Entries in LDL (4)


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


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


Cholesterol-Lowering Foods Reduce LDL Levels More than Low-Fat Diets

Jupiterimages/Thinkstock(TORONTO) -- Millions of Americans pop statins to keep their cholesterol levels down. But new research suggests that cholesterol-friendly foods such as soy products and tree nuts may also contribute to lowering LDL, or "bad," cholesterol levels.

The study, published in the Journal of the American Medical Association, found that people who ate a healthy diet filled with cholesterol-lowering foods experienced a 13-percent decrease in their LDL cholesterol levels. Those who followed a diet low in saturated fats experienced a three-percent decrease.

"The main takeaway here is that people can lower their cholesterol with diet if they put their minds to it," said Dr. David Jenkins, a professor of nutrition and metabolism at University of Toronto and lead author of the study. "These can be small changes. We're not asking people to live behind bars."

Jenkins created the "portfolio diet," which combines foods that allow maximum benefit in lowering cholesterol and preventing heart disease. The regimen includes regular consumption of tree nuts and high amounts of fiber from oats, barley and vegetables. The diet says to replace butter with plant sterol-enriched margarine and substitute soy-based products for meat.

"The study highlighted the power of food to lower risk for cardiovascular disease: What you do eat and what you don't eat are both important," said Dr. Jane Klauer, a New York internist specializing in metabolism and nutrition.

While Jenkins said most study participants followed a moderately healthy diet to begin with, it's possible for people to see positive changes in their cholesterol levels even after making small changes to eating regimens.

"Replacing sources of saturated fat, such as red meat and dairy products, with sources of healthy fats, such as nuts and soy products will definitely have greater benefits than replacing red meat and dairy products with carbohydrates," said Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard School of Public Health.

Before suggesting medication, doctors generally encourage high-cholesterol patients to change their diet and lifestyle. If noninvasive measures do not sufficiently lower the levels, they will often prescribe statin drugs, which reduce the production of cholesterol in the liver.

"Diet should be used with drugs to reach LDL and non-HDL cholesterol goals," Dr. Robert Eckel, director of the General Clinic Research Center at Colorado Health Science University, wrote in an email to "The bulk of evidence indicates the importance of fruits and vegetables, whole grains (fiber), lean poultry and fish to reduce cardiovascular disease risk."

"If goals are not reached with lifestyle changes (including appropriate amounts of physical activity), statins are the drug of choice to reduce cardiovascular disease risk," continued Eckel.

The study had only a six-month follow-up, and many experts suggested a longer follow-up period was necessary to understand the long-term effects of the portfolio diet.

Many experts also noted that an herbivorous, or plant-based, diet would be difficult for meat eaters to maintain.

"The diet was vegetarian and, not surprisingly, had dropouts, even with the counseling," said Dr. Merle Myerson, director of the Cardiovascular Disease Prevention Program at St. Luke's and Roosevelt Hospitals. "I don't think that really long-term adherence would be good."

"The authors state that this is 'long-term.' I don't feel that six months is long-term."

"Convincing people to change dietary patterns is difficult, much less convincing them to become vegetarians," said Klauer. "Change is difficult for people. But as they are rewarded with looking and feeling more vital, they are motivated to persevere."

Copyright 2011 ABC News Radio


Combination Cholesterol Drugs Show No Added Heart Benefits

Jupiterimages/Thinkstock(BETHESDA, Md.) -- The combination of statins and niacin, both cholesterol modifying medications, doesn't reduce the chances of having a heart attack, according to findings by the AIM-HIGH trial conducted by the National Heart Lung and Blood Institute, an arm of the National Institutes of Health.

The findings prompted the NHLBI to stop their trial a year and a half early.

The AIM-HIGH study looked at patients who had lowered their LDL, or so-called bad cholesterol, with the help of statins and tried to see if raising HDL, or good cholesterol, by adding niacin to their therapy would additionally reduce the risk of having a heart attack. But the combined therapy of extended release niacin taken with statins showed no benefit in the patients tested.

Previous studies showed that low HDL cholesterol increases the risk of cardiovascular events in men and women, regardless of LDL cholesterol.

"We have had great clinical data that low HDL levels are bad for decades, but there is no evidence that raising HDL levels does anything to reduce the risk," said Dr. Cam Patterson, chief of the division of cardiology at the University Carolina at Chapel Hill.

Still, many cardiologists believe raising HDL reduces the chance of having a heart attack. In fact, the Framingham Cardiac Risk Score, a risk assessment tool used by cardiologists, looks mainly at the HDL score to assess a patient's risk of heart disease. It's unclear which HDL-raising treatments can reduce the risk of heart disease.

Niacin, found over-the-counter and frequently recommended to be taken two to three times daily, blocks the breakdown of HDL while preventing fat cells from releasing LDL. But niacin, also known as vitamin B3, has also been shown to increase the risk of stroke in some patients.

While many experts said they were surprised by the AIM-HIGH findings, some said they wouldn't abandon their longstanding belief in targeting HDL just yet.

In fact, some patients in the control group of the randomized trial may have had a longstanding history of niacin use before they started the study. The entire group of patients studied also had well-controlled LDL levels, which could indicate that their risk of heart disease or heart attack already may be lower compared to those with uncontrolled cholesterol.

Still, many doctors may be too focused on raising HDL without clear evidence of its benefits, according to Dr. Dean Ornish, founder and president of the preventative medicine research institute at the University of California San Francisco.

"There should be less emphasis on raising HDL and more on lowering LDL via diet and lifestyle, and focus on lipid lowering drugs in combination with diet and lifestyle changes to lower LDL, not raise HDL," said Ornish.

Many experts say patients should not stop taking cholesterol-lowering drugs like niacin or statins without talking to their doctor.

Copyright 2011 ABC News Radio

ABC News Radio