New cholesterol-lowering drug 'could halve risk of heart attack, stroke'

Currently, statin therapy is the standard treatment for many patients with high cholesterol. But a new study published in The New England Journal of Medicine claims a drug called evolocumab could be much more effective; it reduced cholesterol levels so dramatically that patients' risk of cardiovascular events - such as heart attack and stroke - fell by more than half, compared with those receiving standard therapy alone.

Around 71 million people in the US have high LDL cholesterol, putting them at increased risk of cardiovascular diseases.

Lead study author Dr. Marc Sabatine, a senior physician at Brigham and Women's Hospital in Boston, MA, and colleagues recently presented their findings at the American College of Cardiology's 64th Annual Scientific Session in San Diego, CA.

The study was a 1-year extension of 12 phase 2 and 3 clinical trials that had assessed evolocumab's ability to reduce levels of low-density lipoprotein (LDL) cholesterol - commonly referred to as "bad" cholesterol because of the role it plays in blocking the arteries

According to the Centers for Disease Control and Prevention (CDC), around 71 million Americans have high LDL cholesterol - blood levels at 160 milligrams per deciliter (mg/dL) or higher. High LDL cholesterol can raise the risk of heart attack, stroke and heart disease.

The 4,465 patients involved in the study had been a part of at least one of the previous trials investigating evolocumab, which works by blocking a protein that stops the liver from removing LDL cholesterol from the blood - called proprotein convertase subtilisin-kexin 9 (PCSK9).

Of the participants, 2,976 were randomized to receive an injection of evolocumab under the skin every 2 or 4 weeks plus standard therapy, while 1,489 patients received standard therapy alone, which mostly involved moderate- or high-intensity statin therapy. The average follow-up duration was 11.1 months.

The study was open-label, meaning the participants were fully aware of the treatment they were receiving, as were the researchers. However, a central committee that reviewed the data - assessing the effects of evolocumab on LDL cholesterol levels and reporting any cardiovascular events during follow-up - was blinded to the treatment groups.

Evolocumab linked to 53% reduction in cardiovascular events

At study baseline, the average LDL cholesterol level among participants was 120 mg/dL, which the researchers say is similar to the average level found among the general population.

However, the team found that patients treated with evolocumab experienced an average 61% reduction in LDL cholesterol levels. Within 12 weeks, LDL cholesterol levels reduced to less than 100 mg/dL - defined as the optimal range - in 90.2% of evolocumab-treated patients, while levels reached 70 mg/dL or less for 73.6% of patients who received the drug. These reductions were sustained throughout the entire follow-up period, the researchers report.

In comparison, only 26% of patients who received standard therapy alone saw their LDL cholesterol levels fall below 100 mg/dL, while only 3.8% had such levels fall below 70 mg/dL.

What is more, compared with patients who received standard therapy alone, those treated with evolocumab experienced a 53% reduction in cardiovascular events, including heart attack, stroke, hospitalization, angioplasty and death; evolocumab-treated patients had a 0.95% risk of a cardiovascular event during follow-up, while standard-therapy patients had a 2.18% risk.

The team says these results remained even after accounting for patients' age, baseline LDL levels, statin use, primary or secondary prevention and incidence of valve disease. Evolocumab was also found to be well tolerated by patients.

However, the researchers admit their study is subject to some limitations. They note, for example, that the number of cardiovascular events in the study was relatively small, with only 60 identified.

Still, the team believes the findings show that not only is evolocumab effective for dramatically reducing cholesterol levels, but it may be effective for rapid risk reduction of cardiovascular events. Dr. Sabatine adds:

"The reduction in LDL was profound and that may be why we saw a marked reduction in cardiovascular events so quickly. It suggests that if we can drive a patient's LDL cholesterol down a large amount to a very low level, we may start to see a benefit sooner than would be expected with a more modest intervention."

The researchers note that because evolocumab works differently to statins - which block an enzyme in the liver that is responsible for making cholesterol - the drug also holds hope for patients who do not respond to statins or who are unable to tolerate them.

Evolocumab is currently undergoing further testing in a clinical trial involving more than 27,500 patients, the results of which are expected in 2017. Though Dr. Sabatine notes that no definitive conclusions about evolocumab's effectiveness can be made until then, this current study shows promise.

"We know from previous research that evolocumab lowers LDL cholesterol, but these data offer support for their potential to reduce major adverse cardiovascular events in our patients," Dr. Sabatine adds.

The study was funded by Amgen - the biopharmaceutical company that manufactures evolocumab.

In January, Medical News Today reported on a study that identified a more natural way to reduce LDL cholesterol: avocados. Published in the Journal of the American Heart Association, the study revealed that eating one avocado a day as part of a moderate-fat diet reduced LDL cholesterol levels by 13.5 mg/dL for participants who were overweight or obese.

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5 Tips To Increase HDL Cholesterol

Thanks to powerful cholesterol-lowering statin drugs, driving down low-density lipoprotein (LDL), or "bad" cholesterol, has been the primary approach to improving cholesterol levels. But there's more to the story of cholesterol and cardiovascular risk than LDL alone. Another key player is high-density lipoprotein (HDL), the "good" cholesterol. Higher levels of HDL are associated with lower cardiovascular risk. The good news about this good cholesterol is that simple lifestyle changes can help boost HDL, reports in issue of Harvard Women's Health Watch.

HDL removes LDL from artery walls and ferries it to the liver for processing or removal. HDL also fights potentially dangerous inflammation and clot formation. According to a recent review of research on HDL, there's some evidence that increasing HDL can reduce the risk of heart attack and stroke even without changes in LDL.

Harvard Women's Health Watch suggests several things people can do to nudge up HDL levels. Most of these strategies also improve health in other ways.

1. Get aerobic exercise. Moderate to vigorous aerobic exercise can boost HDL by 5% to 10%. Aim for five 30-minute sessions per week.

2. Lose weight if you need to. If you're overweight or obese, you can boost your HDL level by about 1 mg/dL for every seven pounds lost, although any amount of weight loss will help.

3. If you smoke, quit. HDL levels rise by as much as 15% to 20% after you quit.

4. Eat a healthy diet. Avoid trans fats, which increase bad cholesterol and decrease good cholesterol. Avoid highly refined carbohydrates, such as white-flour products.

5. Consider medications. Niacin, available over the counter, is the most effective HDL-raising medication available. Niacin can be strong medicine work with your clinician if you want to try it.

Harvard Women's Health Watch
Harvard Health Publications Harvard Medical School 10 Shattuck St., Ste. 612
Cambridge, MA 02115
United States
http://www.health.harvard.edu

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'Tredaptive'® (Nicotinic Acid/Laropiprant) Authorised In The European Union: New Lipid-Modifying Therapy To Treat LDL-C, HDL-C And Triglycerides

Merck Sharp & Dohme Limited (MSD) announced recently that 'Tredaptive' (nicotinic acid/laropiprant) 1000 mg/20 mg modified-release tablets, a new lipid-modifying therapy for patients with dyslipidaemia and primary hypercholesterolaemia, has been authorised for marketing in the 27 member countries of the European Union (EU) and Iceland and Norway.1

'Tredaptive' combines nicotinic acid (niacin) and laropiprant, a novel flushing pathway inhibitor. Clinical studies have shown nicotinic acid/laropiprant to reduce LDL- cholesterol (LDL-C, or "bad" cholesterol) levels, raise HDL-cholesterol (HDL-C, or "good" cholesterol) and decrease triglycerides (a type of fat in the blood).1 High LDL-C, low HDL-C and elevated triglycerides are risk factors associated with heart attacks and strokes.2,3,4

Professor Ian Young, Consultant in Clinical Biochemistry, Queen's University, Belfast comments, "Lowering LDL-C is the cornerstone of lipid management but a number of studies indicate triglycerides and HDL also have a key role in cardiovascular disease risk. The JBS 2 guidelines recommend that HDL-C and triglyceride values should also be considered in overall lipid management and other lipid lowering drugs should be considered in addition to a statin if cholesterol targets have not been achieved or other lipid parameters need to be addressed. Nicotinic acid/laropiprant can address these key cardiovascular risk factors and therefore could be an important treatment option in combination with statins, when statin monotherapy alone is inadequate, particularly for high risk patients."

Nicotinic acid/laropiprant is indicated for the treatment of dyslipidaemia, particularly in patients with combined mixed dyslipidaemia (characterised by elevated levels of LDL-C and triglycerides and low HDL-C) and in patients with primary hypercholesterolaemia (heterozygous familial and non-familial).1

Nicotinic acid/laropiprant should be used in patients in combination with statins, when the cholesterol lowering effects of statin monotherapy is inadequate. It can be used as monotherapy only in patients in whom statins are considered inappropriate or not tolerated. Diet and other non-pharmacological treatments (e.g. exercise, weight reduction) should be continued during therapy.1

"The approval of nicotinic acid/laropiprant in the European Union further reinforces our long- standing commitment to the cardiovascular area by bringing novel and innovative therapies to patients. The product provides comprehensive management of all three lipid parameters - LDL-C, HDL-C and triglycerides - for many patients," said Stefan Oschmann, President, MSD, Europe, Middle East, Africa and Canada.


Nicotinic acid/laropiprant provided significant improvements in LDL-C, HDL-C and triglycerides

When added to ongoing statin therapy or alone, nicotinic acid/laropiprant 2000 mg/40 mg provided significant improvements in LDL-C, HDL-C and triglycerides when administered for a 24 week period. Nicotinic acid/laropiprant 1000 mg/20 mg daily tablet was initiated at the study start; at week 4 the daily dose was advanced to the maintenance dose of 2000 mg/40 mg (2 x 1000 mg/20 mg tablets) through the remaining 20 weeks of the study. Across weeks 12 to 24 of the study, placebo adjusted results showed that nicotinic acid/laropiprant significantly reduced LDL-C levels (-18 percent), increased HDL-C levels (20 percent) and reduced triglyceride levels (-25 percent).1

When nicotinic acid/laropiprant was co-administered with simvastatin (data pooled across 1000 mg/20 mg or 2000 mg/40 mg doses) LDL-C was reduced by 48 percent, HDL-C increased by 28 percent and triglycerides were reduced by 33 percent following 12 weeks of treatment.1

Flushing with nicotinic acid/laropiprant (modified-release tablet) was significantly less than with nicotinic acid (prolonged release formulation)

In clinical studies, patients taking nicotinic acid/laropiprant (modified-release tablet) experienced significantly less moderate-to-extreme flushing than with nicotinic acid (prolonged release formulation). Patients were initiated on either 1000 mg/20 mg of nicotinic acid/laropiprant or 1000 mg of nicotinic acid or placebo. After 4 weeks, patients were advanced to 2000 mg/40 mg or 2000 mg respectively.1

In patients who continued treatment with nicotinic acid/laropiprant after the dose advancement the weekly frequency of moderate or greater flushing decreased and approached that of patients receiving placebo. In patients treated with nicotinic acid alone, the weekly flushing frequency remained constant (after week 6).1

Fewer discontinuation rates due to flushing with nicotinic acid/laropiprant

In a pool of four active- or placebo-controlled clinical trials of more than 4,700 patients the percentage of patients taking nicotinic acid/laropiprant who discontinued due to any flushing related symptom was 7.2 percent compared to 16.6 percent for the pooled nicotinic acid (prolonged release formulation) alone groups.5

Important information about nicotinic acid/laropiprant

Nicotinic acid/laropiprant is generally well tolerated.5 Flushing is the most common side-effect and is most prominent in the head, neck and upper torso. Additional common clinical adverse reactions (≥ 1 percent to < 10 percent) reported by the investigators as possibly, probably, or definitely related to the product in ≥ 1 percent of patients treated with nicotinic acid acid/laropiprant alone or co-administered with a statin for up to one year included elevations in ALT or AST (consecutive ≥ 3X ULN), fasting glucose, uric acid, dizziness, headache, paraesthesia (a feeling of numbness, tingling, pricking, or burning of the skin), diarrhoea, dyspepsia, nausea, vomiting, erythema (redness of the skin), pruritus (itching), rash, urticaria and feeling hot.1

Nicotinic acid medicinal products have been associated with increases in fasting blood glucose levels.1,5 Diabetic or potentially diabetic patients should be observed closely. Adjustment of diet and/or hypoglycaemic therapy may be necessary.1

As with other nicotinic acid products, nicotinic acid/laropiprant is contra-indicated in patients with significant or unexplained hepatic dysfunction and should be used in caution in those with renal impairment.1

Notes

Impact of three major lipids on cardiovascular risk factors

Cardiovascular disease (CVD) is a general term referring to diseases that affect the heart or blood vessels. Coronary heart disease (CHD), also known as coronary artery disease (CAD), is one of the most common forms of CVD and is the leading cause of death globally.6 Major risk factors for CVD include abnormal blood lipids, meaning not only high LDL-C but also high levels of triglycerides and low levels of HDL-C.7,8

CVD is the main cause of death in Europe, accounting for over 4.3 million deaths (48% of all mortality).9 It is also the UK's number one killer with more than one in three people dying from a heart attack or stroke.10 Coronary Heart Disease by itself is the most common cause of death in the U.K. accounting for 101,000 deaths per year.10

About Merck Sharp & Dohme

Merck Sharp & Dohme Limited (MSD) is the UK subsidiary of Merck & Co., Inc., of Whitehouse Station, New Jersey, USA, a leading research-based pharmaceutical company that discovers, develops, manufactures and markets a wide range of innovative pharmaceutical products to improve human health.

Forward-Looking Statement

This press release contains "forward-looking statements" about product development, product potential or about financial performance based on current expectations of the management of Merck & Co., Inc. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. Merck & Co., Inc. undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise.

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Taurine May Help Women's Hearts

Amino Acid Found in Dark Meat Poultry, Fish May Protect Women With High Cholesterol, Study Suggests

Taurine, an amino acid found in dark meat poultry and other foods, may be good for some people's hearts, according to a new study.
"People with high cholesterol may have a reduced risk of coronary heart disease if they have a high level of taurine in their diet," says researcher Yu Chen, PhD, MPH, associate professor of epidemiology at the NYU Langone Medical Center in New York.
Her research looked only at women. However, she suspects the same benefit may be found for men.
The study was small. Much more research is needed, Chen tells WebMD. Her study is published online in the European Journal of Nutrition.
The American Heart Association and the National Institutes of Health funded the study.

Taurine and Heart Disease Risk: Study Details

There hasn’t been a lot of research on taurine, Chen tells WebMD. The nutrient is found in dark meat turkey and chicken. It is also in some seafood, including white fish, mussels, and clams, she says.
It's also found in energy drinks. Some think it can improve athletic performance, although in a release Chen says the taurine in drinks is man-made and is in unstudied amounts. The taurine in her study is from natural sources.
Animal studies of taurine have found it is involved in many body processes such as blood pressure regulation. It has been found to have antioxidant properties.
Chen looked at data and blood samples collected from the NYU Women's Health Study. This study enrolled more than 14,000 women ages 34 to 65 between 1985 and 1991.
For this study, Chen compared blood samples and diet information from 223 women who developed heart disease or died from it during the study follow-up from 1986 to 2006.
The researchers compared these blood samples to those of 223 others who didn't get heart disease.
They divided the women into three groups, from lowest to highest taurine in their blood.
Overall, the reduction in heart disease risk was not substantial for those in the highest group compared to the lowest.
However, Chen did find a benefit when she looked only at those women who had high total cholesterol, over 250 mg/dL. (Under 200 is considered normal.)
Among those with high cholesterol, those with the highest blood levels of taurine had a lower risk of heart disease.
"Among women with high cholesterol, those with high taurine experienced a 60% reduction in coronary heart disease," she says.
Chen can't say how much or which foods to eat to get those blood levels.
Exactly why the taurine is linked with lower heart disease is not known. She says it could be due to taurine's anti-inflammatory and antioxidant properties.
Eventually, those at risk of heart disease due to high cholesterol may be given a diet prescription in addition to medicine, Chen says.
However, she found an association, not cause and effect.

Taurine and Heart Disease Risk: Perspective

Taurine is gathering research interest, says Paramjit Tappia, PhD, a clinical research scientist at St. Boniface Hospital Research Centre at the University of Manitoba.

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High Cholesterol Risks: Top 2 Dangers

There are usually no symptoms of high-risk cholesterol, yet the dangers are very real -- even fatal.

A lot of people don't take the risks of high cholesterol very seriously. After all, one out of six people have high cholesterol. A staggering 50% of Americans have levels above the suggested limit. Could something so common really be a serious health risk?
Unfortunately, yes. Cholesterol is a direct contributor to cardiovascular disease, which can lead to strokes and heart attacks.

"Despite all of the amazing medicines and treatments we have, cardiovascular disease is still the number one cause of death and illness in our society," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga.
The World Health Organization estimates that almost 20% of all strokes and over 50% of all heart attacks can be linked to high cholesterol.
But if you've been diagnosed with high cholesterol, don't despair. The good news is that high cholesterol is one risk factor for strokes and heart attacks that you can change. You just need to take action now, before your high cholesterol results in more serious disease.

All About High-Risk Cholesterol Numbers

When it comes to high cholesterol risks, it's tough to keep the details straight. We might have a vague idea of whether our cholesterol is "good" or "bad," but we forget the actual numbers by the time we get to the parking lot outside our doctor's office. So it may be worth reviewing the basics.
Cholesterol is a fat-like substance circulating in your blood. Some of your cholesterol comes from the foods you eat. But the bulk of it is actually made in your own body, specifically in the liver. Cholesterol does have some good uses. It is needed to make some hormones and it is important for the function of our cells. But an excess of it in the bloodstream can lead to trouble.
Cholesterol comes in several different forms, but doctors focus mostly on two: LDL cholesterol and HDL cholesterol.

• LDL is also called "bad cholesterol" -- Sperling suggests that you think of the "L" as standing for lousy. LDL cholesterol can clog your arteries, increasing the risk of heart attack and stroke. Most people should aim for a level of less than 100 mg/dL. However, people who already have heart disease may need to aim for under 70 mg/dL.
• HDL is "good cholesterol." Imagine the "H" stands for healthy, Sperling suggests. This type of cholesterol attaches to bad cholesterol and brings it to the liver, where it's filtered out of the body. So HDL cholesterol reduces the amount of bad cholesterol in your system. You should aim for 60 mg/dL or higher.
• Triglycerides are not cholesterol but another type of fat floating in your blood. Just as with bad cholesterol, having a high level of triglycerides increases your risk of cardiovascular problems. Aim for a fasting level of less than 150 mg/dL.

So although we all talk about high cholesterol risks, the term is a little misleading. What we really mean is high levels of bad LDL cholesterol and triglycerides and a low level of good HDL cholesterol.
What about total cholesterol? Although anything under 200 mg/dL is still considered the target, most experts don't focus on the number. It doesn't mean all that much. Someone can have a total cholesterol of under 200 -- which is lower than average for Americans -- but still have unhealthy levels of HDL or LDL, Sperling says. The average level for American adults is 200 mg/dL.  

Realizing the Risks: How Harmful Is High Cholesterol?

Everyone has cholesterol in their blood. But if your levels of LDL are too high, the excess can accumulate on the walls of your arteries. This build-up of cholesterol and other substances -- called plaque -- can narrow the artery like a clogged drain. It can also lead to arteriosclerosis, or hardening of the arteries, which turns the normally flexible tissue into more brittle.

Plaques can form anywhere. If they form in the carotid artery in the neck, it's carotid artery disease. When they form in the coronary arteries -- which supply the heart muscle with blood -- it's called coronary artery disease. Like any organ, the heart needs a good supply of blood to work. If it doesn't get that blood, you could get angina, which causes a squeezing pain in the chest and other symptoms.

There are other high cholesterol risks. If these plaques break open, they can form a clot. If a clot lodges in an artery and completely chokes off the blood supply, the cells don't get the nutrients and oxygen they need and die.

If a clot gets to the brain and blocks blood flow, it can cause a stroke. If a clot lodges in the coronary arteries, it can cause a heart attack.

Do We Underestimate High Cholesterol Risks?

The risks of high cholesterol are quite clear. "If you look at populations of people," says Sperling, "the higher the cholesterol, the higher the level of heart and blood vessel disease." It's that simple.

But experts say that people don't take high cholesterol risks seriously enough. According to 2007 figures from the CDC, 21.5% of American adults said they had never had their cholesterol checked.

One problem is that high cholesterol doesn't cause symptoms that make people pay attention.

"People naturally respond more to medical conditions that cause symptoms," says Nathan D. Wong, PhD, fellow of the American College of Cardiology and director of the Heart Disease Prevention Program at the University of California, Irvine. Since you won't feel your rising cholesterol levels, you won't go to the doctor about it.

By the same token, people may be less likely to stick to treatment for high cholesterol than they would be for a painful condition.

"People on cholesterol-lowering medicine don't feel any better," says Sperling. "It's not like taking a painkiller for an aching knee, where you know it's working." As a result, people may be less likely to follow their treatment plan over the long-term, Sperling says.

Also, high cholesterol risks are usually not immediate. The damage accumulates over years and decades -- high cholesterol in your 20s and 30s can take its toll in your 50s and 60s. Because the effects take time, many people don't feel real urgency in treating it. They feel they can just deal with it later.

"Unfortunately, I think that many people are too casual about their high cholesterol," says Adolph Hutter, MD, a cardiologist at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. "They ignore it for years and it only gets their attention when they actually develop vascular disease."

Taking Action to Lower High Cholesterol Risks

There are many good treatments for heart disease, arteriosclerosis, and other serious conditions caused by high cholesterol. But it's a terrible shame to let things get that far when making changes now could prevent these life-threatening illnesses. Reducing your high cholesterol risks is a crucial step.

So what should you do? First, go to the doctor. "It's very important for all adults to get their cholesterol tested," says Wong. The American Heart Association recommends that every adult 20 years and older have a fasting cholesterol test at least once every five years.

Also, keep track of your cholesterol levels yourself. Write down your current numbers and, if they're high, what numbers you should be striving for.

If you do have high cholesterol, get serious. Talk with your doctor about what your goals should be and how you should achieve them. Make sure you understand what lifestyle changes you need to make. If you already have heart disease or other risk factors like diabetes, you need to be even more careful.

Whatever you do, don't ignore your high cholesterol risks. Don't put off treatment for another year.

"Having high cholesterol may not hurt you today or tomorrow," says Sperling. "But if you don't do something about it, it can have a terrible cost down the road."

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Alternative Treatments for High Cholesterol

There are alternative treatments for lowering cholesterol naturally. But before you add any supplement or alternative therapy to your diet, talk to your doctor. Some supplements may interact with other medication you may be taking or have dangerous side effects.

Supplements for Lowering Cholesterol

Some of the herbal and nutritional supplements said to lower cholesterol include:

• Garlic: According to some studies, garlic may decrease blood levels of total cholesterol by a few percentage points. Other studies, however, suggest that it may not be as beneficial as once thought. It may also have significant side effects and/or interactions with certain medications. Garlic may prolong bleeding and blood clotting time, so garlic and garlic supplements should not be consumed prior to surgery and should not be taken with blood-thinning drugs such as Coumadin (warfarin).
• Guggulipid: Guggulipid is the gum resin of the mukul myrrh tree. In clinical studies performed in India, guggulipid significantly reduced blood levels of total cholesterol and LDL cholesterol. The enthusiasm for using guggulipid as a cholesterol-lowering herbal agent, however, diminished after the publication of negative results from a clinical trial in the U.S. Further research is necessary to determine the safety and efficacy of this herb.
• Red Yeast Rice: Red yeast rice has been found to lower cholesterol in studies and was previously found in the over-the-counter supplement Cholestin. However, in 2001, FDA took Cholestin off the shelf because it contained lovastatin, a compound found in the cholesterol prescription medication Mevacor. Reformulated "Cholestin" no longer contains red yeast rice. Other red yeast rice-containing supplements currently available in U.S. contain very small amounts of lovastatin. Their effectiveness is questionable.
• Policosanol: Produced from sugar cane, policosanol was found to be effective in lowering LDL cholesterol in several trials. Most policosanol supplements found in the U.S., including the reformulated Cholestin, contain policosanol extracted from beeswax and not the sugar cane policosanol. There is no evidence that policosanol extracted from beeswax can lower cholesterol. Additional studies on sugar cane policosanol are needed to determine its effectiveness in lowering cholesterol.
• Other herbal products: The results of several studies suggest fenugreek seeds and leaves, artichoke leaf extract, yarrow, and holy basil all may help lower cholesterol. These and other commonly used herbs and spices -- including ginger, turmeric, and rosemary -- are being investigated for their potential beneficial effects relating to coronary disease prevention.

Dietary Approaches to Lowering Cholesterol

Increased consumption of dietary fiber, soy foods, and plant compounds similar to cholesterol (plant stanols and sterols) can significantly reduce LDL cholesterol, or bad cholesterol.

• Fiber: Only plant foods (vegetables, fruits, legumes, unrefined grains) contain dietary fiber. The soluble fiber found in foods such as oat bran, barley, psyllium seeds, flax seed meal, apples, citrus fruits, lentils and beans are particularly effective in lowering cholesterol.
• Soybeans: Substituting soybeans or soy protein for other proteins have been shown to prevent coronary heart disease by lowering LDL cholesterol and triglycerides. Soy protein is present in tofu, tempeh, soy milk, soy yogurt, edamame, soy nuts, and many other food products made from soybeans.
• Phytosterols: Phytosterols (plant sterol and stanol esters) are compounds found in small amounts in foods such as whole grains as well as in many vegetables, fruits, and vegetable oils. They decrease LDL cholesterol, mostly by interfering with the intestinal absorption of cholesterol. Phytosterols can be found in spreads (like the cholesterol-lowering margarines Benecol, Promise, Smart Balance, and Take Control), dressings for salads, and dietary supplements. Additional phytosterol-fortified foods include Minute Maid Heart Wise orange juice, Nature Valley Healthy Heart chewy granola bars, CocoVia chocolates, Rice Dream Heartwise rice drink, and Lifetime low-fat cheese.

Dietary fiber, soybeans, and phytosterols decrease cholesterol levels by different mechanisms. Therefore, it is not surprising that the combined dietary intake of these foods and other plant substances, along with a low intake of saturated fats, is more effective at reducing cholesterol levels than each individual substance alone.
Including foods rich in omega-3 fatty acids in your diet may also help lower cholesterol. Aim for at least two servings of fatty fish like salmon, mackerel, herring, tuna, and sardines per week. Other dietary sources of omega-3 fatty acids include flax seed and walnuts.

• Omega-3 fatty acids: These essential fatty acids have a favorable effect on cholesterol. Supplement sources include fish oil capsules, flaxseed and flax seed oil. Omega-3 fatty acids decrease the rate at which the liver produces LDL cholesterol and triglycerides. They have an anti-inflammatory effect in the body, decrease the growth of plaque in the arteries, and aid in thinning blood. If you are considering taking omega-3 fatty acids, you should first discuss with your doctor if omega-3 fatty acid supplements are right for you (especially if you are currently taking blood-thinning medication).

Avoid partially hydrogenated and hydrogenated vegetable oils. These man-made oils are sources of trans fatty acids known to increase LDL cholesterol. They lower heart-protecting HDL (good) cholesterol and increase the inflammatory response in the body. You can now find trans fats listed on the Nutrition Facts panel of packaged foods. Minimize consumption of trans fatty acid-containing food.

If a plant-based, low-fat diet alone is not effective at reducing cholesterol levels, such a diet should be combined with cholesterol-lowering medications.

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High Cholesterol: Cholesterol-Lowering Medication

Sometimes cholesterol medication is recommended in addition to a low-saturated fat, low-refined carbohydrate, and high-fiber diet to lower cholesterol.
Cholesterol is an important part of your cells and also serves as the building block of some hormones. The liver makes all the cholesterol the body needs. But cholesterol also enters your body from dietary sources, such as animal-based foods like milk, eggs, and meat. Too much cholesterol in your blood can increase the risk of coronary artery disease.
The first line of treatment for abnormal cholesterol is usually to eat a diet low in saturated and trans fats, and high in fruits and vegetables, nuts, and seeds, and to increase exercise. But for some, these changes alone are not enough to lower blood cholesterol levels. These people may need medicine, in addition to making lifestyle changes, to bring their cholesterol down to a safe level.
Cholesterol-lowering drugs include:

• Statins
• Niacin
• Bile-acid resins
• Fibric acid derivatives
• Cholesterol absorption inhibitors

Cholesterol-lowering medicine is most effective when combined with a healthy diet and exercise.

How Do Statins Work?

Statins block the production of cholesterol in the liver itself. They lower LDL, the "bad" cholesterol, and triglycerides, and have a mild effect in raising HDL, the "good" cholesterol. These drugs are the first line of treatment for most people with high cholesterol. Side effects can include intestinal problems, liver damage, and in a few people, muscle tenderness.  Statins have been shown in multiple research studies to reduce the risk of cardiovascular events like heart attacks and death from heart disease.
Examples of statins include:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Simvastatin (Zocor)
• Rosuvastatin (Crestor)

How Does Nicotinic Acid Work?

Nicotinic acid is a B-complex vitamin. It's found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. The main side effects are flushing, itching, tingling and headache. A recent research study suggested that adding nicotinic acid to statin therapy was not associated with a lower risk of heart disease. Examples of nicotinic acid medication include:

• Nicolar and Niaspan

How Do Bile Acid Resins Work?

These drugs work inside the intestine, where they bind to bile from the liver and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by depleting the body's supply of cholesterol. The most common side effects are constipation, gas and upset stomach. Examples of bile acid resins include:

• Questran and Questran Light
• Colestid
• WelChol

How Do Fibrates Work?

Fibrates reduce the production of triglycerides and can increase HDL cholesterol. Examples of fibrates include:

• Atromid
• Tricor
• Lopid

Ezetimibe lowers bad LDL cholesterol by blocking cholesterol absorption in the intestine. Research studies have not found that ezetimibe is associated with a lower risk of heart disease.

What Are the Side Effects of Cholesterol-Lowering Drugs?

The side effects of cholesterol-lowering drugs may include:

• Muscle aches*
• Abnormal liver function
• Allergic reaction (skin rashes)
• Heartburn
• Dizziness
• Abdominal pain
• Constipation
• Decreased sexual desire
• Flushing with nicotinic acid

*If you have muscle aches, call your doctor immediately. This could be a sign of a life-threatening condition.

Are There Foods or Other Drugs I Should Avoid While Taking Cholesterol-Lowering Medicine?

You should limit grapefruit juice and fresh grapefruit consumption while taking statins, as grapefruit can interfere with the liver's ability to metabolize these medications. Talk with your doctor about your other medications, as it may be appropriate to adjust the dosing of your cholesterol medication depending on interactions.

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New Warnings on Cholesterol-Lowering Statins

Memory loss, confusion, high blood sugar, and type 2 diabetes are possible side effects of the popular cholesterol-lowering drugs known as statins, the FDA warns.

Brand name and generic versions of statin drugs must carry these warnings on their labels, the FDA today announced.

The products include: Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Altoprev (lovastatin extended-release), Livalo (pitavastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin). Combination products include: Advicor (lovastatin/niacin extended-release), Simcor (simvastatin/niacin extended-release), and Vytorin (simvastatin/ezetimibe).

"We want health care professionals and patients to have the most current information on the risks of statins, but also to assure them that these medications continue to provide an important health benefit of lowering cholesterol," Mary Parks, MD, director of the FDA's Division of Metabolism and Endocrinology Products, said in a news release.
The new labels will warn patients about:

• Memory loss and mental confusion. Some people taking statin drugs have experienced these brain-related effects. These effects usually have not been serious and went away when patients stopped using the drugs.
• Risk of high blood sugar.
• Risk of being diagnosed with type 2 diabetes.

There will also be a change in the current recommendation that patients on statins get routine liver tests. Those tests now will be needed only before starting statin treatment and then only as needed.
One statin drug, Mevacor, has been singled out for a special new warning. All statin drugs carry a small but serious risk of muscle injury. But this risk is particularly high for patients taking Mevacor and certain other drugs, including the protease inhibitor class of HIV drugs and some antibiotic and antifungal medications.

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Heart Disease: Exercise for a Healthy Heart

A sedentary (inactive) lifestyle is one of the top risk factors for heart disease. Fortunately, it's a risk factor that you can do something about. Regular exercise, especially aerobic exercise, has many benefits. It can:

• Strengthen your heart and cardiovascular system.
• Improve your circulation and help your body use oxygen better.
• Improve your symptoms of congestive heart failure.
• Increase energy levels so you can do more activities without becoming tired or short of breath.
• Increase endurance.
• Lower blood pressure.
• Improve muscle tone and strength.
• Improve balance and joint flexibility.
• Strengthen bones.
• Help reduce body fat and help you reach a healthy weight.
• Help reduce stress, tension, anxiety, and depression.
• Boost self-image and self-esteem.
• Improve sleep.
• Make you feel more relaxed and rested.
• Make you look fit and feel healthy.

How Do I Get Started?

Always check with your doctor first before starting an exercise program. Your doctor can help you find a program that matches your level of fitness and physical condition. Here are some questions to ask:

• How much exercise can I do each day?
• How often can I exercise each week?
• What type of exercise should I do?
• What type of activities should I avoid?
• Should I take my medication(s) at a certain time around my exercise schedule?
• Do I have to take my pulse while exercising?

What Type of Exercise Is Best?

Exercise can be divided into two basic types:

• Cardiovascular or aerobic is steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the body's ability to use oxygen. Aerobic exercise has the most benefits for your heart. Over time, aerobic exercise can help decrease your heart rate and blood pressure and improve your breathing (since your heart won't have to work as hard during exercise).
• Strengthening exercises are repeated muscle contractions (tightening).

What Are Examples of Aerobic Exercises?

Aerobic exercises include: walking, jogging, jumping rope, bicycling, skiing, skating, rowing, and aerobics.

How Often Should I Exercise?

In general, to achieve maximum benefits, you should gradually work up to an aerobic session of at least  20 to 30 minutes, at least three to four times a week. Exercising every other day will help you start a regular aerobic exercise schedule. The American Heart Association recommends working up to exercising on most days of the week. While the more exercise you can do the better, any amount of exercise is beneficial to your health.

What Should I Include in My Program?

Every exercise session should include a warm-up, conditioning phase and a cool-down.

• Warm-up. This helps your body adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles, slowly increases your breathing, circulation (heart rate) and body temperature. It also helps improve flexibility and reduce muscle soreness. The best warm-up includes dynamic stretching (as compared to the “touch your toes” stretches you did in high school) and the beginning of the activity at a low intensity level.
• Conditioning. This follows the warm-up. During the conditioning phase, the benefits of exercise are gained and calories are burned. If you experience chest pain, significant breathlessness, or dizziness, you should stop exercising and let your doctor know about your symptoms.
• Cool-down. This is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean sit down! In fact, do not sit, stand still or lie down right after exercise. This may cause you to feel dizzy or lightheaded or have heart palpitations (fluttering in your chest). The best cool-down is to slowly decrease the intensity of your activity.

What Is the Rated Perceived Exertion Scale?

The Rated Perceived Exertion (RPE) scale is used to measure the intensity of your exercise. The RPE scale runs from 0-10. The numbers below relate to phrases used to rate how easy or difficult you find an activity. For example, 0 (nothing at all) would be how you feel when sitting in a chair; 10 (very, very heavy) would be how you feel at the end of an exercise stress test or after a very difficult activity.

Rated Perceived Exertion (RPE) scale
0	Nothing at all
0.5	Just noticeable
1	Very light
2	Light
3	Moderate
4	Somewhat heavy
5-6	Heavy
7-9	Very heavy
10	Very, very heavy

When starting an exercise program, you should exercise at a level that feels 3 (moderate) to 4 (somewhat heavy). When using this rating scale, remember to include feelings of shortness of breath, as well as how tired you feel in your legs and overall.

Exercise while sitting

While performing these exercises, maintain good posture. Keep your back straight; do not curve or slump your back. Make sure your movements are controlled and slow. Avoid quick, jerking movements. Do not bounce. Do not hold your breath during these exercises.

• Ankle pumping. Sit on the floor with your feet straight out in front of you. Keeping your heels on the floor, lift your toes up as far as you can. Hold for a count of five.
• Knee straightening. Raise your foot to fully straighten your knee out in front of you. Hold for a count of five. Lower your foot to the floor. Repeat on other side.
• Hip bending. Lift one knee up toward the ceiling. As you lower this knee, raise your other knee. Alternate each leg as if you were marching in place (while sitting.)
• Overhead reaching. Raise one arm straight over your head, with your palm facing away from you. Keep your elbow straight. Slowly lower your arm to your side. Repeat with other arm.
• Shoulder touching. Sit with your arms at your sides and your palms facing up. Bend your elbows until your hands are touching your shoulders. Lower your hands to your sides.
• Single arm lifts. Sit with your arms at your sides, fingers pointing toward the floor. Raise one arm out to your side, keeping your elbow straight and your palm facing down. Slowly lower your arm to your side. Repeat with your other arm.
• Shoulder shrugs. Keeping your back straight, lift your shoulders up and forward toward your ears. Release your shoulders down and back in a smooth circular motion.
• Arm circles. Sit with your arms at your sides, fingers pointing toward the floor. Raise both arms out from your sides (about 1 or 2 feet from your body). Keeping your elbows straight and your palms facing toward you, rotate your arms in small circles.
• Single shoulder circles. Bending one elbow, put your fingertips on your shoulder. Rotate your shoulder and elbow clockwise, then counter clockwise. Repeat with each arm.

How Can I Avoid Overdoing It?

Here are a few guidelines:

• Gradually increase your activity level, especially if you have not been exercising regularly.
• Wait at least one hour after eating a meal before exercising.
• When drinking liquids during exercise, remember to consider any fluid restriction guidelines.
• Exercise at a steady pace. Keep a pace that allows you to talk during the activity.
• Keep an exercise record.

How Can I Stick With It?

• Have fun! Choose an activity that you enjoy. You'll be more likely to stick with an exercise program if you enjoy the activity. Add variety. Develop a group of several different activities to do on alternate days that you can enjoy. Use music to keep you entertained. Here are some questions you can think about before choosing a routine:
• What physical activities do I enjoy?
• Do I prefer group or individual activities?
• What programs best fit my schedule?
• Do I have physical conditions that limit my choice of exercise?
• What goals do I have in mind? (For example, losing weight, strengthening muscles or improving flexibility.)
• Schedule exercise into your daily routine. Plan to exercise at the same time every day (such as in the mornings when you have more energy). Add a variety of exercises so that you do not get bored. If you exercise regularly, it will soon become part of your lifestyle.
• Find an exercise "buddy." This will help you stay motivated.

Also, exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you are certain you will use them regularly.

General Workout Tips for People With Heart Failure

• Be sure any exercise is paced and balanced with rest.
• Avoid isometric exercises such as push-ups and sit-ups. Isometric exercises involve straining muscles against other muscles or an immovable object.
• Don't exercise outdoors when it is too cold, hot, or humid. High humidity may cause you to tire more quickly; extreme temperatures can interfere with circulation, make breathing difficult, and cause chest pain. Better choices are indoor activities such as mall walking.
• Make sure you stay hydrated. It is important to drink water even before you feel thirsty, especially on hot days. But, be careful not to drink too much water. Follow your doctor's guidelines about how much fluid you can have in a day.
• Extremely hot and cold showers or sauna baths should be avoided after exercise. These extreme temperatures increase the workload on the heart.
• Steer clear of exercise in hilly areas unless you have discussed it with your doctor. If you must walk in steep areas, make sure you slow down when going uphill to avoid working too hard.
• If your exercise program has been interrupted for more than a few days (for example, due to illness, vacation, or bad weather), make sure you ease back into the routine. Start with a reduced level of activity, and gradually increase it until you are back where you started.

Exercise Precautions

There are many precautions you must keep in mind when developing an exercise program. Here are some tips.

• Stop the exercise if you become overly fatigued or develop chest pain or shortness of breath; discuss the symptoms with your doctor or schedule an appointment for evaluation.
• Do not exercise if you are not feeling well or have a fever. You should wait a few days after all symptoms disappear before restarting the exercise program, unless your doctor gives other directions.
• If you experience shortness of breath or increased fatigue during any activity, slow down or stop the activity. Elevate your feet when resting. If you continue to have shortness of breath, call your doctor. The doctor may make changes in medications, diet, or fluid restrictions.
• Stop the activity if you develop a rapid or irregular heartbeat or have heart palpitations. Check your pulse after you have rested for 15 minutes. If it's still above 120 beats per minute, call the doctor for further instructions.

If you experience pain:

• Don't ignore it. If you have chest pain or pain anywhere else in the body, do not allow the activity to continue. Performing an activity while in pain may cause stress or damage to the joints.

Warning

Stop exercising and call your doctor if you have any of the following symptoms:

• Chest pain
• Weakness
• Dizziness or lightheadedness
• Unexplained weight gain or swelling
• Pressure or pain in your chest, neck, arm, jaw, or shoulder or any other symptoms that cause concern.

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Tips for Good Cholesterol

Understanding Cholesterol Numbers

Cholesterol levels should be measured at least once every five years in everyone over the age of 20. The screening test that is usually performed is a blood test called a lipid profile. Experts recommend that men aged 35 and older and women aged 45 and older be more frequently screened for lipid disorders. The lipoprotein profile includes:

• LDL (low-density lipoprotein cholesterol, also called "bad" cholesterol)
• HDL (high-density lipoprotein cholesterol, also called "good" cholesterol)
• Triglycerides (fats carried in the blood from the food we eat. Excess calories, alcohol, or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.)

Results of your blood test will come in the forms of numbers. Here is how to interpret your cholesterol numbers:

LDL Cholesterol

LDL cholesterol can build up on the walls of your arteries and increase your chances of getting heart disease. That is why LDL cholesterol is referred to as "bad" cholesterol. The lower your LDL cholesterol number, the lower your risk. The table below explains what the numbers mean.

LDL Cholesterol	LDL-Cholesterol Category
Less than 100	Optimal
100 - 129	Near optimal/above optimal
130 - 159	Borderline high
160 - 189	High
190 and above	Very high

If you have heart disease or blood vessel disease, some experts recommend that you should try to get your LDL cholesterol below 70. For people with diabetes or other multiple risk factors for heart disease, the treatment goal is to reach an LDL of less than 100, although some physicians will be more aggressive.

HDL Cholesterol

When it comes to HDL cholesterol -- "good" cholesterol -- the higher the number, the lower your risk. This is because HDL cholesterol protects against heart disease by taking the "bad" cholesterol out of your blood and keeping it from building up in your arteries. The table below explains what the numbers mean.

HDL Cholesterol	HDL-Cholesterol Category
60 and above	High; Optimal; associated with lower risk
Less than 40 in men and less than 50 in women	Low; considered a risk factor for heart disease

Triglycerides

Triglycerides are the chemical form in which most fat exists in food and the body. A high triglyceride level has been linked to higher risk of coronary artery disease. Here's the breakdown.

Triglycerides	Triglyceride Category
Less than 150	Normal
150 - 199	Mildly High
200 - 499	High
500 or higher	Very high

Total Cholesterol

Your total blood cholesterol is a measure of LDL cholesterol, HDL cholesterol, and other lipid components. Doctors recommend total cholesterol levels below 200

Total Cholesterol	Category
Less than 200	Desirable
200 - 239	Mildly High
240 and above	High

 

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High Cholesterol: Heart-Healthy Diet

Learn how to eat a heart-healthy diet to help reduce your risk of heart disease.

By paying close attention to what you eat you can reduce your risk for heart disease and stroke. Although this is very important for everyone at risk for heart disease, it is even more important if you have had a heart attack and/or history of atherosclerosis (buildup of plaque in the arteries).

Feed Your Heart Well

Feeding your heart well is a powerful way to reduce or even eliminate some risk factors. Adopting a heart-healthy diet can help reduce LDL cholesterol (the "bad" cholesterol), lower blood pressure, lower blood sugars, and reduce body weight. Although many dietary plans just tell you what you CAN'T eat (usually your favorite foods!), the most powerful nutrition strategy helps you focus on what you CAN eat. In fact, heart disease research has shown that adding heart-healthy foods is just as important as cutting back on others.
Here are 5 nutrition strategies to lower your cholesterol and reduce your risk of heart disease:

1. Eat more vegetables, fruits, whole grains, and legumes. These wonders of nature may be one of the most powerful strategies in fighting heart disease. The increase in dietary fiber as part of a healthy diet helps lower bad LDL cholesterol. Aim for at least 4.5 cups of fruits and vegetables a day, three 1-ounce servings of whole grains a week, and four servings a week of nuts, legumes, and seeds.
2. Choose fat calories wisely. Keep these goals in mind: Limit total fat grams; eat a bare minimum of saturated fats (less than 7% of total calories each day) and avoid trans fats (for example, fats found in some packaged baked goods, solid fats ); when you use added fat, use unsaturated fats (for example, fats found in vegetable oils such as canola, olive, and peanut oils). Another strategy is to use plant stanols or sterols as a dietary option to help lower bad LDL cholesterol.
3. Eat a variety of lean protein foods. Chicken, fish, and vegetable proteins are better than red meats (beef, pork, and lamb), which contain more saturated fat and cholesterol. Fish and some vegetable sources contain omega-3 fatty acids, which have been shown to help reduce the risk of abnormal heart rhythms that can lead to sudden cardiac death. They also help lower levels of blood fats (triglycerides), fight atherosclerosis, and decrease blood pressure. The American Heart Association recommends that at least two 3.5-ounce servings a week of fish be included as part of a heart-healthy diet. Limit processed meats to no more than 2 servings a week.
4. Limit cholesterol and fat consumption. The American Heart Association recommends less than 300 milligrams a day of dietary cholesterol for healthy people and less than 200 mg if you have heart disease. Limiting dietary cholesterol has an added bonus: You'll also cut out saturated fat, as cholesterol and saturated fat are usually found in the same foods (mainly meat proteins). Get energy by eating complex carbohydrates (whole wheat pasta, brown or wild rice, whole-grain breads) and limit simple carbohydrates (regular soft drinks, sugar, sweets). Limit sugar-sweetened drinks to less than 450 calories a week.
5. Feed your body regularly. Skipping meals often leads to overeating. For some, eating five to six mini-meals may help keep cravings in check, help control blood sugars and regulate metabolism. This approach may not be as effective for those who are tempted to overeat every time they are exposed to food. For these individuals, three balanced meals a day may be a better approach.

   Other Heart-Healthy Strategies

6. Reduce salt intake. The American Heart Association recommends less than 1500 mg of sodium a day. Try using dried herbs, vinegars, and citrus to add flavor to dishes.
7. Exercise. The human body was meant to be active. Exercise strengthens the heart muscle, improves blood flow, helps raise "good" HDL cholesterol), and helps control blood sugars and body weight.
8. Don't smoke.
9. Keep a healthy weight.

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Cholesterol

Tips for Good Cholesterol

At the risk of sounding like a certain 20-something socialite, High-Density Lipoprotein (HDL) is hot! Advances in research have brought more attention to the blood lipid (or fat) we often call "good" cholesterol.
"Good" cholesterol doesn't refer to the cholesterol we eat in food, but rather to the high-density lipoprotein cholesterol circulating in our blood. It's one of the fats measured in the lipid panel blood test doctors perform. And it's the component you want more of, because a higher HDL is associated with a lower risk of heart disease.
Experts from the National Cholesterol Education Program (NCEP) note that although LDL or "bad" cholesterol has gotten most of the attention, there's growing evidence that HDL plays an important role.

Facts About "Good" Cholesterol

• HDL cholesterol normally makes up 20%-30% of your total blood cholesterol.
• There is evidence that HDL helps protect against the accumulation of plaques (fatty deposits) in the walls of coronary arteries.
• Research suggests that a five-point drop in HDL cholesterol is linked to a 25% increase in heart disease risk.
• In prospective studies -- that is, studies that follow participants for a period of time to watch for events like heart attacks or death from heart disease -- HDL usually proves to be the lipid risk factor most linked to heart disease risk.
• HDL cholesterol levels are thought to be impacted by genetics.
• Women typically have higher HDL cholesterol levels than men. About a third of men and about a fifth of women have HDL levels below 40 mg/dL. Doctors consider levels of less than 40 mg/dL to be low.

Researchers from the Netherlands who analyzed 60 studies concluded that the ratio of total cholesterol to HDL (in which your total cholesterol number is divided by your HDL number) is a better marker for coronary artery disease than LDL measurement alone.
"Boosting HDL is the next frontier in heart disease prevention," says P.K. Shah, MD, director of cardiology at Cedars-Sinai Medical Center in Los Angeles. Shah says that if the new drugs designed to increase HDL levels prove effective, they could potentially reduce the number of heart attacks and strokes by 80% to 90% -- and save millions of lives. HDL-boosting drugs are now being tested.

How Does HDL Cholesterol Help Your Heart?

Experts aren't yet sure exactly how HDL cholesterol helps reduce the risk of heart disease. But a few possibilities have emerged.
The NCEP says that high HDL levels appear to protect against the formation of plaques in the artery walls (a process called atherogenesis), according to studies in animals.
Lab studies, meanwhile, suggest that HDL promotes the removal of cholesterol from cells found in plaques, or lesions, in the arteries.
"Recent studies indicate that the antioxidant and anti-inflammatory properties of HDL also inhibit atherogenesis," says the NCEP report.

8 Ways to Increase HDL Cholesterol

What many people don't know is that some diet and lifestyle changes may help to increase HDL cholesterol levels, although to a small extent.
Here are some of the contenders:
1. Orange Juice. Drinking three cups of orange juice a day increased HDL levels by 21% over three weeks, according to a small British study (at 330 calories, that's quite a nutritional commitment). This study could be highlighting an effect from high-antioxidant fruits and vegetables. Stay tuned in the years to come.
2. Glycemic Load. The glycemic load is basically a ranking of how much a standard serving of a particular food raises your blood sugar. And as the glycemic load in your diet goes up, HDL cholesterol appears to go down, according to a small recent study. Along these lines, the NCEP report recommends that most of our carbohydrate intake come from whole grains, vegetables, fruits, and fat-free and low-fat dairy products. These foods tend to be on the lower end of the glycemic scale.
3. Choosing Better Fats. Replacing saturated fats with monounsaturated fats can not only help reduce levels of "bad" cholesterol, it may also increase levels of "good" cholesterol, according to the Food & Fitness Advisor newsletter from Cornell University's Center for Women's Healthcare.
4. Soy. When substituted for animal-based products, soy foods may have heart health benefits. Soy products are low in saturated fats and high in unsaturated fats. Soy products are also high in fiber. An analysis found that soy protein, plus the isoflavones found in soy "raised HDL levels 3%, which could reduce coronary heart disease risk about 5%," says Mark Messina, PhD, a nationally known soy expert. Messina notes that soy also may lead to a small reduction in LDL cholesterol and triglycerides (another type of blood fat), and a possible enhancement in blood vessel function. Other studies have shown a decrease in LDL cholesterol (about 3%) and triglycerides (about 6%) with about three servings of soy a day. That adds up to 1 pound of tofu, or three soy shakes. Further research should focus on whether a higher soy diet intervention is associated with a reduction in heart disease risk.
5. Alcohol in Moderation. Drinking moderate amounts of alcohol is associated with a higher level of HDL. Alcohol is also associated with a lower risk of cardiovascular disease in men and women.
6. Aerobic exercise. Moderately intense exercise of at least 30 minutes on most days of the week is the exercise prescription that can help raise your HDL, according to many health care professionals.
7. Stopping smoking. Experts agree that kicking the habit can increase your HDL numbers a bit, too.
8. Losing weight. Being overweight or obese contributes to low HDL cholesterol levels, and is listed as one of the causes of low HDL, according to the NCEP.

 

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