Title
Fecal concentrations of biliary acids
Time Frame
12 weeks
Title
Fecal concentrations of AB-Life probiotic strains
Time Frame
12 weeks
Title
Fecal concentration of calprotectin
Time Frame
12 weeks
Title
Fasting blood sodium concentration
Time Frame
12 weeks
Title
Fasting blood potassium concentration
Time Frame
12 weeks
Title
Fasting blood bicarbonates concentration
Time Frame
12 weeks
Title
Fasting blood calcium concentration
Time Frame
12 weeks
Title
Fasting blood inorganic phosphate concentration
Time Frame
12 weeks
Title
Urine aspect
Time Frame
12 weeks
Title
Urine color
Time Frame
12 weeks
Title
Urinary density level
Time Frame
12 weeks
Title
Urinary bilirubin level
Time Frame
12 weeks
Title
Urinary urobilirubinogen level
Time Frame
12 weeks
Title
Urinary protein level
Time Frame
12 weeks
Title
Urinary glucose level
Time Frame
12 weeks
Title
Urinary ketones level
Time Frame
12 weeks
Title
Urinary nitrites level
Time Frame
12 weeks
Title
Urine sediment
Time Frame
12 weeks
Title
Urine osmolality
Time Frame
12 weeks
Title
Urine pH
Time Frame
12 weeks
Title
Urinary red cells level
Time Frame
12 weeks
Title
Urinary white cells level
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: To be eligible to the study, male and female volunteers will have to fulfill the following criteria (assessment based on the medical examination performed at V1 with a checking at V3): Age between 18 and 65 years (limits included). BMI between 18,5 and 30 kg/m² ((limits excluded). For women : Non menopausal with reliable contraception since at least two cycles before the beginning of the study and agreeing to keep it during the entire duration of the study (condom alone without spermicide gel and oestrogenic contraceptive excluded) or menopausal without oestrogenic replacement therapy. Good general and mental health with in the opinion of the investigator: no clinically significant and relevant abnormalities of medical history or physical examination. Able and willing to participate to the study by complying with the protocol procedures as evidenced by his dated and signed informed consent form. Affiliated with a social security scheme. Agree to be registered on the volunteers in biomedical research file. After V1 biological analysis the subjects will be eligible to the visit V2 on the following criteria: - Fasting plasma LDLc level (Friedewald estimation method) between 1,3 and 1,89 g/L (3,35 - 4,92 mmol/L, limits included with ± 2% tolerated around). After V2 biological analysis the subjects will be eligible to the study on the following criteria: - Fasting plasma LDLc level (Friedewald estimation method) between 1,3 and 1,89 g/L (3,35 - 4,92 mmol/L, limits included with ± 2% tolerated around). A re-screening can occur from 2 months after the exit of study for failure to comply with the one or more of the eligibility criteria listed above. Exclusion Criteria: Volunteers with the following criteria will be considered as non eligible to the study (assessment based on the medical examination performed at V1 with a checking at V3): Suffering from a metabolic disorder such as diabetes, uncontrolled thyroidal trouble or other chronic severe disease. Suffering from a severe chronic disease (e.g. cancer, HIV, renal failure, hepatic or biliary disorders ongoing, chronic inflammatory digestive disease, arthritis or other chronic respiratory trouble, etc.) or gastrointestinal disorders found to be inconsistent with the conduct of the study by the investigator (e.g. celiac disease). With a history of ischemic cardiovascular event or, during the previous 6 months a surgical procedure. With a known or suspected food allergy or intolerance or hypersensitivity to any of the study products' ingredient. Suffering from an uncontrolled hypertension (systolic blood pressure ≥ 160 mmHg and diastolic blood pressure ≥ 100 mmHg). Pregnant or lactating women or intending to become pregnant within 5 months ahead. Under lipid-lowering treatment (e.g. statins, fibrates, ezetimibe, bile acid sequestrants, niacin, etc.) or stopped less than 4 months before the randomization. Under medication which could affect blood lipid parameters (e.g. long-term corticosteroid systemic drug, systemic antibodies, androgens or phenytoin, etc.) or stopped less than 1 month before the randomization (stable long-term treatment with beta blocker or thiazide diuretics tolerated). Regular intake of dietary supplements or "functional foods" which may interfere with lipid absorption and/or metabolism (e.g. rich in plant stanol or sterol like PRO-ACTIV or DANACOL products, red yeast rice, policosanol, omega-3 fatty acids like fish oils, ST HUBERT OMEGA 3 or PRIMEVERE products, soya protein, oat fiber like QUAKER OATS, psyllium, chitosan, guar gum, inulin, etc.) or stopped less than 3 months before the randomization. Under treatment which could disturb microbiota balance or stopped in a too short period before the randomization (e.g. less than one month for laxatives, less than 6 weeks for antibiotics). Regular intake of dietary supplements or "functional foods" containing prebiotics, probiotics or symbiotics (e.g. BION 3, LACTIBIANE, ACTIMEL, ACTIVIA, etc.) or stopped less than 1 month before the randomization. Under treatment or dietary supplement which could significantly affect parameter(s) followed during the study according to the investigator or stopped in a too short period before the randomization. With significant change in food habits or in physical activity in the 3 months before randomization or not agreeing to keep them unchanged throughout the study. With reported body weight variation > 5% in the 3 months prior the randomization or with a hyper or hypocaloric diet planned in the next 5 months. With a personal history of anorexia nervosa, bulimia or significant eating disorders according to the investigator. Consuming more than 3 standard drinks of alcoholic beverage daily for men or 2 standard drinks daily for women or not agreeing to keep his alcohol consumption habits unchanged throughout the study. Smoking more than 10 cigarettes daily or not agreeing to keep his smoking habits unchanged throughout the study. Recent history of chronic alcohol or drug abuse (in the last 2 years). Having a lifestyle deemed incompatible with the study according to the investigator including high level physical activity (defined as more than 10 hours of significant physical activity a week, walking excluded). Who made a blood donation in the 3 months before the randomization or intending to make it within 4 months ahead. Taking part in another clinical trial or being in the exclusion period of a previous clinical trial. Having received, during the last 12 months, indemnities for clinical trial higher or equal to 4500 Euros. Under legal protection (guardianship, wardship) or deprived from his rights following administrative or judicial decision. Presenting a psychological or linguistic incapability to sign the informed consent. Impossible to contact in case of emergency. After V1 biological analysis the subjects will be considered as non eligible to the study on the following criteria : Fasting plasma glucose level > 1,26 g/L (6,99 mmol/L). Fasting plasma triglycerides > 3,5 g/L (3,95 mmol/L). Fasting plasma TC, HDLc or insulin with an abnormality judged as clinically significant according to the investigator. After V2 biological analysis the subjects will be considered as non eligible to the study on the following criteria: Fasting plasma TC, HDL or TG with an abnormality judged as clinically significant according to the investigator. Serum AST, ALT, GGT, ALP or bilirubin with an abnormality judged as clinically significant according to the investigator. Serum urea or creatinine with an abnormality judged as clinically significant according to the investigator. Complete blood count with clinically significant abnormality according to the investigator. Volunteers with the following criteria at the V3 will be considered as non eligible to the study: Capsules' consumption less than 80% of capsules during the run-in period (since V1) according to the quantities returned. Gastroenteritis history finished less than 2 weeks before the randomization. The included subjects who cannot be randomized at V3 because of a too short wash out period related to the non inclusion criteria E8, E10, E12 or E34 can delay their visit V3 without to exceed 28 days from the visit V2. A re-screening can occur from 2 months after the exit of study for failure to comply with the one or more of the eligibility criteria listed above (except for E33 criteria).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Gendre, M.D.
Organizational Affiliation
BioFortis
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ariana Salavert, Ph. D.
Organizational Affiliation
AB-BIOTICS
Official's Role
Study Director
Facility Information:
Facility Name
Naturalpha
City
Lille
ZIP/Postal Code
59020
Country
France
Facility Name
Biofortis
City
Saint-Herblain
ZIP/Postal Code
44800
Country
France

12. IPD Sharing Statement

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A Trial to Evaluate the Efficacy of AB-Life Probiotic Product on LDL-Cholesterol Reduction in Moderate Hypercholesterolemia

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