Entries in Cholesterol (22)


Heart Disease Trigger May Be in Your Genes

Zoonar/Thinkstock(NEW YORK) -- A type of cholesterol you've probably never heard of may be linked to the third leading cause of heart disease in the country.

In a study published Wednesday in the New England Journal of Medicine, a team of researchers from McGill University, Harvard, Johns Hopkins and other institutions report discovering an abnormality in the gene responsible for a little-known type of cholesterol called Lp(a).  This form of cholesterol appears to cause a condition known as aortic stenosis, which affects 1.5 million Americans.

In aortic stenosis, the main valve regulating blood flow between the heart and the rest of the body can become critically narrowed.  To better understand this, picture a room with a door that hangs on an old, creaky hinge so damaged by years of rust that it can only open a small crack.  Now imagine what would happen if you and your friends all tried to squeeze out through the door at once, and you'll have an idea of the trouble blood cells have leaving the heart through a heavily calcified aortic valve.

Patients with aortic stenosis often lack symptoms until it reaches a critical stage marked by fainting, heart attacks or early death.  On average, half of patients will die within two years once these symptoms develop, unless they undergo surgical correction.

In the new study, the authors found that people with a common genetic variant for Lp(a) have a 60 percent greater risk of developing aortic calcifications than others.

"We've all know that Lp(a) is strongly associated with an increased risk of heart attack for some time now," said the study's lead author, Dr. George Thanassoulis of McGill University in Canada.  "But now we can link it to heart valve disease for the first time."

"It is interesting that one molecule that we don't routinely screen for is linked to a number of cardiovascular diseases," he continued.

As for who should be screened for this type of cholesterol -- much as how patients are currently tested for "good" HDL and "bad" LDL cholesterol -- doctors are split.

"These results do not support widespread screening in and of themselves," Thanassoulis said, adding that although aortic stenosis is a common cardiac condition, it only affects 1 to 2 percent of the population.  In other words, even patients with the genetic variation still only have a roughly one-in-30 lifetime chance of developing aortic stenosis.

Dr. Lori Mosca, director of Preventive Cardiology at New York-Presbyterian Hospital, said that because of this fact, she would only recommend such screening in those at a high risk for heart problems.

"Lp(a) is an inherited risk factor for premature heart disease that is not responsive to lifestyle interventions [like diet and exercise]," she said.  "I consider measuring it if I have a patient with a personal or family history of premature heart disease or aortic stenosis."

These doctors say determining the level of this cholesterol could be important.  Learning which patients have extremely high Lp(a) can help to better predict risk for heart attack in some individuals, according to a study published last month in the Journal of the American College of Cardiology by one of the new study's coauthors, Dr. Borge G. Nordestgaard.

And even though Lp(a) can't be lowered by taking cholesterol-busting statins, European guidelines currently suggest treating patients with Lp(a) levels in the top 20 percent with niacin, another type of cholesterol lowering medication that they say may have some effect.

On the other end of the debate are doctors like Dr. Steven Nissen of the Cleveland Clinic, who said that even when someone has a high Lp(a) level, there is little evidence that lowering it would have a benefit.

"Although Niacin lowers Lp(a) a little bit, there are no outcome data suggesting a favorable effect," Nissen said.

Dr. Stephen Kopecky of the Mayo Clinic agreed.  He said that when it comes to preventing heart disease, tried-and-true advice still applies.

"Too often, Americans may be looking for a quick fix that will allow us to trade in our bodies for new ones after 55 years or so," he said.  "But there is still no substitute for trying to prevent all types of heart disease through improvements in our diet and exercise."

Copyright 2013 ABC News Radio


Cholesterol Levels Down Among US Adults

Zoonar/Thinkstock(NEW YORK) -- Cholesterol levels among U.S. adults have dropped an average of 10 points in two decades, a new study found, but cardiologists say Americans still have a lot to do to improve their health.

The survey-based study of more than 35,000 men and women found a decrease in total cholesterol from an average of 206 to 196 mg/dL as well as a 13-point drop in low-density lipoprotein cholesterol -- better known as LDL or “bad” cholesterol. The results held up after adjusting for age, gender, race and obesity, and were even seen in adults who had never taken cholesterol-lowering medications.

“These findings are important because individuals with high levels of total or ‘bad’ cholesterol have a greater chance of developing heart disease, one of the leading causes of death in the United States,” said lead author Margaret Carroll, a survey statistician at the National Center for Health Statistics at the Centers for Disease Control and Prevention in Hyattsville, Md.

The drop in cholesterol among adults not taking cholesterol-lowering drugs suggests statins aren’t the only factor, according to Carroll. Another possible contributor, she said, is the decrease in dietary trans-fats -- a form of fat known to raise cholesterol.

Since 2003, the Food and Drug Administration has mandated that trans-fats be labeled on food products. And some community and state health departments have required restaurants to limit trans-fats on their menu items.

While the drop in cholesterol is good news, other factors, such as smoking, obesity, poor diet, lack of exercise, high blood pressure and alcohol use, can also raise the risk for heart disease, according to Dr. Dariush Mozaffarian, a cardiologist and associate professor of medicine and epidemiology at Harvard Medical School, who was not involved with the study.

“Physical activity has been relatively flat overall,” he said, adding that obesity rates have actually increased since the 1990s.

“We’re not eating enough of the healthy things,” Mozaffarian added. “Things like fruits, vegetables, nuts, vegetable oils, and whole grains.”

So it may be too early to rejoice.

“We’ve gone from a F+ to a D- in our report card. That’s great,” Mozaffarian said.  “But we want to get to an A.  We have a long way to go.”

Copyright 2012 ABC News Radio


Cholesterol Debate: HDL a Lost Cause?

Zoonar/Thinkstock(NEW YORK) -- A day after a study in the journal Lancet challenged the long-standing notion that raising levels of HDL -- commonly known as "good" cholesterol -- prevents heart attacks, top cardiology experts differed on whether the research really means the end of the road for therapies aimed at boosting HDL levels to beat back heart disease.

Some, like Dr. Philip Greenland, said the new evidence may very well close the book on such efforts.

"After several blows to the head of this theory, it is on the ropes, or maybe even down for the count," wrote Greenland, senior associate dean for clinical and translational research at the Feinberg School of Medicine at Northwestern University in Chicago, in an email to ABC News.

Others, like Dr. Christopher Cannon, say the story might not be over yet. While he admits that the study shows that raising good cholesterol to stave off heart disease is not as straightforward as first imagined, he believes that drugs now being tested that aim to boost HDL levels even higher may hold promise.

"It casts some doubt on the benefits of higher HDL, but the real answers will come from clinical trials of new medications that raise HDL," Cannon, professor of medicine at Harvard Medical School and senior investigator of the TIMI Study Group, said in an email. "We are testing a drug now... that increases HDL by 60 mg/dl on average -- and that will hopefully answer the question on whether HDL is important."

HDL levels are still an important predictor of heart health. For decades, doctors have used this measure as a way of predicting a patient's risk for future heart disease.

"These data do not take away the predictive value of HDL in the general population," said the new study's senior author Dr. Sekar Kathiresan, who is director of preventive cardiology at Massachusetts General Hospital in Boston. "Low amounts of HDL cholesterol have been correlated with an increased risk of heart attack."

Naturally, this correlation made HDL levels seem an attractive target for drugs to reduce the risk of heart disease. To help doctors understand whether this was the case, Kathiresan and his colleagues looked at a group of people who had higher HDL levels because of differences in their genetic makeup. They compared these people with others without this genetic predisposition.

Based on past studies, the researchers expected the patients with higher HDL cholesterol to be protected from a heart attack. To their surprise, that was not the case; there was no difference between the two groups.

So what does this mean for patients? "Just because an intervention raises HDL, we cannot assume that this lowers the risk of a heart attack," Kathiresan said.

This study comes on the heels of several other recent clinical trials that suggest that medications designed to increase HDL are not effective in reducing coronary heart disease. These trials examined, among other things, extended-release niacin and several drugs in an experimental class of medications known as CETP inhibitors.

Several of these studies are still in progress. Yet, none of this research has demonstrated that raising HDL is effective at reducing the rates of heart attacks and heart disease.

Still, some experts in the field say despite the recent negative studies, many questions remain to be answered. Dr. Michael Miller, director of the Center for Preventive Cardiology at the University of Maryland Medical Center, said the findings of the study belie the complexity of HDL, and that more research is needed before such efforts are abandoned.

"Bottom line: don't throw the baby out with the bathwater," he said in an email. "The inverse relationship between HDL and heart disease is based on a half-century worth of data."

As for what the general public can take away from the research, Dr. Dean Ornish said the findings underscore the idea that when it comes to reducing heart disease risk, it's not a simple matter of good versus bad.

"I think this study shows a fundamental confusion about HDL," said Ornish, founder and president, Preventive Medicine Research Institute in San Francisco. "Not everything that raises HDL is good, and not everything that lowers it is bad."

"Many people, including physicians, get into a simple-minded idea that HDL is 'good cholesterol' and LDL is 'bad cholesterol.' It's not so simple."

Copyright 2012 ABC News Radio


This Just In: Healthy People Live Longer, Study Finds

Jupiterimages/Thinkstock(ATLANTA) -- Unhealthy habits, like smoking and being overweight, have long been linked to heart disease and cancer, America’s top killers.  The reverse of that coin -- the impact of healthy habits on preventing disease and death -- has been a mantra in the medical community. Now a new study adds weight to that, finding that healthful behaviors, like exercising and eating a balanced diet, can reduce the risk of early death by up to 76 percent.

“It’s common sense,” said study author Quanhe Yang, an epidemiologist with the U.S. Centers for Disease Control and Prevention’s Division for Heart Diseases and Stroke Prevention. “We know what increases the risk of cardiovascular disease. And if you can prevent or postpone those risk factors from developing, it will really reduce your risk long term.”

Yang and colleagues used surveys to probe seven measures of healthy living -- smoking, physical activity, blood pressure, blood sugar, cholesterol, diet and weight -- in nearly 45,000 adult men and women between 1988 and 2010. They found people who were “ideal” on six or more of the parameters were 76 percent less likely to die from heart disease and 51 percent less likely to die from other causes, including cancer.

“We can prevent cardiovascular disease by preventing the risk factors from occurring in the first place,” said Yang. The study was published Tuesday in the Journal of the American Medical Association.

Heart disease is the leading cause of death in the U.S., killing nearly 600,000 Americans each year, according to the CDC. While each healthy living parameter independently affected the risk of death due to heart disease, having an ideal blood pressure was the biggest contributor, reducing the risk by 40 percent.

“There are about 68 million people with hypertension in the U.S.,” said Yang. “If you could bring that down by 10 percent, you could prevent 14,000 cardiovascular events.”

Not smoking and eating an ideal diet reduced the risk of death from cardiovascular disease by 13 percent each, Yang said. But less than one percent of the U.S. study population ate an ideal diet consisting of fruits, veggies, fish, whole grains with limited sodium and sugar.

Although smoking has declined since 1988, blood sugar -- a marker of diabetes -- and weight have risen steadily. Only 2.1 percent of the study subjects were ideal on six or more parameters. They tended to be younger, female and more educated. The majority of subjects were healthy on three of the seven parameters.

Yang said he hopes to see smoking continue to decline, and weight and diabetes level off. He also hopes to see the proportion of people with ideal physical activity and diet increase.

“If we can shift the whole population towards ideal cardiovascular health metrics, we will really reduce the risk of cardiovascular disease and death,” said Yang.

Copyright 2012 ABC News Radio


Study: Experimental Cholesterol-Busting Drug Shows Promise

Zoonar/Thinkstock(CINCINNATI) -- Along with lifestyle changes, a class of medications called statins is first-line therapy for lowering cholesterol. These drugs have been shown to lower levels of bad cholesterol and cut the risk of death for those who take them. But they do not work for all patients. Up to 10 percent of patients experience significant side effects, including muscle pain. An even greater number are unable to get their LDL-C, or "bad cholesterol," down to a range that has been shown to decrease heart disease.

Now, new research suggests that doctors treating at-risk patients may one day have another weapon in the arsenal against high cholesterol. In a study published in the New England Journal of Medicine, researchers looked at a new, experimental class of cholesterol-busting medication -- known for now at least as PCSK9 inhibitors.

In the study, supported by the pharmaceutical companies Regeneron and Sanofi, researchers led by Dr. Evan Stein of the Metabolic and Atherosclerosis Research Center in Cincinnati, found the drug, called REGN727, could decrease bad cholesterol by as much as 65 percent in healthy individuals. More surprisingly, in participants who were already taking the powerful cholesterol-lowering medication atorvastatin -- better known by the trade name Lipitor -- adding this drug further decreased their bad cholesterol by as much as 61 percent. During this preliminary study, there were no side effects that were serious enough to halt the research -- another positive sign.

Stein further noted that the experimental drug may lead to "even greater reductions in LDL-C than the most effective statins."

Dr. Robert Eckel, former president of the American Heart Association, said that if the drug indeed lives up to its promises, it could potentially benefit many patients he sees every day. "Despite the proven benefit of statins in reducing [cardiovascular] risk, additional LDL-C lowering therapies are needed for patients with several genetic disorders that cause high levels of LDL-C and those with statin intolerance." These patients, he added, make up 40 percent of the patients treated at his clinic.

Dr. Dan Rader, a professor of medicine at the University of Pennsylvania who also acts as a consultant for Regeneron and Sanofi, said a new offering for these patients would be a welcome development. "It is worth stating that we really don't have great options for add-on therapy to statins or for statin-intolerant patients.

"Inhibitors of PCSK9 are perhaps the most exciting new approach to LDL-lowering based on very strong human genetics supporting the efficacy and safety of this approach."

And Dr. Christopher Cannon, a professor of medicine at Brigham and Women's Hospital in Boston, called PCSK9 inhibitors a "very important new class of drug. It reduces a major risk factor [for heart disease] by nearly two-thirds."

But some doctors warned that, although promising, the results of this study are just one step in a long process before these drugs can reach the market.

"It is an early study," said Dr. Harlan Krumholz, a professor of medicine at Yale University, said. "It is information that can be used to mount a rationale for further study and investment. But for patients, it is far too early to tell."

Dr. Scott Grundy, at the University of Texas Southwestern Medical Center at Dallas, echoed the sentiment. "PCSK9 inhibitors hold a lot of promise, but there is a long road between their ability to lower LDL and proof that they are practical and reduce risk for [coronary heart disease]."

Copyright 2012 ABC News Radio


FDA Announces New Warning Labels for Cholesterol Drug

iStockphoto/Thinkstock(WASHINGTON) -- Federal regulators announced on Tuesday they would add additional safety warnings to the labels on statins, a class of drugs that lower cholesterol.

Statins -- more commonly known by the brand names Lipitor, Crestor and Zocor -- inhibit the enzyme that plays a big part in the liver's production of cholesterol.

The U.S. Food and Drug Administration now requires that statin labels include warnings about the rare, but serious risk of liver damage, memory loss and confusion along with type 2 diabetes.  Certain statins, known by the generic name lovastatin, can raise the risk of muscle weakness.

The decision came following an internal meeting between the FDA's Office of Surveillance and Epidemiology and Office of New Drugs, according to Dr. Amy Egan, the FDA's deputy director of safety in the division of metabolism drug products.

Egan said most of the information reviewed, especially the effect of statins on memory loss, came from a small number anecdotal reports compiled over one year.  She added that the warning for memory loss was more for serious cognitive problems than simple forgetfulness.

"We can't establish causality with statin therapy," said Egan, regarding the new warnings.

Most of the studies the division evaluated were short-term studies, suggesting that the long-term effects of statin therapy were unclear.  Egan also said it had yet to be determined which statins and at what dose could increase the risk of the listed side effects.

Many experts said the added labels should not deter patients from statins.  Instead, they should report any side effects they experience to their physician.

Consumers will be able to see the label changes on their medications within the next 30 days, Egan said. 

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Copyright 2012 ABC News radio


Children Should Get Cholesterol Tests, Panel Says

Thomas Barwick/Getty Images(WASHINGTON) -- All children should be screened for cholesterol levels between ages nine and 11, and again between ages 17 and 21, even those who are not at an increased risk of high cholesterol and heart disease, according to new guidelines endorsed by the American Academy of Pediatrics.

Previously, experts recommended that only certain children be screened for cholesterol early in life, such as those children with a family history of high cholesterol or heart disease or children who have diabetes or are obese. But a panel of experts from the National Heart, Lung and Blood Institute now recommends that all children be screened to help pediatricians detect elevated cholesterol in their young patients, with the goal of preventing heart disease later in life.

The guidelines will be presented Sunday at a meeting of the American Heart Association and are published online Friday in the journal Pediatrics.

Copyright 2011 ABC News Radio


FDA Meets to Discuss Strategies for Reducing Salt Intake

Jupiterimages/Thinkstock(SILVER SPRING, Md.) -- The U.S. Food and Drug Administration held a day-long hearing Thursday, discussing strategies to help Americans cut the salt from their diets -- the latest assault in the crusade against sodium.

In the past few decades, the government has created guidelines, cajoled industry groups and garnered support from major medical groups such as the World Health Organization and the American Heart Association to encourage more Americans to get the salt out of their diets. Their action stems from the medical wisdom that many know by heart: a diet high in salt raises blood pressure, which increases the risk of heart attacks, strokes and a host of other cardiovascular problems. If the food industry, restaurants and citizens cut their daily salt intake, the feds argue, the national burden of cardiovascular disease would be eased.

The FDA's goal is to get the food industry to gradually reduce the amount of salt in processed and restaurant foods, which account for 75 percent of Americans' salt intake, according to the U.S. Centers for Disease Control and Prevention.

But a number of scientists and physicians say that the case against salt is far from closed. The evidence connecting high-sodium diets with heart disease and death is flimsy, they argue, and does not warrant such sweeping changes in salt consumption.

"Other than in those patients with underlying heart or kidney failure, there is little conclusive evidence that moderate salt intake actually increases heart disease risk," said Dr. Stuart Seides, associate director of cardiology at the Washington Hospital Center.

At the forefront of the fight to save salt is the Salt Institute, an industry group representing salt manufacturers.

The group is mobilizing a grassroots effort to save their seasoning, including a Facebook page and a two-minute YouTube video featuring the group's vice president of science and research, Mortin Satin, the "Salt Guru" who exhorts all salt lovers to send in comments to the FDA's hearing, warning the feds to keep their hands off salt.

Copyright 2011 ABC News Radio


Obama’s Cholesterol Should Be Lower, Doctors Say

Pete Souza/White House via Getty Images(NEW YORK) -- When it comes to President Obama’s health, some cardiologists recommend that his cholesterol levels go the way of his approval ratings: low.

On Monday, “first doctor” Jeffrey C. Kuhlman released a two-page report on the results of the president’s physical exam, his second since taking office. The report said the 50-year-old president has apparently kicked his tobacco habit, gets regular exercise, eats a healthy diet and drinks alcohol in moderation.

But some cardiologists say Obama’s cholesterol numbers are a bit of a worry. His LDL, or bad cholesterol, level was 110, lower than his February 2010 score of 138. Although his new numbers are an improvement, Dr. Lori Mosca, director of preventive cardiology at Columbia University Medical Center in New York, said the president’s score could be lower.

“A U.S. president should have an optimal LDL of less than 100,” Mosca said. “It’s great that he is improving with his lifestyle, especially stopping smoking.”

But because the president is an ex-smoker, doctors say his risk of developing heart disease is higher. Many said taking a statin would help Obama get his bad cholesterol levels down.

When it comes to good cholesterol, called HDL, the president seems to be in great shape. The current report puts his HDL levels at 69, a dramatic improvement over his February 2010 score of 46. Such a major improvement is out of the ordinary, some cardiologists noted.

“The LDL is modestly better than last year, which is good, but the HDL is dramatically better, which is puzzling,” said Dr. Chip Lavie, director of cardiac rehabilitation and prevention at the Ochsner Clinic Foundation and Hospital in New Orleans. “An increase of over 40 percent is way above expected, raising the possibility that either the 2010 HDL value or the current value is not accurate.”

The report did not mention if Obama currently takes medication for his cholesterol.

Copyright 2011 ABC News Radio


How to Lower Cholesterol Without Pills

Plustwentyseven/Digital Vison/Thinkstock(NEW YORK) -- A nutrient-poor diet filled with added sugars and unhealthy trans fats is known to cause high cholesterol, so it makes sense try and fix the problem with healthy food. Although 25 percent of adults over the age of 45 take cholesterol-lowering drugs called statins, which can sap your energy and cause problems for your sex life, research reveals that changes to your diet might actually do a better job—without the energy-sapping, sex-killing side effects.

The researchers, whose study appeared in the Journal of the American Medical Association, followed 345 people with high cholesterol who were placed on one of two vegetarian, low-cholesterol diets for six months. The first was a low-saturated-fat diet and participants were told simply to eat low-fat dairy and get more fruits and vegetables into their meals. The second group had help from nutritionists to incorporate specific cholesterol-lowering foods into their meals, including soy proteins, nuts, oats, peas, and beans. That group saw a drop in cholesterol three times higher than the group on the regular low-saturated-fat diet, and both diets proved to be at least as successful as early trials of statins.

If you've been battling high cholesterol, try some of these swaps for a tasty, low-cholesterol diet:

The low-fat group ate Raisin Bran cereal for breakfast, but the second group ate oat-bran cereal with strawberries and jam. For a seasonal twist, try this recipe for a Peachy Oat Breakfast and chase it down with a glass of soy milk, as those in the study did.

For a cholesterol-lowering hunger fix, grab another peach (or some cantaloupe, grapes, nectarines, or apricots—also in season now) and a handful of almonds when hunger strikes, and chase them down with another glass of soy milk. Or throw all your fruit, soy milk, and nuts, along with a little ice, into a blender to make an immunity-building smoothie.

For lunch, the low-cholesterol group downed sandwiches made with oat-bran bread, tofu slices, lettuce, tomato, and cucumber, accompanied by Spicy Black Bean Soup. The tofu slices provided the soy protein that proved so successful at lowering cholesterol, but if that doesn't tempt your palate, replace tofu with avocado, as in this Roasted Bell Pepper and Avocado Sandwich and have another glass of soy milk instead.

The healthy dieters had more almonds and fresh fruit in the afternoon, but with an added dose of psyllium, a form of soluble fiber made from ground up psyllium seeds. Psyllium may not be very appetizing, so to get your fill of fiber, try these Banana, Yogurt, and Walnut Muffins; the bananas and oatmeal both contain high levels of soluble fiber.

Dieters who shed the most cholesterol swapped pasta for pearled barley and an omelet for a tofu bake with ratatouille. To jazz up plain barley, make a Creamy Barley Risotto or add asparagus and cucumbers and top with a yogurt-dill dressing. Then add some tofu to this recipe for Easy Ratatouille. Just be sure your tofu is organic; nonorganic tofu has been found to contain high levels of cancer-causing hexane.

Copyright 2011 ABC News Radio

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