Cholesterol Archive

People with high cholesterol are urged to eat a diet low in saturated fat and high in vegetables, fruits, and whole grains. A study suggests that when it comes to reducing LDL (bad) cholesterol, they may do even better if they also eat certain cholesterol-lowering foods. The findings were published in The Journal of the American Medical Association (Aug. 24/31, 2011).

The study. Researchers at the University of Toronto enrolled 351 women and men with hyperlipidemia (high levels of fats in the blood), including an LDL level that averaged 171 milligrams per deciliter, or mg/dL. (Optimal LDL is less than 100 mg/dL). None of the participants were taking cholesterol-lowering drugs. All were instructed to follow weight-maintaining, largely vegetarian diets. Some were assigned to incorporate a "portfolio" of cholesterol-lowering foods into their diet. These foods included soluble fibers such as oatmeal, barley, psyllium-enriched cereals, okra, and eggplant; nuts; soy protein (soy milk, tofu, and soy meat substitutes); and margarines enriched with plant sterols. The control group was advised to focus on eating low-fat dairy, whole grains, fruits, and vegetables and to avoid the portfolio foods.

Q. My doctor just started me on Zocor to lower my cholesterol. I have had just one side effect, forgetfulness. It's not as bad as it sounds, since my memory remains excellent, except that I often forget to take my pill in the evening. So I'd like to know if it would be okay for me to take Zocor in the morning with my other pills, which I never forget.

A. Many people have trouble remembering to take medications; drugs that are administered several times during the day are particularly troublesome.

Another reason to avoid foods made with a lot of sugar.

The human body handles glucose and fructose — the most abundant sugars in our diet — in different ways. Virtually every cell in the body can break down glucose for energy. About the only ones that can handle fructose are liver cells. What the liver does with fructose, especially when there is too much in the diet, has potentially dangerous consequences for the liver, the arteries, and the heart.

COURAGE not followed by action

Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS. Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine 2007; 356:1503-16.

Borden WB, Redberg RF, Mushlin AI, Dai D, Kaltenbach LA, Spertus JA. Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention. JAMA 2011; 305:1882-9.

The target for the safest amount of "bad" cholesterol continues to drift downward.

In 1986, a "desirable" blood level of low-density lipoprotein (LDL, the so-called bad cholesterol) was 130 milligrams per deciliter (mg/dL). Today, information from medical anthropologists and some high-powered clinical trials suggests the new "desirable" should be half that. This has guideline writers, doctors, and the rest of us wondering: how low should we go with LDL?

How healthy are you, and how does your life expectancy stack up against the average? To answer these questions, your doctor will ask about your smoking, drinking, diet, and exercise. He'll measure your cholesterol, blood pressure, blood sugar, and weight or waist size. And he may ask if you're happy or stressed and if you sleep well.

These facts and numbers do count; men who rate well in midlife stay healthier and live longer than gents who score poorly. Still, scientists are always looking for additional measurements that predict survival. And research from Denmark proposes an unlikely candidate: semen quality.

Ideal CV health

Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010; 121:586-613.

Bambs C, Kip KE, Dinga A, Mulukutla SR, Aiyer AN, Reis SE. Low prevalence of "ideal cardiovascular health" in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study. Circulation 2011; 123:850-7.

Niacin, also known as vitamin B₃ and nicotinic acid, is an essential nutrient. We need a small amount of it to ward off a disease called pellagra.

But like many vitamins these days, niacin has gotten more attention lately because of the benefits it might have when consumed in large amounts. Daily doses of 1,000 milligrams (mg) or more increase "good" HDL cholesterol and also reduce triglycerides. Many people, including quite a few doctors, view niacin as a useful, inexpensive — and perhaps more natural — way to bring about desirable cholesterol levels and reduce the risk of heart disease. Research going back to the early 1980s has shown that to be the case. Drug companies have sensed an opportunity and are selling products like Advicor (niacin plus lovastatin) and Simcor (niacin plus simvastatin) that combine high doses of HDL-raising niacin with statin drugs that lower "bad" LDL cholesterol.

Aiming high is usually a good strategy for achieving a goal... except when it backfires. That's what happened with a large clinical trial dubbed AIM-HIGH. It was suddenly stopped more than a year ahead of schedule, casting a cloud over the use of niacin, a safe, effective medication with a proven track record for raising levels of protective high-density lipoprotein (HDL).

AIM-HIGH was designed to gauge whether adding a prescription form of niacin (Niaspan) to a cholesterol-lowering statin makes sense for people with low HDL. This combination had been tested in earlier trials, all of which showed a benefit. The big difference in AIM-HIGH was the very low target for low-density lipoprotein (LDL, the so-called bad cholesterol): between 40 and 80 milligrams per deciliter (mg/dL).

Our April 2011 article "Meet the statins" contained an error in Table 2. The correct interactions between grapefruit juice and statin drugs are listed here:

Drug levels boosted by grapefruit: atorvastatin, lovastatin, simvastatin.

Levels not affected by grapefruit: fluvastatin, pitavastatin, pravastatin, rosuvastatin.