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November 2009 Br J Cardiol 2009;16:295–8

Colesevelam – where does it fit into our clinical practice?

Devaki Nair

Abstract

Introduction Bile acid sequestrants (BAS) were the first class of lipid-lowering drug to be developed for reducing blood cholesterol levels.1 Now, after their introduction 30 years ago, BAS still continue to command a position in the treatment of hyperlipidaemia.2 How do BAS work? Figure 1. Mode of action of bile acid sequestrants BAS bind to negatively charged bile acids in the intestine and impede their absorption (figure 1). This process depletes the bile acid pool and disrupts the enterohepatic circulation of bile acids, thus, increasing the synthesis of bile acids. Cholesterol is, therefore, diverted to bile acid synthesis, thereby reduc

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