Tag Archives: cholesterol

An Update on New Research – Straight from the Source!

IMG_8348rt5x7bwThere is always plenty of research being conducted on heart disease prevention, but this week I decided to go straight to the source. This week I will be blogging directly from the Cardiometabolic Health Congress in Boston – a collection of presentations on recent concepts and new research in the treatment of conditions like high blood pressure, high cholesterol and diabetes. The goal? To prevent heart disease and stroke.

Here are some highlights from the first day:

High Cholesterol: The big news in cholesterol treatment is the development of a new class of potent drugs, PCS-K9 inhibitors, (Which I previously reported on here) which are different from statins – they lower cholesterol potently, but must be given by injection. For now, they are reserved for patients with seriously elevated levels while taking statins – or those intolerant of statins.

While statins are very effective in patients with a history of heart disease, many patients who take them have never had cardiovascular disease – they were prescribed purely for prevention. Many people given statins are actually at low long term risk – and the statin may not impact their risk further. Recent research shows that we can refine which patients benefit by using a test to look for early evidence of plaque buildup in the arteries. This test, called a coronary calcium scan (or heart scan) is cheap and quick, and can clarify which patients really will benefit from a statin.  Here is a recent article from the New York TImes with more details.

Obesity: Anyone who has tried to lose weight know the frustration of seeing the weight return over time. We often attribute this to poor will power, but research now shows that certain hormones are activated that actually “stimulate” the body to gain weight – like a weight “thermostat” that tries to return to a prior setting. New research is trying to interrupt this cycle and allow weight to stay off.

Research also shows that there are different “types” of obesity – many people consider themselves overweight, but are otherwise very healthy – normal blood pressure, blood sugars, and cholesterol. In others, their weight leads to chronic issues and eventual complications. So always think of your weight in the context of your overall health.

Finally, when we decide to eat something, we assume we are doing so in response to feeling “hungry”. But research show that we often eat in response to other cues – sights and smells, emotional states, and availability of food. (A great example of “mindless” eating is chomping on popcorn while we are engrossed with a movie) So if you struggle with willpower, try to limit these non-hunger “cues” – remove unhealthy food from the house, and try to steer clear of temptations as you go about your day.

Tomorrow, we will hear about new research into high blood pressure and diabetes. (As always – these are general concepts – only your doctor can address your specific health issues).

A New Option for Patients Who Can’t Tolerate Statins

IMG_8348rt5x7bwFor over 20 years, statins (such as atorvastatin and simvastatin) have been one of our primary weapons to fight heart and vascular disease, because of their ability to reduce cholesterol, and subsequently prevent heart attacks and strokes. But in many patients, statins are poorly tolerated or ineffective at reducing cholesterol to  the desired target.

Recently, a new class of cholesterol-fighting drugs were discovered, and the first of these agents has been approved by the FDA. These medications, called PCS-K9 inhibitors, work differently than statins, and do not seem to have the common side effects of statins, such as muscle soreness. They appear to markedly lower cholesterol, and appear to be safe.  This article in the Wall Street Journal nicely summarizes the promise of these drugs, as well as the drawbacks (the drugs are very expensive, and must be given by injection).

In addition to those drawbacks, the new agents have yet to establish a long-term track record of safety and prevention of heart attacks and strokes. So initially, these agents will be reserved for patients who have genetic elevations of cholesterol, and those with known cardiovascular disease for whom statins are ineffective or not tolerated. In the near future, more agents will become available (lowering their price), and further studies will guide how to best use them.

In the meantime, statins remain our best weapon against high cholesterol – and are safe and well tolerated, even when given for many years. And as the above article documents, well-done studies have shown that most muscle soreness in patients on statins is either unrelated to the medication, or resolves when a different statin is used.

And of course, remember that diet and exercise, not just medications,  are effective weapons against high cholesterol.

More articles about cholesterol:

Overview of Prevention

The New Cholesterol Guidelines: What do they mean for you?

 

Is Butter really “Back”? Not exactly. . . .

IMG_8348rt5x7bwIf you are perplexed by some the recent media stories claiming that butter (and other saturated fats) may not be so bad (such as this article from the New York Times last year) – here is an excellent article from a trusted, knowledgeable resource – the Harvard School of Public Health – that clarifies the issue (click here for article).

Here is the conclusion of the article:

In the case of dietary fat, most scientists do agree on a number of points. First, eating foods rich in polyunsaturated fat will reduce the risk of heart disease and prevent insulin resistance. Second, replacing saturated fat with refined carbohydrates will not reduce heart disease risk. Third, olive oil, canola oil, and soybean oil are good for you—as are nuts (especially walnuts), which, while they include some saturated fat, are also high in unsaturated fat, tipping the balance in their favor. Finally, omega-3 and omega-6 fatty acids are essential for many biological processes—from building healthy cells to maintaining brain and nerve function—and we should eat a variety of healthy foods, such as fish, nuts, seeds, and vegetable oils, to obtain adequate amounts of both fatty acids.

Other, finer points are still unclear. For instance, monounsaturated fat is believed to lower risk for heart disease. But it’s difficult to study in Western populations, because most people get their monounsaturated fat from meat and dairy, which are also full of saturated fat. Still, people can choose from a variety of monounsaturated-fat-rich foods, such as peanuts and most tree nuts, avocados, and, of course, olive oil. And though scientists agree that omega-3 and omega-6 fatty acids are essential, they debate how much of each we actually need.

As you can see, the point is not that butter is good – it’s that replacing it with other processed foods such as refined carbohydrates won’t improve your health.

Here is my earlier post on saturated fats, along with links to a useful video and other resources.

Here is more information about a heart healthy diet.

 

Asian Americans Face Greater Risk for Stroke and Hypertension

Asian Americans are at higher risk for stroke and hypertension compared to whites, according to a study examining U.S. death records from 2003–2010.

IMG_8348rt5x7bwAlthough heart disease is the No. 1 killer of all Americans, certain races and ethnic groups face higher cardiovascular risk than others. Asian Americans are the fastest growing racial/ethnic group in the United States, yet little is known about heart risks in distinct subgroups of the Asian American population.

Published in the Journal of the American College of Cardiology, a recent study analyzed death records for the six largest Asian-American subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean and Vietnamese. Together, these subgroups make up 84% of the Asians in the United States.

After comparing U.S. death rates from 2003–2010, researchers found that stroke and high blood pressure was more common among every Asian American subgroup compared to non-Hispanic whites. Compared to whites, Asian Indians and Filipino men also had greater mortality from coronary artery disease—a condition that occurs when the heart’s arteries narrow, often due to the plaque build-up on the arterial walls. (text taken from http://www.cardiosmart.com)

Until further studies clarify the specific reasons for elevated risk in Asian Americans, the goals for prevention in this population are similar to all adults, with a few areas of emphasis:

1. Blood Pressure Control – monitoring blood pressure – .and prompt treatment of elevated readings – it is important for all adults, but in Asian American’s we may need to emphasize more thorough monitoring, and consider intervention ( either lifestyle changes or medications) at an earlier age or with lower blood pressure targets. Here is more information.

2. Manage Your Cholesterol – in recent years we have certainly learned more about specific changes of cholesterol in the Asian population. For example, here is an article I co-authored which looked at specific cholesterol findings in Indian Americans.  Even though the spectrum of specific cholesterol abnormalities vary among the various agents are groups, the lifestyle advice to minimize the impact is universal: Reduce intake of saturated fats, processed grains, and minimize wheat based carbohydrates. Here is more information.

3. Stop smoking and minimize tobacco exposure. Hopefully the impact here is self-explanatory. Here is additional information.

4. Monitor Blood Sugar – Type 2 (or “adult onset”) diabetes is far more common in certain Asian populations (such as Indians), especially those that have moved to Western countries that eat highly processed diets. In many Asians, diabetes can develop even in the absence of the usual weight gain (e.g. abdominal fat) typical in other populations. Ask your physician about screening recommendations for those at risk of diabetes.

4. Stay Active! Regular readers of our blog should be well versed in the many benefits of the ultimate medical therapy: Regular exercise. Here is an overview of the benefits of exercise, and here is even more information.

For now, the screening recommendations for prevention of heart disease and stroke in Asian Americans are no different from the population at large. However, there is some evidence that certain screening tools may benefit certain populations. These include advanced blood testing and imaging to screen for early coronary plaque. If you are concerned about your risk, you should ask your physician whether additional screening may be useful. or even consider calculating your very own “Heart Age”.  In the meantime, clinical studies are providing more and more information about cardiovascular risk in this growing segment of Americans.

Low Fat or Low Carb? A new study sheds some light. . . .

IMG_8348rt5x7bwWhat is the optimal diet for weight loss and reducing long-term risk? This question has been debated for some time. A new study funded by the National Institutes of Health (NIH), and described in detail here, sheds some light on the issue (but is probably not the final word). In this study, researchers divided about 150 participants into 2 groups – one consumed a “low carb” diet but could eat unlimited fats (even saturated fats, such as butter), while the second group consumed a low-fat diet, as touted by many health organizations for some time. This group had no limits on carb intake. Here is a summary of the results, from the New York Times:

By the end of the yearlong trial, people in the low-carbohydrate group had lost about eight pounds breadmore on average than those in the low-fat group. They had significantly greater reductions in body fat than the low-fat group, and improvements in lean muscle mass — even though neither group changed their levels of physical activity.

In the end, people in the low-carbohydrate group saw markers of inflammation and triglycerides — a type of fat that circulates in the blood — plunge. Their HDL, the so-called good cholesterol, rose more sharply than it did for people in the low-fat group.  Blood pressure, total cholesterol and LDL, the so-called bad cholesterol, stayed about the same for people in each group.

Nonetheless, those on the low-carbohydrate diet ultimately did so well that they managed to lower their Framingham risk scores, which calculate the likelihood of a heart attack within the next 10 years. The low-fat group on average had no improvement in their scores.

So the low-carb group, despite eating high levels of fat (mostly unsaturated – the good kind), lost more weight and improved the cardiovascular risk profile, in comparison to the low-fat group.

HeartHealth Docs take home message: This study was not large, but well done, and shows that reducing carbohydrate intake may be more important than reducing saturated fat. We advocate this type of diet, but still recommend moderation of saturated fats. So when you raise a toast of red (or white) wine this weekend, enjoy some cheese. . .but skip the crackers!

Here are several more articles on a heart healthy diet, as well as saturated fats, and nutrition counts.

 

Exercise – A Great Way to Multitask for Heart Health @CapCityHalf @OhioHealth

BW ARA labcoatEight thousand two hundred fifty three runners completed Saturday’s 11th Cap City Half marathon, in addition to participants in the Patron Quarter Marathon and Commit to Be Fit 5K events.  It was a great event for Ohio.  The HeartHealth Doctors have posted information about heart function and exercise.  Exercise such as running can be the ultimate way to multitask for heart health by managing stress, getting to or keeping goal weight, improving cholesterol profile, and reducing high blood pressure. Exercise has been shown to impact diabetes risk and can assist diabetes management.  Research shows being more active is key to heart health; walking is an excellent way to exercise.  Walking 10 minutes twice daily gets you close to the recommended guidelines for physical activity (150 minutes per week of moderate (means heart rate increases, but you can have a conversation)).

The American College of Cardiology’s Cardiosmart resource has great information about how to Move More. Being active directly impacts numerous risk factors for heart disease.

Heart Health professionals are responding to the evidence of heart health benefits of exercise and athletics.  Sports Cardiology is a section of the American College of Cardiology and provides an area for Cardiovascular Specialists (doctors who treat heart and vascular disease) to help people be active.  Someone wanting to be active could be a professional athlete, a young person, someone who participated in sports at school and now wants to return to competition, or patients who have completed cardiac rehabilitation programs and want to continue to develop their exercise regimen with the goal of improving their heart health.  The membership in the Sports Cardiology section of the American College of Cardiology has grown from 150 in 2011 to > 4000 members.  Cardiologists are working to promote the benefits of exercise, balanced with modifying/reducing risks athletes may face.

The half marathon run May 3 had an Ohio feel to it; weather ranging from cool temperature, warmer temperature, intermittent grey skies, intermittent rain, some sunshine.  There were great crowds, creative signs for encouragement, good music from bands, DJ’s, and the help of many many volunteers.  It was a well run event (!) and sets the stage for the U.S.A. Men’s and Women’s National Half Marathon Championships coming to Cap City in 2016, 2017.  You don’t have to be a national champion runner to get benefit from exercise; use a tracker to check your steps (> 22,000 yesterday!), or commit to someone (or a group) who want/s to be more active.  Yesterday ~11,955 total event participants at the Cap City Half / Patron Quarter Marathon / Commit to Be Fit 5K – did great heart health multitasking.

 

2 months. . . .and 1700 “hits” . . . Thanks!

IMG_8348rt5x7bwBW ARA labcoatLooking back at the first 2 months of our site, we have been so surprised and encouraged by the interest in heart prevention and wellness. We have had nearly 1,700 page views and over 170 followers. So thanks for your support, and for continuing to promote cardiovascular wellness!

Here are some posts from the past 2 months you may have missed:

Here are 10 tips for women to improve their heart health

Calculate your “Heart Age” . . . and learn what it means

An overview of exercise and it’s role in heart prevention. . and preventing dementia too.

10 tips for heart healthy eating. . . and disease prevention and Nutrition Counts!

Understand what the new cholesterol guidelines mean for you and your loved ones with high cholesterol

Is Fish Oil useful? Here is a link to our current views. . .  and an overview of other supplements as well.

Online resources about high blood pressure

As always, we appreciate your suggestions for topics. . Thanks again for your support!