Cholesterol Archive

The "nocebo effect" may explain why some people believe they can't tolerate statins.

For more than 20 years, cholesterol-lowering statin drugs have been a mainstay for preventing and treating heart disease. But up to half of people prescribed these drugs are no longer taking them within a year or two. The reasons vary, but some people experience what they believe to be statin-related side effects — most often muscle pain. Others avoid statins altogether because of worries over side effects.

"Far too any people think they cannot tolerate statins when they actually can," explains Dr. Jorge Plutzky, director of preventive cardiology at Harvard-affiliated Brigham and Women's Hospital. To be clear, muscle problems are a known side effect of statins. However, serious muscle-related complications are extremely rare (see "What is rhabdomyolysis?"). And when people experience the more common — but less worrisome — muscle-related symptoms, those issues usually resolve with a lower statin dose or a change to a different statin, Dr. Plutzky says.

People with fluctuating numbers — like blood pressure, cholesterol, and weight — may be at higher risk of heart attack, stroke, and even death.

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Most people battle "yo-yoing" at some point, when their weight, blood pressure, or some other health number keeps going up and down.

On the surface, this may not seem like a problem if you routinely hit the healthy numbers. Yet new research suggests that fluctuations like this may pose a greater health risk than staying at a single level, even if it's not a perfect one.

Healthy older adults ages 75 and older might not benefit from the drugs to protect against cardiovascular disease.

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Cardiovascular disease is the leading cause of death for people ages 75 and over. The cholesterol-lowering statin drugs can help protect against heart attack or stroke, both for people who have already had one and those who are at high risk for one of these events.

But what if you are in this older age bracket and have no history of cardiovascular problems? Do you really need one of these cholesterol-lowering drugs to protect yourself from future heart attacks and strokes?

Research we're watching

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Having high levels of "bad" LDL cholesterol may put you at higher risk of dying from cardiovascular disease — even you are otherwise considered at low risk. A study published online August 16 by the journal Circulation came to this conclusion by looking at data from more than 36,000 patients who had no history of cardiovascular disease or diabetes and were classified as low risk for developing cardiovascular disease over the next 10 years.

Researchers tracked participants for approximately 27 years and found that people who had LDL levels of 160 or higher were 70% to 90% more likely than those with LDL cholesterol levels below 100 to die from cardiovascular disease during the course of the study.

You need adequate amounts of good dietary fat.

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Low fat? No fat? Try more fat. Dietary fats are essential for maintaining good overall health, especially as you age. "Your body needs a regular intake of fat," says Vasanti Malik, a research scientist with the Department of Nutrition at Harvard's T.H. Chan School of Public Health. "Fat helps give your body energy, protects your organs, supports cell growth, keeps cholesterol and blood pressure under control, and helps your body absorb vital nutrients. When you focus too much on cutting out all fat, you can actually deprive your body of what it needs most."

Two types of fats

To understand the role fats play in a healthy diet, you have to look closer at the two types of dietary fats: saturated and unsaturated. (A third kind, trans fats, have been all but eliminated from U.S. foods.)

Research we're watching

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About one in 10 people has eczema, a chronic inflammatory condition that leaves skin dry and itchy. People with more severe forms may experience a scaly rash or skin that cracks and oozes. These people may also be at greater risk for heart attack and stroke, according to a study in the May 23 issue of The BMJ.

For the study, researchers analyzed data from more than 385,000 adults with eczema, which was classified as mild, moderate, or severe. Each was matched with up to five people of similar age and sex who didn't have eczema.

Studies have shown that alcohol can have a good or bad impact depending on how much you drink.

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Should you enjoy that glass of wine with dinner? Is it okay to relax with a cold beer? When it comes to your heart health, the answer is not clear. The existing research is quite conflicting — some studies say alcohol improves heart health, while others imply the reverse.

So, what's the truth?

"It comes down to moderation," says Dr. J. Michael Gaziano, a preventive cardiologist with Harvard-affiliated Brigham and Women's Hospital's Division of Aging and VA Boston. "A safe amount — about one drink per day — may support a healthy heart and lower your risk of heart disease, while too much can be damaging."

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Peppers, which belong to the genus Capsicum, come in a variety of colors, shapes, sizes, and flavors. Bell peppers (available in green, yellow, orange, red, and even purple) make a nice addition to a salad or plate of crudités. Supermarkets carry bags of assorted mini bell peppers that are convenient both for snacking and using in recipes.

While sweet bell peppers are crunchy and mild, hot peppers — such as jalapeños, serranos, and habaneros — provide a tongue-tingling punch of heat. They contain varying amounts of the phytochemicals responsible for the spiciness in hot peppers.

Research we're watching

About four in 1,000 adults in this country are born with a genetic condition marked by abnormally high cholesterol levels, known as familial hypercholesterolemia (FH). Their "bad" LDL cholesterol can be two to three times as high as the common target LDL value of 100 milligrams per deciliter (mg/dL) or lower for healthy people. But only about half of people with FH are getting proper treatment for the disease, according to a report in the May 22 issue of Circulation.

For the study, researchers analyzed health surveys done between 1999 and 2014 with nearly 42,500 adults in the United States. Although more than 80% of people with FH or severely high cholesterol were aware of their condition, only half were taking cholesterol-lowering statins. And among those who were, only one-third were taking optimal doses of the drugs.

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%.