Is lowering LDL cholesterol enough?

Unfortunately, the prevention and treatment of atherosclerosis are more complicated than just lowering LDL cholesterol levels. LDL cholesterol reduction is only half of the battle against atherosclerosis. Individuals who have normal or only mildly elevated LDL cholesterol levels can still develop atherosclerosis and heart attacks even in the absence of other risk factors such as cigarette smoking, high blood pressure, and diabetes mellitus. Additionally, successfully lowering elevated LDL cholesterol levels cannot always prevent atherosclerosis and heart attacks. In many clinical trials to lower LDL cholesterol, there were patients who adhered to their assigned diets, faithfully took their cholesterol-lowering medications, and successfully lowered their LDL cholesterol to target levels, yet still suffered progressive atherosclerosis and heart attacks. It is clear that while lowering LDL cholesterol below NCEP target levels is an important step, there are other factors involved. What is lipoprotein (a), (Lp(a)) cholesterol?

Lipoprotein (a) (Lp(a)) is an LDL cholesterol particle that is attached to a special protein called apo(a). In large part, a person's level of Lp(a) in the blood is genetically inherited. Elevated levels of Lp(a) (higher than 20 mg/dl to 30 mg/dl) in the blood are linked to a greater likelihood of atherosclerosis and heart attacks in both men and women. The risk is even more significant if the Lp(a) cholesterol elevation is accompanied by high LDL/HDL ratios. Certain diseases are associated with elevated Lp(a) levels. Patients on chronic kidney dialysis and those with nephrotic syndromes (kidney diseases that cause leakage of blood proteins into the urine) tend to have high levels of Lp(a). There are many theories as to how Lp(a) causes atherosclerosis although exactly how Lp(a) accumulates cholesterol plaques on the artery walls has not been well defined. Clinical trials conclusively proving that lowering Lp(a) reduces atherosclerosis and the risk of heart attacks have not been conducted. Currently, there is no international standard for determining Lp(a) cholesterol levels and commercial sources of Lp(a) testing may not have the same accuracy as research laboratories. Therefore, specifically measuring and treating elevated Lp(a) cholesterol levels are not widely performed in this country. How can Lp(a) cholesterol levels be reduced?

Most lipid-lowering medications such as statins, Lopid, and cholestyramine have a limited effect in lowering Lp(a) cholesterol levels. Estrogen has been shown to lower Lp(a) cholesterol levels by approximately 20% in women with elevated Lp(a) cholesterol. Estrogen can also increase HDL cholesterol levels when given to postmenopausal women. Additionally, nicotinic acid (Niacin or Niaspan) in high doses has been found to be effective in lowering Lp(a) cholesterol levels by approximately 30%. Read More......

Why is HDL the good cholesterol?

HDL is the good cholesterol because it protects the arteries from the atherosclerosis process. HDL cholesterol extracts cholesterol particles from the artery walls and transports them to the liver to be disposed through the bile. It also interferes with the accumulation of LDL cholesterol particles in the artery walls.

The risk of atherosclerosis and heart attacks in both men and is strongly related to HDL cholesterol levels. Low levels of HDL cholesterol are linked to a higher risk, whereas high HDL cholesterol levels are associated with a lower risk.

Very low and very high HDL cholesterol levels can run in families. Families with low HDL cholesterol levels have a higher incidence of heart attacks than the general population, while families with high HDL cholesterol levels tend to live longer with a lower frequency of heart attacks.

Like LDL cholesterol, life style factors and other conditions influence HDL cholesterol levels. HDL cholesterol levels are lower in persons who smoke cigarettes, eat a lot of sweets, are overweight and inactive, and in patients with type II diabetes mellitus.

HDL cholesterol is higher in people who are lean, exercise regularly, and do not smoke cigarettes. Estrogen increases a person's HDL cholesterol, which explains why women generally have higher HDL levels than men do.

For individuals with low HDL cholesterol levels, a high total or LDL cholesterol blood level further increases the incidence of atherosclerosis and heart attacks. Therefore, the combination of high levels of total and LDL cholesterol with low levels of HDL cholesterol is undesirable whereas the combination of low levels of total and LDL cholesterol and high levels of HDL cholesterol is favorable.

What are LDL/HDL and total/HDL ratios?

The total cholesterol to HDL cholesterol ratio (total chol/HDL) is a number that is helpful in estimating the risk of developing atherosclerosis. The number is obtained by dividing total cholesterol by HDL cholesterol. (High ratios indicate a higher risk of heart attacks, whereas low ratios indicate a lower risk).

High total cholesterol and low HDL cholesterol increases the ratio and is undesirable. Conversely, high HDL cholesterol and low total cholesterol lowers the ratio and is desirable. An average ratio would be about 4.5. Ideally, one should strive for ratios of 2 or 3 (less than 4).

What are the treatment guidelines for low HDL cholesterol?

In clinical trials involving lowering LDL cholesterol, scientists also studied the effect of HDL cholesterol on atherosclerosis and heart attack rates. They found that even small increases in HDL cholesterol could reduce the frequency of heart attacks. For each 1 mg/dl increase in HDL cholesterol, there is a 2 to 4% reduction in the risk of coronary heart disease. Although there are no formal NCEP (please see discussion above) target treatment levels of HDL cholesterol, an HDL level of <40>

How can levels of HDL cholesterol be raised?

The first step in increasing HDL cholesterol levels (and decreasing LDL/HDL ratios) is therapeutic life style changes. When these modifications are insufficient, medications are used. In prescribing medications or medication combinations, doctors have to take into account medication side effects as well as the presence or absence of other abnormalities in cholesterol profiles.

Regular aerobic exercise, loss of excess weight (fat), and cessation of smoking cigarettes will increase HDL cholesterol levels. Regular alcohol consumption (such as one drink a day) will also raise HDL cholesterol. Because of other adverse health consequences of excessive alcohol consumption, alcohol is not recommended as a standard treatment for low HDL cholesterol.

Medications that are effective in increasing HDL cholesterol include nicotinic acid (niacin), gemfibrozil (Lopid), estrogen, and to a much lesser extent, the statin drugs (discussed below). A newer medicine, fenofibrate (Tricor) has shown much promise in selectively increasing HDL levels and reducing serum triglycerides. Read More......

Tips

1. Use liquid plant oils for cooking and baking. Olive, canola, and other plant-based oils are rich in heart-healthy unsaturated fats. Try dressing up a salad or spring vegetables with a delicious, olive oil-based vinaigrette, such as this recipe for fresh mint vinaigrette.

2. Ditch the trans fat. In the supermarket, read the label to find foods that are trans free. In restaurants, steer clear of fried foods, biscuits, and other baked goods, unless you know that the restaurant has eliminated trans fat. Read more about how to spot trans fats—and how to avoid them.

3. Switch from butter to soft tub margarine. Choose a product that has zero grams of trans fat, and scan the ingredient list to make sure it does not contain partially hydrogenated oils.

4. Eat at least one good source of omega-3 fats each day. Fatty fish, walnuts, and canola oil all provide omega-3 fatty acids. Read more about omega-3 fatty acids and why they are so important to good health.

5. Go lean on meat and milk. Beef, pork, lamb, and dairy products are high in saturated fat. Choose low-fat milk, and savor full-fat cheeses in small amounts; also, choose lean cuts of meat.

Read More......

Choose healthy fats, limit saturated fat, and avoid trans fat.

The total amount of fat you eat, whether high or low, isn't really linked with disease. What really matters is the type of fat you eat.

The "bad" fats—saturated and trans fats—increase the risk for certain diseases. The "good" fats—monounsaturated and polyunsaturated fats—lower disease risk. The key to a healthy diet is to substitute good fats for bad fats—and to avoid trans fats.

Although it is still important to limit the amount of cholesterol you eat, especially if you have diabetes, dietary cholesterol isn't nearly the villain it's been portrayed to be. Cholesterol in the bloodstream is what's most important. And the biggest influence on blood cholesterol level is the mix of fats in your diet—not the amount of cholesterol you eat from food.

Read More......

How Controlling Cholesterol ?

Of all the natural supplements available to help lower cholesterol, red rice yeast extracts are by far the most effective. Red rice yeast (Monascus purpureus) has a long history of use in China as a natural food coloring and healthful ingredient. It is a source of naturally occurring statins, and because it delivers a mix of those compounds rather than a single molecule, it is much less likely to cause the side effects that sometimes occur with the pharmaceutical versions.

As you may know, in 2001 the FDA banned the sale of the most popular brand of red yeast rice extract, Cholestin, because one of its components (lovastatin) was already a patented drug when Cholestin came on the market (the product now sold as "Cholestin" in the United States does not contain any red rice yeast). You can still obtain Cholestin that contains red rice yeast extract in some European countries, and other brands of red rice yeast extract are still sold in the U.S. Because supplements are unregulated and the demand for quality ingredients is growing, some products will not actually contain any red rice yeast extract and will be ineffective. If you don't get satisfactory results, you can always switch to a better quality brand or even to a prescribed statin.

The most common side effects of prescribed statin drugs are headache, digestive upset, liver dysfunction, and muscle pain. These last two problems can be serious, but statins are well tolerated by most people, and serious side effects are rare. Red rice yeast supplements can cause the same side effects in sensitive people, but in my experience the incidence is significantly less than with the purified prescription compounds.

I recommend that anyone who takes statins or red rice yeast extract supplements for cholesterol control should also take 90 - 120 mg of coenzyme Q10 every day, since these drugs inhibit the body's natural synthesis of CoQ10, which is needed for formation of ATP, our bodies' energy currency. (That may account for the muscle pain that some people experience.)

No matter what supplement or drug you use for cholesterol control, be sure to get at least 30 minutes a day of aerobic exercise and reduce the amount of saturated fat and trans-fats in your diet. Other beneficial lifestyle changes include drinking green tea, eating one clove of garlic per day (diced or crushed in food), and consuming more soluble fiber (such as oat bran), foods rich in omega-3 fatty acids (good sources include salmon, sardines and walnuts) and plenty of leafy greens and fresh fruits.

Read More......

Why Cholesterol Matters

Cholesterol is a type of fat called a lipid. The body uses it for many things, such as making new cells. Your liver makes the cholesterol that your body needs. You also get cholesterol from the foods you eat.

Your body needs some cholesterol. But if you have too much, it starts to build up in your arteries. (Arteries are the blood vessels that carry blood away from the heart.) This is called hardening of the arteries, or atherosclerosis. It is usually a slow process that gets worse as you get older.

To understand what happens, think about how a clog forms in the pipe under a kitchen sink. Like the buildup of grease in the pipe, the buildup of cholesterol narrows your arteries and makes it harder for blood to flow through them. It reduces the amount of blood that gets to your body tissues, including your heart. This can lead to serious problems, including heart attack and stroke.

To find out how you are doing, compare your total cholesterol number to the following:

• Best is less than 200.
• Borderline-high is 200 to 239. Even borderline-high cholesterol makes you more likely to have a heart attack.
• High is 240 or above.

What are the symptoms?
High cholesterol doesn't make you feel sick. But if cholesterol builds up in your arteries, it can block blood flow to your heart or brain and cause a heart attack or stroke.

By the time you find out you have it, it may already be clogging your arteries. So it is very important to start treatment even though you may feel fine.

What are the different kinds of cholesterol?
Cholesterol travels through the blood attached to a protein. This package of cholesterol (a lipid) and protein is called a lipoprotein. Lipoproteins are either high-density or low-density, based on how much protein and fat they have.

• Low-density lipoproteins (LDL) are the “bad” cholesterol. LDL is mostly fat with only a small amount of protein. It can clog your arteries. If you have high cholesterol, your doctor will want you to lower your LDL.
• High-density lipoproteins (HDL) are the “good” cholesterol. HDL is more protein than fat. It helps clear the bad cholesterol from your blood so it does not clog your arteries. A high level of HDL can protect you from a heart attack.
• Triglycerides are another type of fat in the blood that can affect your health. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

It may help to think of HDL as the “Healthy” cholesterol and LDL as the “Lousy” cholesterol. Or you could remember that HDL should be High and LDL should be Low.
Experts have come up with the best level for each type of cholesterol. Compare your numbers to these targets:

• LDL should be less than 100. LDL increases your risk of heart problems, so the lower your LDL, the better. A level of 160 or above is high.
• HDL should be more than 40. HDL over 60 helps protect against a heart attack. HDL below 40 increases your risk of heart problems. The higher your HDL, the better. A high HDL number can help offset a high LDL number.
• Triglycerides should be less than 150. A level above 150 may increase your risk for heart problems.

What causes high cholesterol?
Many things can cause high cholesterol, including:

• Diet. Eating too much saturated fat and cholesterol can raise your cholesterol. Saturated fat and cholesterol are in foods that come from animals (such as beef, pork, veal, milk, eggs, butter, and cheese), many packaged foods, stick margarine, vegetable shortening, and snack foods like cookies, crackers, and chips.
• Weight. Being overweight may raise triglycerides and lower “good” HDL.
• Activity level. Not exercising may raise “bad” LDL and lower HDL.
• Overall health. Diseases such as hypothyroidism can raise cholesterol. Smoking may lower HDL.
• Age. Cholesterol starts to rise after age 20. In men, it usually levels off after age 50. In women, it stays fairly low until menopause. After that, cholesterol levels rise to about the same levels as in men.
• Family. Some people inherit a rare disease called a lipid disorder. It can cause very high total cholesterol, very low HDL, and high triglycerides. If you have this problem, you will need to start treatment at a young age.

How is high cholesterol diagnosed?
Doctors use a blood test to check cholesterol.

• A fasting cholesterol test (also called a lipoprotein analysis) is the most complete test. It measures total cholesterol, HDL, LDL, and triglycerides. You cannot have food for 9 to 12 hours before this test.
• A simple cholesterol test can measure total cholesterol and HDL. You can eat before this test. Sometimes doctors do this test first. If it shows you have high cholesterol or low HDL, then you will get a fasting cholesterol test.

How is it treated?
The two main treatments are lifestyle changes and medicines. The goal of treatment is to lower your "bad" LDL cholesterol and reduce your risk of a heart attack. You may also need to raise your "good" HDL cholesterol. A high level of HDL helps reduce your risk of heart problems.

Some lifestyle changes are important for everyone with high cholesterol. Your doctor will probably want you to:

• Follow the Therapeutic Lifestyle Changes (TLC) diet. The goal is to reduce the amount of saturated fat you eat. Eating saturated fat raises your cholesterol. The TLC diet helps you learn to make better food choices by picking lean meats, low-fat or nonfat products, and good fats like olive and canola oils.
• Lose weight, if you need to. Losing just 5 to 10 pounds (2.3 to 4.5 kilograms) can lower your cholesterol and triglycerides. Losing weight can also help lower your blood pressure.
• Be more active. Exercise can raise your “good” HDL and may help you control your weight.
• Quit smoking, if you smoke. Quitting can help raise your HDL and improve your heart health.

Sometimes lifestyle changes are enough on their own. But if you try them for a few months and they don't lower your cholesterol enough, your doctor may prescribe a cholesterol-lowering medicine called a statin. You also may need medicines to lower triglycerides or raise HDL.

You may need to start taking medicine right away if your cholesterol is very high or if you have another problem that increases your chance of having a heart attack. People who have a high risk for heart attack benefit from taking higher doses of statins to lower their LDL cholesterol as much as possible. The more these people can lower their LDL, the less likely they are to have a heart attack.

It is important to take your medicine just the way your doctor tells you to. If you stop taking your medicine, your cholesterol will go back up.

You will need to have your cholesterol checked regularly. Your results can help your doctor know if lifestyle changes have helped or if you need more or different medicines. Read More......