Cholesterol and lipids Archive

For people at high risk, PCSK9 inhibitors may prevent heart attacks and save lives. But gaining access to these pricey drugs remains a challenge.

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Three years ago, the FDA approved two drugs that lower harmful LDL cholesterol values dramatically — by more than 50%. The drugs, alirocumab (Praluent) and evolocumab (Repatha), belong to a new category of medications known as PCSK9 inhibitors. Both are given by a self-administered injection once or twice a month.

They're intended for people whose cholesterol levels remain stubbornly high, despite making lifestyle changes (such as diet and exercise) and taking the maximum dose of a high-potency statin and other cholesterol-lowering drugs. In the past two years, results from two large studies found that both PCSK9 inhibitors lowered the risk of serious heart-related events such as heart attack and stroke by 15%.

Research we're watching

Is your workplace noisy? You may want to keep close tabs on your blood pressure and cholesterol. A CDC study published in the American Journal of Industrial Medicine found that high cholesterol and high blood pressure were more common among workers who toiled in noisy environments.

The study found that 25% of U.S. workers surveyed reported experiencing noise exposure at work. The noisiest industries included mining, construction, and manufacturing.

Research we're watching

Cholesterol-lowering statins may be underused in younger people at risk for heart attack, new research suggests.

The study, in the Jan. 23, 2018, Journal of the American College of Cardiology, included more than 1,600 people ages 50 and younger who had experienced a heart attack. Only one in eight was taking a statin before the heart attack.

On call

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Q. I am about the same age as President Trump, and I also had a recent physical. My LDL (bad) cholesterol reading was 136, which my doctor thought was too high. But Mr. Trump's doctor said his LDL cholesterol of 143 was "excellent." Which is it?

A. The report of President Trump's health status brought out many armchair cardiologists — and real cardiologists — to comment on his cholesterol levels and risk for heart disease. The White House doctor's report stated that the president's "heart health" (not his cholesterol) was deemed excellent based on a normal exercise test and heart ultrasound. However, his LDL level of 143 was felt to be too high, and his doctor recommended doubling the president's statin medication. While the president doesn't show evidence of current heart disease, what is his future risk? A 71-year-old man with his cholesterol value would have a 10-year risk of heart attack, stroke, or cardiac death of 16% (about a one-in-six chance).

Research we're watching

People who carry excess weight but have normal blood pressure, blood sugar, and cholesterol values are sometimes dubbed "fat but fit." But they're still more likely to develop heart disease than people who aren't overweight, a new study suggests.

Researchers analyzed more than 7,600 cases of heart disease that occurred over a 12-year period in 10 European countries. They also used data from 10,000 healthy people without heart disease as a comparison group. Compared with people at a healthy weight, those who were overweight or obese had up to a 28% higher risk of developing heart disease.

Research we're watching

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Want to help improve your cholesterol profile? Swap your midmorning muffin for a handful of almonds, suggests a study in the Aug. 1, 2017, Journal of Nutrition.

Nutritionists have long known that eating almonds and other nuts tends to lower harmful LDL cholesterol and raise desirable HDL cholesterol. But recent evidence suggests that the heart-protecting effects of HDL depend on a person's particular complement of the various forms of HDL, some of which are more beneficial than others.

A certain amount of healthy fat is good for your heart.

Low-fat, no-fat, fat-free. Fat has been shamed for so long, it's easy to think there's no place for it in a heart-healthy diet. But the opposite is true. "It's a myth that lowering fat intake is healthy," says Dr. Frank Sacks, professor of cardiovascular disease prevention at the Harvard T.H. Chan School of Public Health. "The key is to use more healthful unsaturated fats and less of the detrimental saturated fats."

The good and the bad

To understand the role of fat in heart health, you first have to look at where it's found in food. There are two types of fat: saturated and unsaturated.

Ask the doctor

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Q. My doctor prescribed Lovaza to help lower my high triglyceride level, which is 530 milligrams per deciliter (mg/dL). But I'm a vegetarian and don't want to take a drug made from fish oil. Are there other options?

A. You're not alone: several of my vegetarian patients also have asked me this question. But let's begin with some background. Triglycerides — which are the main form of fat found in our bodies — are part of a standard lipid panel blood test. Values higher than 150 mg/dL are associated with a higher risk of heart disease.

Research we're watching

Have you considered taking a red yeast rice supplement to "naturally" lower your cholesterol, either instead of or in addition to a prescription statin? Think again. These popular over-the-counter supplements contain an ingredient identical to the one found in the prescription drug lovastatin (Mevacor) — but in completely unpredictable amounts, a new study finds.

Researchers tested 28 different brands of red yeast rice from four mainstream retailers (GNC, Walgreens, Walmart, and Whole Foods). Two brands contained no detectable levels of the active ingredient, called monacolin K. In the other 26, monacolin K levels ranged from a trace to nearly 5.5 milligrams (mg) per 1,200 mg of red yeast rice. For some brands, the recommended daily serving overlapped with the dosage of prescription lovastatin.

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For years, doctors prescribed cholesterol-lowing statins based largely on cholesterol test results. The goal was to lower total cholesterol to under 200 mg/dL, and LDL (bad) cholesterol to under 100 mg/dL. But in late 2013, new guidelines on statin use issued by the American Heart Association (AHA) and the American College of Cardiology (ACC) proposed a major change to that strategy.

These guidelines shifted from a numbers-based approach to a risk-driven approach. Instead of aiming for a specific cholesterol value, doctors were urged to look at a person's entire cardiovascular risk profile when considering treatment. This is a reasonable approach that can help better define when to initiate drug therapy.