Food Policy
New Research Confirms We Got Cholesterol All Wrong
The u.s. government has pushed a lot of bad nutrition advice over the years. maybe it should stop advising us on what to eat..
Baylen Linnekin | 9.22.2018 7:30 AM
A comprehensive new study on cholesterol, based on results from more than a million patients, could help upend decades of government advice about diet, nutrition, health, prevention, and medication. Just don't hold your breath.
The study, published in the Expert Review of Clinical Pharmacology , centers on statins, a class of drugs used to lower levels of LDL-C, the so-called "bad" cholesterol, in the human body. According to the study, statins are pointless for most people.
"No evidence exists to prove that having high levels of bad cholesterol causes heart disease, leading physicians have claimed" in the study, reports the Daily Mail . The Express likewise says the new study finds "no evidence that high levels of 'bad' cholesterol cause heart disease."
The study also reports that "heart attack patients were shown to have lower than normal cholesterol levels of LDL-C" and that older people with higher levels of bad cholesterol tend to live longer than those with lower levels.
This is probably news to many in government. But it's not news to everyone.
"In fact researchers have known for decades from nutrition studies that LDL-C is not strongly correlated with cardiac risk," says Nina Teicholz, an investigative journalist and author of The New York Times bestseller The Big Fat Surprise (along with a great recent Wall St. Journal op-ed highlighting ongoing flaws in federal dietary advice). In an email to me this week, she pointed out that "physicians continue focusing on LDL-C in part because they have drugs to lower it. Doctors are driven by incentives to prescribe pills for nutrition-related diseases rather than better nutrition—a far healthier and more natural approach."
Cholesterol in our diets comes from animals and animal products —including eggs, meat, fish, and dairy. The government told us for decades that these foods were, to varying degrees, dangerous.
Federal dietary policy is shaped by the Dietary Guidelines Advisory Committee (DGAC), which meets every five years to update its findings. The government touts the DGAC and the dietary guidelines it develops as "an important resource to help our Nation reach its highest standard of health."
The federal government's war on cholesterol, as early DGAC recommendations suggest, dates back decades. For example, the 1995 DGAC report stressed the dangers of dietary cholesterol.
"Most people are aware that high levels of saturated fat and cholesterol in the diet are linked to increased blood cholesterol levels and a greater risk for heart disease," it declares. "Choosing foods with less cholesterol and saturated fat will help lower your blood cholesterol levels."
Only in 2015 did federal dietary guidelines (mostly) halt the assault on cholesterol . Many hailed the news, while still stressing that high cholesterol levels in our bloodstreams is still a danger.
"There's a growing consensus among nutrition scientists that cholesterol in food has little effect on the amount of cholesterol in the bloodstream," a Harvard Medical School blog post noted that same year. "And that's the cholesterol that matters."
"The government's new stance on dietary cholesterol is in line with that of other nations, which do not single out cholesterol as an issue," the Washington Post reported following the release of the most recent dietary guidelines in 2016. "Yet it should not be confused with officials' continued warning about high levels of 'bad' cholesterol in the blood—something that has been clearly linked to heart disease."
But this most recent study is throwing cold water on many of those continued government warnings about blood cholesterol.
What's more, if bad cholesterol isn't so bad, then the benefits of so-called good cholesterol are also under assault. Recently, *HDL, the so-called "good" cholesterol, was itself deemed suspect in some cases.
Dietary fat also appears not to be the danger the government says it is. Another new study, reported on by Ron Bailey this week, suggests, as he writes, that the federal government's warnings to avoid dairy products that are high in fat "is bunk."
I'm not a nutritionist. I don't know if the science on cholesterol is settled. But the federal government has warned us for decades about cholesterol in our bodies and in our food. The fact those warnings are now changing means the government has, despite what I'm sure are the good intentions of everyone involved, been handing out poor dietary advice and developing regulations that reflect that poor advice.
I'm one of many who has called out the DGAC and the federal government for foisting "decades of confusing and often-contradictory dietary advice" upon the American public. I also suggested, in a column last year, that one way the government might back up its claims to possess invaluable and unparalleled expertise in the areas of food policy and nutrition would be stop regularly reversing or altering its recommendations.
"The reason that we don't know about these huge reversals in dietary advice is that the nutrition establishment is apparently loathe to make public their major reversals in policy," Teicholz says. "The low-fat diet is another example: neither the AHA or the dietary guidelines recommend a low-fat diet anymore. But they have yet to announce this to the American public. And some in the establishment are still fighting to retain the low-fat status quo."
I am not your doctor, nor your nutritionist. I have no idea what you should eat. Maybe the government should adopt that mantra, too.
*Correction: This sentence initially referred to LDL as the "good" cholesterol. LDL is widely considered to be an unhealthy cholesterol, while HDL is conventionally considered good.
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Recommended
Have you ever wondered if there’s a natural way to lower your high blood pressure, guard against Alzheimer's, lose weight, and feel better? Well as it turns out there is. Michael Greger, M.D. FACLM, founder of NutritionFacts.org, and author of the instant New York Times bestseller “How Not to Die” celebrates evidence-based nutrition to add years to our life and life to our years.
New Research on Cholesterol
Cholesterol is a vital component of our cells, which is why our body makes all that we need…until our diet gets in the way.
This episode features audio from How Do We Know that Cholesterol Causes Heart Disease? , The Best Food for High Cholesterol , and Amla vs. Drugs for Cholesterol, Inflammation, & Blood-Thinning . Visit the video pages for all sources and doctor’s notes related to this podcast.
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Podcast Transcript
Isn’t it crazy to think of all the different kinds of foods so many of us eat every day? Chips, cookies, burgers, fries. Our bodies dutifully process whatever it is we choose to swallow – regardless of whether or not what we eat could actually harm us or shorten our lives. Our bodies are amazing as they try and pull out nutrients while trying to protect us from all the garbage. So – maybe – just maybe – we should try and give our bodies a break.
I’m Dr. Michael Greger and you’re listening to the Nutrition Facts podcast. I’m here to tell you that nutrition matters. We could choose a diet proven to not only prevent and treat but reverse our #1 killer, heart disease, along with other deadly diseases such as type 2 diabetes and high blood pressure. But many of us – don’t make that choice.
Our goal today is to help you make that choice – and present you with the results of the latest in peer-reviewed nutrition and health research, presented in a way that’s easy to understand.
Cholesterol is a vital component of our cells, which is why our body makes all that we need. For most Americans eating a conventional diet, cholesterol-laden plaque accumulates inside the coronary arteries that feed our heart muscle. This plaque buildup, known as atherosclerosis, is the hardening of the arteries by pockets of cholesterol-rich fatty material that builds up beneath the inner linings of our blood vessels. This process seems to occur over decades, slowly bulging into the space inside the arteries, narrowing the path for blood to flow.
So – knowing that – what would happen if you randomized babies at birth to a lifetime of low cholesterol levels? Nature did it for us! In this video, I introduce the concept of Mendelian randomization.
“It is well accepted that coronary atherosclerosis is a chronic progressive disease that begins early in life and slowly progresses over several decades before [symptoms arise]. However, the average age in cholesterol-lowering drug trials is 63, and therefore, people “had already been exposed to a lifetime of circulating LDL-[cholesterol].” So, no wonder pharmaceutical “therapies…typically [reduce] cardiovascular disease risk by [only] 20% to 30%.”
We know LDL, so-called bad cholesterol, plays “a central role…in the initiation, development, and progression” of our #1 killer. Over a hundred prospective studies involving more than a million people have demonstrated that those with higher LDL levels are at higher risk.
“It seems reasonable to assume…that if lowering [cholesterol] later in life” can help, then “keeping LDL[-C] levels low…earlier” in life may prevent our arteries from getting clogged in the first place. But, let’s not just assume.
“It would be [considered]…unethical to set up a controlled clinical trial in which young adults with elevated serum cholesterol levels were treated or not treated over their lifetime”—just like you couldn’t ethically set up a study in which half the kids are made to start smoking, to see if smoking really does cause lung cancer. That’s where observational studies come in. You can follow people who already smoke, and compare their disease rates to those that don’t.
It’s like 40 years ago, when the president of the American Heart Association tried to argue that we should all stop smoking—even though there were no randomized controlled trials. Look, those who smoke have a higher risk of heart attack; the more we smoke the higher the risk; and, after we stop, our risk drops. The same can be said for high cholesterol.
If you look at young men, aged 18 through 39, and follow them for up to 34 years, cholesterol levels, even when you’re young, predict long-term risk of heart disease and death. Men in their 20s and 30s who have a total cholesterol even just under 200, have a “substantially longer estimated life expectancy”—around four to nine years longer—than those over 240.
“Evidence from observational studies, however, [is] vulnerable to [so-called] confounding [factors].” Eating a diet plant-based enough to lower cholesterol below average may add years to our lives, regardless of what our cholesterol is. Ideally, we’d have “a long-term randomized controlled trial.”
And, nature may have actually set one up for us. Each of us, at conception, gets a random assortment of genes from our mother and our father, and some of those genes may affect our cholesterol levels. Just like there’s rare genetic mutations that result in unusually high cholesterol, there are rare genetic mutations that lead to unusually low cholesterol—providing an ideal system “to assess the consequences of low LDL cholesterol levels independent…of” confounding diet and lifestyle factors.
About 1 in 40 African Americans have a mutation that drops their LDL cholesterol from up around 130 down towards more optimal levels. Now, this group didn’t eat healthy to get there. It’s just in their genes. More than half had high blood pressure; there were lots of smokers and diabetics, yet those with genetically low LDL levels still had a “significant reduction in the incidence of [coronary heart disease]…even in the presence of [all these other] risk factors. How significant? How much less heart disease? How about 88% of heart disease gone?
The astounding finding was that the heart disease risk in these individuals was reduced by more than 80%; whereas, the same 20- to 40-point decrease in LDL from drugs only reduces risk like 30%. Makes sense, though, right? The folks with the mutation had low levels like that their whole life; they didn’t just start taking some pill when they were 60 years old.
“The magnitude of the effect of long-term exposure to lower LDL[-cholesterol] concentrations observed in each of these studies represents threefold greater reduction in the risk of [heart disease],” compared to drug treatment “started later in life.”
“Therefore, a primary prevention strategy that promotes keeping LDL[-cholesterol] levels as low as possible, beginning as early in life as possible, and sustaining those low levels of LDL[-cholesterol] throughout the whole of one’s lifetime has the potential to dramatically reduce the risk of [coronary heart disease].” And, that’s just what a healthy diet can do.
In our next story – we take a look at the amazing benefits of amla— or dried Indian gooseberries, on cholesterol. Are they too good to be true?
“Medicinal plants are [said to be] nature’s gift to human beings to promote a disease-free healthy life”—here in reference to amla, a fruit, the Indian gooseberry, described as an “Ayurvedic wonder.” You hear a lot of that larger-than-life talk about amla coming out of Indian medical journals. Who can forget “Amla…, a wonder berry in the treatment and prevention of cancer.” Amla is so revered that you find serious scientists, at serious academic institutions, and serious peer-reviewed medical journals, making statements like this: “[E]very part of the [Indian gooseberry] plant has its unique therapeutic characteristic for the remedy of almost all the ailments…[and] can be adopted as a single bullet [against disease].” Okay, then.
I first ran across it looking at the total antioxidant content of thousands of different foods.
I did a series of videos about it ages ago. And, to my surprise, the #1 most antioxidant-packed single whole food on the planet, on average, was amla: dried powdered Indian gooseberries, beating out the prior heavyweight champion, cloves, with, just for comparison’s sake, up to a hundred times or more antioxidants by weight than blueberries.
So, here’s this fruit that has enjoyed “a hallowed position in Ayurveda,” the ancient system of medicine in India—so hallowed it was mythologically pegged as “the first tree…in the universe.” So, for thousands of years—before we even knew what an antioxidant was—they were revering this plant that just so happens to turn out to be the most antioxidant-packed fruit on the planet Earth. Okay, you got my attention. But, I still needed to see it put to the test.
Well, indigenous tribal healers used amla to treat diabetes. So, researchers decided to give it a try. In fact, the subject of one of my first Nutrition Facts videos of all time, over five years ago: the effect of amla fruit on the blood sugars and cholesterol levels of normal subjects and type 2 diabetic patients. In my video, I talked about the jaw-dropping effects of five cents’ worth of this powdered fruit— five pennies’ worth—compared to a diabetes drug. But, what about the cholesterol effects?
If you take healthy individuals and give them a placebo sugar pill, nothing much happens to their cholesterol. Ideally, we want our total cholesterol under 150. This was a pretty healthy group; the average cholesterol in the U.S. is over 200, which is where the diabetics started out in this study. And, when you give them placebo pills, nothing much happens either. But, give people just about a half-teaspoon of amla powder a day—not some extract or something, just dried Indian gooseberries, a powdered fruit–absolutely astounding! That’s the kind of thing we see like six months after putting people on statin drugs.
What we care about most is LDL, the so-called bad cholesterol, shooting for under at least 70, ideally. No impact of the placebos, but again, just about a half-teaspoon of amla, which would cost you about five cents a day. That’s why I was so excited, after all these years, to dig back into the amla literature to see if these findings had been confirmed or replicated elsewhere. So, I typed amla into PubMed, and waded through all the papers on using amla to decrease methane in cow farts, and speed the growth of chickens, or hey, what about amla ice cream? After all, amla is packed with fiber and phytonutrients. In contrast, ice cream is not.
And now – we put Indian gooseberry extracts to the test – against cholesterol-lowing statin drugs and the blood thinners aspirin and Plavix.
Indian gooseberries, otherwise known as amla, have been touted as everything from a cancer fighter to a “hair tonic” to a “refrigerant,” whatever that means—what, like Freon? Not to mention, a “snake venom detoxifier.” Based on what kind of research?
Yes, “[d]ietary intake of [both turmeric and amla] increases the lifespan [of fruit flies].” But, do we really care about the effects of amla on the lifespan, or the “sexual behavior” for that matter, of fruit flies? How do you even study the sexual behavior of fruit flies? Why, obviously, you just introduce “a virgin female and [a] bachelor male…into an “Elens-Wattiaux mating chamber.” Can you imagine having an insect-mating chamber named after you? Then, it’s just a matter of getting out a stopwatch. Twenty minutes is the average duration, but almost a half-hour on amla, the studly beast, and it dropped the mating latency, the time between when they were introduced to one another in the chamber, and when they started getting busy from ten down to seven…seconds! They don’t mess around. Well, actually, they do mess around—and quite rapidly. And, on amla, they lay more eggs, and more hatch into larvae. But, just like when you hear amla is “the best medicine to increase…lifespan,” you’re probably not thinking about flies. When you read about amla may be a “potent aphrodisiac”, you’re probably not thinking, “More maggots!”
They found extraordinary improvements in total cholesterol and LDL cholesterol—in actual humans, but that was compared to placebo. What about compared to simvastatin, a leading cholesterol-lowering drug, sold as Zocor? Treatment with the drug “produced significant reduction[s]” in cholesterol, as one would expect. But, so did the amla. In fact, you could hardly tell which was which. Now note, this was only about a 10 to 15% drop in total and LDL cholesterol. How about versus Lipitor, the cholesterol-lowering drug known as atorvastatin? No effect of taking placebos, but significant improvements for the drug, and significant improvements for two amla doses—but again, only about 15% or so. Did they just use the juice again? No, worse; some patented extract of amla. So, instead of five cents a day, it’s 50 cents a day, and doesn’t seem to work as well.
It’s like the cancer story. “For [Indian gooseberries] to become relevant clinically,” they’re praying that “patentable derivatives [be] synthesized. Without the possibility of patents, the pharmaceutical industry [isn’t going to] invest” in the research; their shareholders wouldn’t let them. It’s patents over patients. But, without that research, how can we ever prove its worth—or worthlessness, for that matter?
So, drug and supplement industry interest in patenting natural food product remedies is a double-edged sword. Without it, there would never have been this study—showing not only benefits for cholesterol, but also arterial function: reducing artery stiffness in the two amla-extract groups and the drug group, but not placebo, as well as a dramatic drop in inflammation; C-reactive protein levels cut in half.
So, amla—or at least amla extracts—”may be a good therapeutic alternative to statins in diabetic patients with [artery] dysfunction because it has [many of] the beneficial effects of the statins but without the well-known [potential] adverse [side-]effects of [the drugs]”—including muscle damage or liver dysfunction.
The amla extract was also compared to the blood-thinning drugs, aspirin and Plavix, often prescribed after heart attacks, and achieved about three-quarters of the same platelet aggregation-inhibiting effect as the drugs; significantly increasing the “bleeding and clotting time,” where they poke you with a needle, and see how many seconds it takes you to stop dripping. So, that’s actually a good thing, if you have a stent or something that you don’t want to clog up. But, it didn’t thin the blood outside the normal range, and so it may not unduly raise the risk of major bleeding.
It also appears to decrease the effects of stress on the heart. They had people plunge their hand into ice water, and keep it there until the pain became “unbearable.” This causes your arteries to constrict and your blood pressure to go up—but not as much if you’re taking amla extract. Good to know for your next ice bucket challenge.
To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts podcast landing page. There, you’ll find all the detailed information you need plus links to all the sources we cite for each of these topics.
Be sure to also check out my new How Not to Die Cookbook , beautifully designed, with more than 100 recipes for delicious, life-saving, plant-based meals, snacks, and beverages. And, like all my books, DVDs, and speaking engagements, all the proceeds I receive are donated to charity.
NutritionFacts.org is a nonprofit, science-based public service, where you can sign up for free daily updates on the latest in nutrition research via bite-sized videos and articles.
Everything on the website is free. There are no ads, no corporate sponsorship. It’s strictly non-commercial. I’m not selling anything. I just put it up as a public service, as a labor of love, as a tribute to my grandmother, whose own life was saved with evidence-based nutrition.
Thanks for listening to Nutrition Facts. I’m Dr. Michael Greger.
This is just an approximation of the audio content, contributed by Allyson Burnett.
Beans, Beans: The Truth About Lectins
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Study challenges “good” cholesterol’s role in universally predicting heart disease risk
Lower levels of HDL cholesterol were associated with increased risks for heart attacks in white but not Black adults, and higher levels were not protective for either group
A National Institutes of Health-supported study found that high-density lipoprotein (HDL) cholesterol, often called the “good cholesterol,” may not be as effective as scientists once believed in uniformly predicting cardiovascular disease risk among adults of different racial and ethnic backgrounds. The research, which published in the Journal of the American College of Cardiology , found that while low levels of HDL cholesterol predicted an increased risk of heart attacks or related deaths for white adults – a long-accepted association – the same was not true for Black adults. Additionally, higher HDL cholesterol levels were not associated with reduced cardiovascular disease risk for either group.
“The goal was to understand this long-established link that labels HDL as the beneficial cholesterol, and if that’s true for all ethnicities,” said Nathalie Pamir, Ph.D., a senior author of the study and an associate professor of medicine within the Knight Cardiovascular Institute at Oregon Health & Science University, Portland. “It’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions.”
To do that, Pamir and her colleagues reviewed data from 23,901 United States adults who participated in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS). Previous studies that shaped perceptions about “good” cholesterol levels and heart health were conducted in the 1970s through research with a majority of white adult study participants. For the current study, researchers were able to look at how cholesterol levels from Black and white middle-aged adults without heart disease who lived throughout the country overlapped with future cardiovascular events. Study participants enrolled in REGARDS between 2003-2007 and researchers analyzed information collected throughout a 10- to 11-year period. Black and white study participants shared similar characteristics, such as age, cholesterol levels, and underlying risk factors for heart disease, including having diabetes, high blood pressure, or smoking. During this time, 664 Black adults and 951 white adults experienced a heart attack or heart attack-related death. Adults with increased levels of LDL cholesterol and triglycerides had modestly increased risks for cardiovascular disease, which aligned with findings from previous research.
However, the study was the first to find that lower HDL cholesterol levels only predicted increased cardiovascular disease risk for white adults. It also expands on findings from other studies showing that high HDL cholesterol levels are not always associated with reduced cardiovascular events. The REGARDS analysis was the largest U.S. study to show that this was true for both Black and white adults, suggesting that higher than optimal amounts of “good” cholesterol may not provide cardiovascular benefits for either group.
“What I hope this type of research establishes is the need to revisit the risk-predicting algorithm for cardiovascular disease,” Pamir said. “It could mean that in the future we don’t get a pat on the back by our doctors for having higher HDL cholesterol levels.”
Pamir explained that as researchers study HDL cholesterol’s role in supporting heart health, they are exploring different theories. One is quality over quantity. That is, instead of having more HDL, the quality of HDL’s function – in picking up and transporting excess cholesterol from the body – may be more important for supporting cardiovascular health . They are also taking a microscopic look at properties of HDL cholesterol, including analyzing hundreds of proteins associated with transporting cholesterol and how varying associations, based on one protein or groups of proteins, may improve cardiovascular health predictions.
“HDL cholesterol has long been an enigmatic risk factor for cardiovascular disease,” explained Sean Coady, a deputy branch chief of epidemiology within the National Heart, Lung, and Blood Institute (NHLBI)’s Division of Cardiovascular Sciences. “The findings suggest that a deeper dive into the epidemiology of lipid metabolism is warranted, especially in terms of how race may modify or mediate these relationships.” The authors conclude that in addition to supporting ongoing and future research with diverse populations to explore these connections, the findings suggest that cardiovascular disease risk calculators using HDL cholesterol could lead to inaccurate predictions for Black adults.
“When it comes to risk factors for heart disease, they cannot be limited to one race or ethnicity,” said Pamir. “They need to apply to everyone.”
The REGARDS study is co-funded by the National Institute of Neurological Disorders and Stroke and the National Institute of Aging and received additional support from NHLBI. To learn more about cholesterol and heart health, visit https://www.nhlbi.nih.gov/health/blood-cholesterol . To learn about heart-healthy living, visit https://www.nhlbi.nih.gov/health/heart-healthy-living . Study: Zakai NA, Minnier J, Safford MM, et al. Race-dependent association of high-density lipoprotein cholesterol levels with incident coronary artery disease. J Am Coll Cardiol . 2022; doi: 10.1016/j.jacc.2022.09.027.
About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit www.nhlbi.nih.gov .
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .
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Heart Health
The new cholesterol guidelines: What you need to know
- By Deepak L. Bhatt, M.D., M.P.H , Former Editor in Chief, Harvard Heart Letter
The new cholesterol guidelines from the American College of Cardiology and American Heart Association are out! These guidelines — last updated in 2013 — have been highly anticipated by the cardiology and broader medical community. They have been approved by a variety of additional professional societies, including the American Diabetes Association. Thus, the majority of physicians are very likely to follow them. So, what exactly is new and what do you need to know?
It starts with a healthy lifestyle, with statins for those who need them
A healthy diet and regular physical activity are recommended for all age groups as the foundation to prevent cardiovascular disease (CVD) and CVD risk factors such as high cholesterol.
However, once there is atherosclerotic cardiovascular disease (plaque in the arteries), the new guidelines recommend that high-intensity statin therapy or maximally tolerated statin therapy should be used, in addition to lifestyle modification, to reduce low-density lipoprotein cholesterol (LDL-C). For example, this recommendation applies to patients with a history of prior cardiovascular events such as heart attacks, or of procedures such as stenting. The goal is to lower LDL-C levels by 50% or more.
Cholesterol targets are back!
Much to the delight of physicians, concrete LDL-C targets have been reintroduced into this version of the guidelines. For individuals with atherosclerotic cardiovascular disease who are at very high risk of cardiac complications, drug therapy beyond statins is recommended to achieve a target LDL-C of 70 mg/dl.
The first addition beyond high-intensity statins would be the now generic ezetimibe, a cholesterol-lowering drug that works by preventing the absorption of cholesterol in the intestine. If that does not do the trick, the injectable PCSK9 inhibitors are considered a reasonable next step, with the caveat that the drugs are expensive and their long-term safety beyond three years is not well established. However, since the guidelines were finalized, one of the two companies that makes PCSK9 inhibitors has lowered the list price. This may ultimately help make these potent cholesterol reducing drugs more cost-effective.
The same algorithm as above is recommended for otherwise healthy people whose LDL-C is greater than or equal to 190 mg/dL. In this case, however, the target is 100 mg/dL instead of 70 mg/dL, presumably because there is no evidence (yet) of actual atherosclerosis.
In people 40 to 75 years of age with diabetes who have an LDL-C greater than or equal to 70 mg/dL, a moderate-intensity statin is recommended. If there are additional risk factors or the person is 50 years or older, then a high-intensity statin is considered reasonable.
The above recommendations are not controversial among expert physicians in the field. In fact, some may say that these guidelines are not aggressive enough in terms of wanting lower cholesterol targets in very high risk patients. But none who understand the data would disagree with the above guidelines as general starting points. If you have atherosclerotic cardiovascular disease, a very high cholesterol level, or diabetes, then, in addition to a healthy lifestyle, you really ought to be on a statin, assuming you can tolerate it, and maybe additional medications, depending on your cholesterol level.
What about healthy people with moderately elevated cholesterol levels?
What about healthy people who don’t fit into the above categories? The guidelines provide clear guidance, but things do get a bit more nuanced. Here, there really needs to be a discussion between the patient and their doctor.
Whether to start a statin or not depends on whether there are other cardiovascular risk factors, such as smoking, high blood pressure, or diabetes, and the actual LDL-C level. A family history of premature atherosclerotic cardiovascular disease would be another factor to consider, as might South Asian ethnicity or premature menopause (before age 40). Other blood test abnormalities, such as elevated triglycerides or elevated high-sensitivity C-reactive protein levels (a marker of inflammation), might also push towards starting someone on a statin. Another recommendation in the new guidelines is for potential use of coronary artery calcium (CAC) scans to decide whether or not to initiate statin therapy in select cases where the decision based on clinical risk factors is unclear. Patient preferences and cost (though most statins are now generic) are other potential issues to weigh. Online risk calculators may help.
Bottom line: If you are one of the large number of people who fall into this category, talk to your doctor about whether you should be on medications to lower your cholesterol, or whether lifestyle changes are enough.
Follow me on Twitter @DLBHATTMD
About the Author
Deepak L. Bhatt, M.D., M.P.H , Former Editor in Chief, Harvard Heart Letter
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Link between high cholesterol and heart disease 'inconsistent', new study finds
New research from RCSI University of Medicine and Health Sciences has revealed that the link between 'bad' cholesterol (LDL-C) and poor health outcomes, such as heart attack and stroke, may not be as strong as previously thought.
Published in JAMA Internal Medicine , the research questions the efficacy of statins when prescribed with the aim of lowering LDL-C and therefore reducing the risk of cardiovascular disease (CVD).
Previous research has suggested that using statins to lower LDL-C positively affects health outcomes, and this is reflected in the various iterations of expert guidelines for the prevention of CVD. Statins are now commonly prescribed by doctors, with one third of Irish adults over the age of 50 taking statins, according to previous research.
The new findings contradict this theory, finding that this relationship was not as strong as previously thought. Instead, the research demonstrates that lowering LDL-C using statins had an inconsistent and inconclusive impact on CVD outcomes such as myocardial infarction (MI), stoke, and all-cause mortality.
In addition, it indicates that the overall benefit of taking statins may be small and will vary depending on an individual's personal risk factors.
The lead author on the paper is Dr Paula Byrne from the HRB Centre for Primary Care Research based in RCSI's Department of General Practice. Commenting on the findings, Dr Byrne said: "The message has long been that lowering your cholesterol will reduce your risk of heart disease, and that statins help to achieve this. However, our research indicates that, in reality, the benefits of taking statins are varied and can be quite modest."
The researchers go on to suggest that this updated information should be communicated to patients through informed clinical decision-making and updated clinical guidelines and policy.
This important discovery was a collaboration with Professor Susan M Smith, also of RCSI and with researchers from the University of New Mexico, USA, (Dr Robert DuBroff), the Institute for Scientific Freedom in Denmark (Dr Maryanne Demasi), Bond University in Australia (Dr Mark Jones) and independent researcher Dr Kirsty O'Brien.
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Materials provided by RCSI . Note: Content may be edited for style and length.
Journal Reference :
- Paula Byrne, Maryanne Demasi, Mark Jones, Susan M. Smith, Kirsty K. O’Brien, Robert DuBroff. Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment . JAMA Internal Medicine , 2022; DOI: 10.1001/jamainternmed.2022.0134
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Cholesterol is a natural component in everyone’s blood, and supports normal function of cell membranes, hormone levels and more. However, having too much, is considered hyperlipidemia, hypercholesterolemia or high blood cholesterol — a major risk factor for heart attack, heart disease and stroke. About 71 million Americans have high cholesterol.
Here’s what happens in your body when you have high cholesterol: The waxy cholesterol builds up in artery walls and contributes to plaque, a hard deposit that narrows and clogs the arteries. (You may hear this referred to as atherosclerosis, or “hardening of the arteries.”)
When plaque builds up, it becomes harder for the heart to circulate blood and oxygen, which can cause chest pain or shortness of breath with increased exertion (angina). If a blood clot forms at the site of a disrupted plaque in a narrowed artery, it can block blood flow to the brain (a stroke) or to the heart (a heart attack).
There are actually several different types of cholesterol, one of which is high density lipoprotein (HDL) cholesterol. High levels of some kinds of cholesterol, including low density lipoprotein (LDL) cholesterol, can be harmful to your heart and blood vessels.
To keep blood cholesterol numbers in a desirable range, it helps to follow these practices:
- Know your numbers. Adults over age 20 should have their cholesterol measured at least every five years. That gives you and your doctor a chance to intervene early if your numbers start to rise.
- Stick to a healthy diet. Saturated fats, trans fats and dietary cholesterol can all raise cholesterol levels. Foods thought to keep cholesterol low include monounsaturated fats (such as nuts and olive oil), polyunsaturated fats (such as fish and canola oil) and water-soluble fiber (such as oats, beans and lentils). Get practical ideas to on eating for cardiovascular health .
- Exercise and manage your weight. Along with a healthy diet, staying fit and maintaining a normal weight for your height lower your cardiovascular risks by minimizing the odds of other contributing health problems like obesity and diabetes. If you’re overweight, losing as little as 5 to 10 percent of your weight can significantly lower your risk of cardiovascular disease. Learn how implementing an exercise routine helps your heart in The ABCs of Moving More for Heart Health .
Only one in three people who have high LDL cholesterol have the condition under control. The main goal of treatment is to lower, or control, your LDL level to minimize your personal risk for heart attack or cardiovascular disease, based on your cholesterol numbers and other risk factors, such as a history of cardiovascular disease.
Lifestyle changes are recommended for anyone with high cholesterol. These include:
Diet upgrades . First on the treatment menu is a heart-healthy diet. “I find that my patients generally love the Mediterranean diet ,” says Johns Hopkins Ciccarone Center cardiologist Michael Blaha, M.D., M.P.H. “It tastes great, it’s satiating, and there’s excellent evidence that it reduces cholesterol and cardiovascular risk.”
Highlights of the Mediterranean diet include reducing saturated fat (found in animal products, butter, whole and 2% dairy products, coconut oil and palm oil) and trans fats (found in fried foods and baked goods). Eat mostly polyunsaturated or monounsaturated fats (found in fish, avocadoes, olive oil, nuts, and canola and soybean oil). Alcohol can raise triglycerides, so you may be advised to cut back.
Regular exercise . Aim for at least 30 minutes of exercise a day, most days. The American Heart Association recommends 40 minutes of moderate to vigorous exercise three to four times per week.
Weight management . This step is especially important for those who are overweight and who have high triglyceride levels or too-big waistlines (above 40 inches for men or 35 inches for women).
Medications . In addition to lifestyle changes, some people are prescribed drugs designed to lower cholesterol. Here are some of those medications:
- Statin medications slow the liver’s production of cholesterol and can help remove cholesterol circulating in the blood.
- Selective cholesterol absorption inhibitors (like ezetimibe) prevent the absorption of cholesterol from the intestine and help removal in the liver.
- PCSK9 inhibitors may be available for patients with high cholesterol in certain circumstances.
- Resins (bile acid sequestrants) bind to bile, a digestive acid, which causes the liver to produce more bile and thus use up more cholesterol.
- Fibrates lower triglycerides (rather than LDL levels).
- Niacin (nicotinic acid) is a B vitamin that affects the production of fats in the liver.
- Omega-3 fatty acid medications derived from fish oils also work to lower high triglyceride levels.
Lowering Your Cholesterol
Working to lower your cholesterol can be a long-term effort, and changing your health habits is key, Blaha says. To increase your odds of success:
- Don’t count on medications alone . You have to make lifestyle changes as well, according to Blaha.
- Start small . Modifying your diet and lifestyle in minor ways will make it easier to incorporate those changes into your life over the long haul. For example, rather than embarking on a drastic calorie-cutting diet, start by swapping out high-cholesterol and high-fat foods you love for healthier choices. For instance, buy skim milk instead of whole. Substitute olive oil for butter when you cook. Purchase foods with “no trans fats” on the labels.
- Know your cholesterol-lowering drugs . Some of these medications interact with grapefruit and pomegranate (and their juices). Pay close attention to your doctor’s guidelines about cholesterol drugs, and never stop taking them without consulting your physician. Be sure to report medication side effects to your doctor.
New guidelines for LDL levels and addressing cardiovascular disease risk
New guidelines for assessing your heart disease give you and your doctor powerful tools for estimating your cardiovascular disease risk and lowering your LDL cholesterol levels. Working with your health care team, you can create a plan with a customized combination of lifestyle changes, medications and continued monitoring.
A cost-effective test can detect the early risk factors for heart disease
Using computerized tomography (CT), a coronary artery calcium scan can detect calcium and plaque in the walls of your heart’s arteries. The test is relatively inexpensive and can reveal early warning signs of heart disease so you can take action to lower your risk.
PSCK9 inhibitors can lower your LDL cholesterol: a lot
PSCK9 inhibitors may be a good choice for people with an inherited form of high cholesterol. These new drugs can lower dangerous LDL levels by half or more. The drugs’ costs are high, but the health care industry is working with manufacturers and pharmacists to bring the price down and make PSCK9 inhibitors available to more people.
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What’s New in Cholesterol Treatment
By Joyce Oen-Hsiao, as told to Keri Wiginton
Right now, cholesterol treatment is more about finding ways to combine current cholesterol drugs a little bit differently and target treatment based on the person themselves. It’s not just standardized -- giving everyone a statin right away. New research is about targeting which therapies are better for the elderly, which therapies are better for people with cancer, things like that.
New Treatments for High Cholesterol
There’s a new drug called Nexletol, and it’s used for people with the highest risk. That’s people with genetic or familial high cholesterol or those who have heart disease and further need to lower their cholesterol. It’s called bempedoic acid. It works to lower the cholesterol your liver makes.
Statins are different because they lower cholesterol in the blood by reducing the liver’s ability to make cholesterol. This then allows the liver to accept more cholesterol from the blood, thereby driving down cholesterol levels. They can drive down low-density lipoprotein (LDL) through the HMG receptor. This is an enzyme that processes cholesterol in the body. But Nexletol actually holds up cholesterol production in the liver as well, but through a different enzyme on a pathway known as the ACL pathway.
Other drugs that have come over the last couple of years are the PCSK9 inhibitors. These are great because they act to lower the cholesterol in a totally different way than a statin. They don’t give the muscle aches. And they don’t necessarily give the liver toxicity, as well.
The only issue with a PCSK9 inhibitor is that it’s an injection. Luckily, you only have to give yourself a shot every 2 weeks, so it’s really not that often. We’ve been using it a lot more in people who have trouble getting their LDL controlled.
It’s also very good for people with familial hypercholesterolemia. This is an inherited disorder in which the body doesn’t recycle LDL cholesterol correctly, so your blood levels are always high unless you get treatment. FH happens when there is a mutation to one of several genes in the body. Most often it is in the LDL-receptor gene that helps to find and remove cholesterol in the body.
Nexletol is also a good starting point before you start doing LDL apheresis -- when doctors filter your blood to remove LDL cholesterol.
Another newer option is actually a statin. It’s called pitavastatin, or Livalo. It has the same LDL- and total cholesterol-lowering property as all the other statins, but somehow doesn’t give the muscle aches. A lot of people have had a lot of success taking this over any of the other statins out there. It gets their LDL down to where it needs to be.
A Healthy Lifestyle Still Matters
Most of the time, if people get onto a good lifestyle modification of diet and exercise, they can usually drop their bad cholesterol maybe about 20-30 points. They can often drop their statin to the lowest dose, if they continue following those good lifestyle choices.
And I’ve seen a handful of people who’ve been able to come completely off cholesterol medications.
More often than not, I ask people to make lifestyle changes, and they say, “Doc, you know I’m not going to exercise.” Then we talk about their risk factors. I say, “OK, if you’re not going to change your lifestyle, then at this point we have to give you medication to lower your cardiovascular risk of stroke and myocardial infarction and other health problems.” If you do it right, you can have this open dialogue with people to figure out what is the best option for them.
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Making sense of cholesterol – the good, the bad and the dietary
Sep 16, 2020
It's Cholesterol Education Month, a good time to protect your health by sorting out the sometimes-confusing facts.
Categories: Cholesterol | Tags: Cholesterol , Food & Nutrition News , Prevention
Inherited high cholesterol may be common in people with heart disease
May 29, 2020
Familial hypercholesterolemia, a genetic disorder that causes high LDL cholesterol, affects 1 in 17 people with cardiovascular disease, researchers reported.
Categories: Cholesterol | Tags: Cholesterol , Heart disease
Why do women get cholesterol-lowering statins less frequently than men?
Aug 19, 2019
Women with high cholesterol are less likely than men to be offered statins to reduce their heart disease risk. A new study looks into why.
Categories: Cholesterol | Tags: Cholesterol , Heart disease , Stroke News
More clues to the genetics behind an inherited cholesterol disorder
May 15, 2019
Familial hypercholesterolemia remains largely underdiagnosed and undertreated, but researchers are discovering new clues to the cause of this genetic disorder that leads to premature heart disease.
Dangerous blood clots may be the latest risk from 'bad' cholesterol
May 14, 2019
It was known to narrow arteries, which can lead to heart attacks and strokes. But LDL cholesterol is now suspected of contributing to venous thromboembolism, too.
Safety of statins emphasized in new report
Dec 10, 2018
Statins are safe medications, and people with or at risk for heart disease and stroke should take them as directed, according to a new scientific statement from the American Heart Association.
Coronary calcium test could help clarify heart disease risk – and control cholesterol
Nov 13, 2018
When a patient's risk for heart disease is unclear, a screening for calcium in the arteries can help doctors define a plan of action for reducing cholesterol and cardiovascular risk.
Categories: Cholesterol | Tags: Cholesterol , Heart disease , Scientific Sessions
New guidelines: Cholesterol should be on everyone's radar, beginning early in life
Nov 10, 2018
New cholesterol guidelines say managing the waxy, fat-like substance in the blood should be a concern for all ages.
Categories: Cholesterol | Tags: Cholesterol , Scientific Sessions , Heart disease
Questions about cholesterol? Here are some answers.
Cholesterol is tricky to understand, but here are some basics.
Categories: Cholesterol | Tags: Cholesterol , Scientific Sessions
Researchers suggest way to possibly eliminate artery-clogging condition
Oct 4, 2018
Researchers have proposed a unique clinical trial to reduce the early onset of atherosclerosis, the buildup of the plaque in the arteries that can lead to heart attacks and strokes.
Guidelines Resource Center
The American Heart Association regularly releases guidelines and scientific statements for preventing and treating heart disease and stroke.
What do these guidelines mean for you? Should you change your medications? Should you see a doctor for treatment? How do you know if you’re healthy? You’ll find answers here in the Guidelines Resource Center.
Active Wellness Blog
New Research on Cholesterol and Heart-Health
Within our bodies millions of processes occur every day, such as turning the foods we eat into energy. These processes require oxygen. Byproducts of using oxygen are called oxidants, often referred to as “free radicals”. Free radicals can also be introduced to our bodies through external sources such as tobacco smoke, pollution, and exposure to the sun. In the same way that oxidation can cause rust on the surface of some objects, free radicals can cause damage to cell walls, cell structures and even the genetic material of a cell. If the genetic material of a cell is attacked, this can lead to changes in the body’s DNA “genetic blue print” and has been linked to a number of diseases, including cardiovascular disease. 1
Antioxidants work to deactivate free radicals by binding to oxidants, which prevents the damage from occurring. Diets high in antioxidant-rich foods, that is, foods containing vitamin C, vitamin E, selenium and carotenoids, such as beta-carotene, lycopene, lutein, and zeaxanthin, have been linked to a reduced risk of developing heart disease. As a result, current national guidelines on the prevention of cardiovascular disease recommend choosing foods rich in antioxidants. 2
Berries contain a variety of antioxidants, which help keep free radicals under control. Anthocyanins, ellagic acid and resveratrol are types of antioxidants found in an assortment of berries. One study showed that blueberries, blackberries and raspberries have the highest antioxidant activity of commonly consumed fruits, next to pomegranates. 3
Studies suggest that the antioxidants in berries may help lower inflammation. Long-term inflammation arising from chronic stress, sedentary lifestyles and unhealthy food choices can lead to diabetes, heart disease and obesity, 4 so berries are really a big deal in counteracting those negative effects! But that’s not all that berries can help do.
Test-tube and human studies suggest that berries may protect cells from high blood sugar levels, help increase insulin sensitivity, and reduce blood sugar and insulin response to high-carb meals. Importantly, these effects appear to occur in both healthy people and those with insulin resistance. 5
In one study of healthy women, eating 5 ounces (150 grams) of puréed strawberries or mixed berries with bread led to a 24–26% reduction in insulin levels, compared to consuming the bread alone. 6 Moreover, in a six-week study, obese people with insulin resistance who drank a blueberry smoothie twice per day experienced greater improvements in insulin sensitivity than those who consumed berry-free smoothies. 7
Berries are also an excellent source of soluble fiber, which is known to be important for slowing down the movement of food through the digestive tract. This slower movement helps us feel full for a longer period of time. Ideally, this may help us eat less and make weight management easier. One study found that doubling fiber intake could help absorb up to 130 fewer calories per day. 8
Unsurprisingly, berries are considered heart-healthy food that may help lower LDL levels and help protect the bad cholesterol from becoming oxidized, which may reduce the risk of heart disease. In a controlled study of obese people, those eating 1.5 ounces (50 grams) of freeze-dried blueberries for 8 weeks noticed a 28% reduction in their oxidized LDL levels. 9
Berries are highly nutritious, may provide a variety of health benefits, and are easy to incorporate into an Active Wellness nutritional plan! Kenzen® Super Ciaga® powder makes it even simpler if you find it hard to access fresh berries. Simply combine it with PiMag® water or blend into smoothies for an energy and antioxidant boost!
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1, 2 https://my.clevelandclinic.org/health/articles/16739-antioxidants–heart-health
3, 4, 5, 6, 7, 8, 9 https://www.healthline.com/nutrition/11-reasons-to-eat-berries#:~:text=Berries%20are%20some%20of%20the,cholesterol%2C%20while%20reducing%20oxidative%20stress
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Study: 20% of patients refused cholesterol-lowering drugs, despite benefits
Cardiovascular disease is the number one killer worldwide. Twenty million U.S. adults have it. Yet, many patients are refusing one of medicine’s best tools for addressing the condition.
A new study in JAMA Network Open, found that roughly 20% of high-risk patients don’t take statins, even when their doctor recommends them. Statins are a group of cholesterol-lowering medications, taken as a daily pill, that have been shown to protect against heart attacks and strokes.
The new study found that one group is particularly resistant to taking this type of medication: women.
WBUR spoke with Alexander Turchin, co-author of the study and the director of quality in the Division of Endocrinology at Brigham and Women’s Hospital.
The conversation has been edited for clarity and brevity.
On the results of the study:
“The idea for this research started with my patients. I noticed that some of them did not accept my recommendation of statin therapy, often without ever trying them. And so that made me wonder whether this is part of a broader phenomenon.
“So we conducted a population-based study that involved over 24,000 people. We looked at the data in electronic medical records over nearly 20 years. And we found that, in fact, this is common.
“Even when we focused on individuals at high risk of cardiovascular disease — for example, they already had cardiovascular disease or they had diabetes, which puts people at very high risk for cardiovascular disease, or they had very high cholesterol levels — we found that one in five individuals, when initially recommended statin therapy, do not accept this recommendation from their clinician.”
And you also found a gap between men and women, is that right?
“That’s exactly right and this wasn’t what we expected. We found that women were about 20% more likely than men to not accept a statin therapy recommendation. And as time went on, this gender gap increased. Ultimately, many people change their mind and do accept the statin therapy recommendation. But men are more likely to change their mind than women.
“By the end of the study — we followed people for a little less than eight years — women were 50% more likely, on average, to never accept a statin therapy recommendation compared to men.”
Are these differences between women and men a result of them having different medical conditions? Say, one group is more likely to get diabetes or heart disease.
“We looked at that and even when we looked by subgroups — say just patients who have coronary artery disease or just patients who have stroke — we found the same thing. Women are more likely than men to not accept the recommendations of statins.”
What are the implications of this in terms of the patient’s health?
“The implications can be very significant. Statins decrease their risk of heart attacks. They decrease the risk of ischemic strokes. They decrease the risk of cholesterol building up and blocking blood vessels that supply oxygen and nutrients to the tissues.
“If people aren’t taking these medications, they’re 20% more likely to have a heart attack or stroke.”
What was your reaction when you saw these numbers?
“We really need to work out how best to get the message across to patients. We need to be able to answer the patient’s questions, if they have concerns. We need to provide them all the information they need to make their health care decisions and, from what we know, the best health care decision for people at high risk for heart attacks and strokes is to take statins.”
Do you have a sense of why patients are refusing statins?
“We didn’t specifically address this in the study, so I can only speculate. But there is a lot of misinformation out there that tells people that statins are not a great thing.
“So, for example, if you go to Amazon and you put the word ‘statins’ in the search box, the first things that come back are books with titles like: A Statin-Free Life, The Dark Side of Statins, The Truth About Statins: Risks and Alternatives to Cholesterol Lowering Drugs. I’m not picking these out. These are the top things that come back in my search.
“Then you go to Facebook — and, of course, everyone gets slightly different results — but what I get when I put the word ‘statins’ in the search box is lists of groups with titles like: Stopped Our Statins or No More Statins.”
Are there drawbacks, side effects or reasons that patients legitimately wouldn’t want to take statins?
“No medication is without side effects. And there are some side effects that statins have. Some people can get muscle aches, for instance. They may increase your blood sugar slightly. However, the benefits that one can get are very substantial.
“There have been multiple studies, including hundreds of thousands of people, that have shown that statins reduce the risk of heart attacks and reduce the risk of ischemic strokes, particularly in individuals at high risk for these events.
“And, if you try statins and they don’t work, there are alternative medications that you can try. But in our study, very few people tried these alternative medications.”
Do we see this type of refusal with other prescription drugs or medical interventions?
“Yes. It’s not that uncommon.
“We’ve studied patients with diabetes who had high blood sugars and were offered insulin [by their doctor]. And we found that many of them refused that recommendation.
“Now, to some extent, that might be more understandable than statins because insulin is an injectable medication and some people don’t like to give themselves injections. And, since that study came out, there have been alternatives to insulin that have a lot of benefits.
“But we don’t have anything much better than statins and, certainly, we don’t have anything that has the combination of low-cost, effective and safe.”
This article was originally published on WBUR.org.
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March 1, 2023
Alzheimer's study links cholesterol and toxic protein clusters
by Texas A&M University
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Study: Over 20% of patients at high risk of cardiovascular disease refuse to take statin medications
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Heart disease is the leading cause of death worldwide, killing someone in the United States every 34 seconds, according to the Centers for Disease Control and Prevention. A new study by investigators from Brigham and Women's Hospital, a founding member of the Mass General Brigham healthcare system, conducted the first population-based study on patients' nonacceptance of statin therapy recommendations.
The study found that in patients at high risk of developing cardiovascular disease, over 20 percent refused to take statin medications. They were particularly surprised to see that women were about 20 percent more likely than men to refuse statin therapy when it was first suggested by their physician, and 50 percent more likely than men to never accept the recommendation. The study also showed that all patients who refused statin therapy developed higher LDL ("bad") cholesterol levels, likely increasing their risk even further. The results are published in JAMA Network Open .
"Our study highlights the alarming number of patients who refuse statins and signals that physicians must have discussions with patients about why," says Alex Turchin, MD, MS, an associate professor at Harvard Medical School and director of quality in the Brigham's Division of Endocrinology, Diabetes, and Hypertension. "We need to better understand what our patients' preferences are and to be able to provide more patient-centered care."
After Turchin began noticing that many of his patients with high cholesterol, including those with diabetes, were opting not to take safe and beneficial medications like statins that can lower cholesterol and bring down the risk of heart attack and stroke, he developed a system to more closely study the phenomenon by analyzing the text of provider notes.
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The study focused on high-risk patients who either had coronary artery or vascular disease, diabetes, very high cholesterol, or had suffered a stroke. All were recommended statin medications by their physicians to reduce their risk of heart attack and stroke and reduce cholesterol levels. The retrospective study included more than 24,000 patients who were seen at Mass General Brigham between Jan. 1, 2000, and Dec. 31, 2018.
"Even in this higher-risk patient population, so many people did not accept statin therapy," Turchin said. The study found that while about two-thirds of the patients who were being recommended statin therapy eventually tried it, about one-third never did. And it took three times as long for people in the study who initially said no to taking statin medications to reduce their LDL cholesterol levels to less than 100, compared to people who initially said yes.
The study's biggest surprise, however, was the much higher rate of refusal by women than men. Turchin and his colleagues wonder if this might be due in part to a false misconception that heart disease impacts men more than women, and plan to further research the reasons underlying these results.
"Ultimately, we need to talk to our patients and find out in more detail why they would prefer not to take statins," Turchin says. He is currently looking at the impacts of nonacceptance of statin therapy on outcomes that matter to most to patients including heart attacks, strokes, and death. "I think people underestimate how much of a difference modern medicine has made in extending people's lives, and their quality of life, and medications can play a big role in that."
Brigham and Women's Hospital
Brown, C., et al. (2023) Association of Sex Disparities in Nonacceptance of Statin Therapy and Low-Density Lipoprotein Cholesterol Levels Among Patients at High Cardiovascular Risk. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2023.1047 .
Posted in: Medical Research News | Medical Condition News
Tags: Cardiovascular Disease , Cholesterol , Diabetes , Endocrinology , Healthcare , Heart , Heart Attack , Heart Disease , High Cholesterol , Hospital , Lipoprotein , Medical School , Medicine , Proteomics , Research , Statin , Stroke , Therapeutics , Vascular
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Study: 1 in 5 patients at risk for cardiovascular disease refuses to take statins
Feb. 28 (UPI) -- Some 20% of patients at high risk of developing cardiovascular disease refuse to take physician-recommended statin medication, with that percentage significantly higher among women, a new study from Brigham and Women's Hospital in Massachusetts said Tuesday.
The study, published in JAMA Network Open, also showed that all the patients who refused the therapy went on to develop higher "bad" cholesterol levels, or LDL. That likely increased their risk even further, researchers said. Advertisement
The study said women were 20% more likely to refuse the statin treatment than men, and they were 50% more likely to never accept the doctor's recommendation.
"Our study highlights the alarming number of patients who refuse statins and signals that physicians must have discussions with patients about why," Alex Turchin, an associate professor at Harvard Medical School and director of quality in the Brigham's Division of Endocrinology, Diabetes and Hypertension, said in a statement. RELATED Angioplasty patients with depression less likely to take medication
"We need to better understand what our patients' preferences are and to be able to provide more patient-centered care."
The Centers for Disease Control and Prevention says that statins have been proven to lower LDL, or "bad" cholesterol, by slowing the liver's production of cholesterol. They also increase the liver's ability to remove LDL cholesterol that already is in the blood. Advertisement
"Ultimately, we need to talk to our patients and find out in more detail why they would prefer not to take statins," Turchin said. "I think people underestimate how much of a difference modern medicine has made in extending people's lives, and their quality of life, and medications can play a big role in that." RELATED Cholesterol-lowering statins may reduce risk for bleeding strokes
The study focused on more than 24,000 high-risk patients from 2000 to 2018 who either had coronary artery or vascular disease, diabetes, very high cholesterol, or had suffered a stroke.
Researchers said they were all recommended statin medications by their physicians to reduce their risk of heart attack and stroke and reduce cholesterol levels. Turchin said he started the research after noticing his own patients were rejecting statins over time.
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Women are much more likely to say no to cholesterol-lowering drugs, Boston researchers find
Heart disease is the number one killer in the United States, hands down, and cholesterol-lowering drugs, known as statins, have long proven successful in helping reduce the risk for heart attacks and strokes.
But a new study from Boston researchers finds that among patients at the highest risk of developing cardiovascular disease, more than one in five refused to take statin medication.
And those most likely to say “no thank you” were women. The study published Tuesday in JAMA Network Open found that women were about 20 percent more likely than men to refuse statin therapy when it was first suggested by their physician, and 50 percent more likely than men to never accept the recommendation.
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“It may be that some women are less accepting of the fact they have cardiovascular disease, that [they think] this is a man’s disease,” said Dr. Alexander Turchin, senior author of the study and director of quality in diabetes at Brigham and Women’s Hospital Division of Endocrinology, Diabetes, and Hypertension.
Heart disease is often underestimated in women, specialists say, because of the misperception that they are protected against heart problems. Their estrogen is heart protective, and women have a reduced risk for heart disease compared to similarly aged men. But women’s risk for cardiovascular problems rises substantially after menopause.
The study delved into the medical records of more than 24,000 patients within the Mass General Brigham health system from 2000 through 2018. The study, however, did not explore what prompted patients to decline statins.
The researchers focused on high-risk patients, with an average age of 59, who either had coronary artery or vascular disease, diabetes, very high cholesterol, or had suffered a stroke. All were recommended statin medications by their physicians to reduce their risk of heart attack and stroke and reduce cholesterol levels.
Dr. Rebekah Gardner, an attending physician at Rhode Island Hospital’s Center for Primary Care, said she finds that women are more likely to be reluctant about statins. She said it may be that women have read or heard about studies involving potential side effects from taking the drugs, such as muscle aches, and in those studies, women more frequently reported problems.
Gardner said women may also be more likely to share those thoughts and experiences with each other and also be more open to trying alternatives to statins.
“Women may be more motivated to try and make lifestyle changes before trying a medication, like changing up their diet or more exercise,” Gardner added. “I see that all the time as well.”
Who would be the best candidates for trying diet and exercise first?
“For many patients, a trial of diet and exercise would be a completely reasonable approach and may even be preferred because it would provide benefits beyond mitigating cardiovascular risk,” Gardner said in an e-mail. “Patients in this group might be those with a moderately elevated cholesterol level but without heart disease, diabetes, hypertension, tobacco use, etc.”
But she noted that for patients in the new study, lifestyle changes would be recommended in addition to the statin, not as a substitute.
“Statins would be the strong recommendation here because those patients are a very high-risk group, and, for them, prior research has shown that taking a statin can reduce heart attacks and strokes beyond lifestyle changes alone,” Gardner said.
One finding that surprised Turchin, the study’s senior author, is that patients most likely to decline statins had English as their primary language. He isn’t sure what to make of that, but wonders if these patients are more comfortable searching the Internet for information about statins and are then dissuaded from taking them by reams of often misleading articles about the medications.
When Turchin searched sites such as Amazon and Facebook, he said, mostly negative information popped up.
“The first thing that comes back is ‘a statin-free life,’ ‘the dark side of statins,’ ‘the truth about statin risks,’ and ‘alternatives to cholesterol-lowering drugs,’ ” he said.
Turchin said pharmaceutical companies had no input into the current statin study. He has, separately, received research grants from two companies that manufacture statin medications, but said the funding is for unrelated studies on obesity and potassium.
Other physicians who prescribe statins said the study’s findings about large numbers of patients declining the medications ring true in their experiences.
Dr. Russell Phillips, a primary care general internist at Beth Israel Deaconess Medical Center, said that often the decision by his patients to start taking a statin is not made in a single office visit, but stretches out over months and several discussions.
And that process, he said, can be challenging for time-pressured primary care physicians who must explain the need for lifelong treatment with a statin for something that is not causing the patient any apparent symptoms and seems like an abstract risk sometime in the future.
“I would love to have resources that I could direct patients to that would lay out the risks and benefits for them,” Phillips said. “There are decision aids created to help patients think about benefits for mammograms and colonoscopies, but not many for this decision.”
The Boston researchers found patients who were most likely to accept statins when they were recommended were those typically at the very highest risk for heart attacks and strokes: they either had diabetes, extremely high levels of LDL or “bad” cholesterol, a history of smoking, or had already suffered an adverse cardiac event.
That meshes with Dr. James Udelson’s experience.
“Once they have had something bad happen, it’s easier to get people to [take the medication], stop smoking, after they had a heart attack or stroke. It’s never easy but it’s easier,” said Udelson, chief of cardiology at Tufts Medical Center.
The study found that about two-thirds of the patients who were being recommended statin therapy eventually tried it. And, among those who initially declined but then relented, it took three times as long for them to reduce their LDL cholesterol levels to less than 100 milligrams per deciliter (a standard measure), compared to people who took the drugs right away.
Gardner, the Rhode Island Hospital physician, said the study provides physicians some valuable insights.
“Going into the encounter knowing that folks may decline and may later accept, that was a finding that I thought was really encouraging, that they might accept it later and so to not give up,” she said.
“Maybe I need to slow down and ask how they see the benefits and risk, and maybe we can find common ground.”
Kay Lazar can be reached at [email protected] Follow her on Twitter @GlobeKayLazar .
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Alzheimer’s study links cholesterol and toxic protein clusters
Department of biochemistry and biophysics study more closely connects diet and alzheimer’s disease development.
February 28, 2023
Cholesterol tremendously increases the toxicity of a peptide implicated in Alzheimer’s progression, according to research by scientists in the Department of Biochemistry and Biophysics in Texas A&M’s College of Agriculture and Life Sciences .
The study, “Lipids uniquely alter the secondary structure and toxicity of amyloid beta 1-42 aggregates,” by Dmitry Kurouski, Ph.D., and research assistants Kiryl Zhaliazka and Mikhail Matyeyenka, was supported by a $1.5 million Maximizing Investigators’ Research Award from the National Institutes of Health . It was published in FEBS Journal — the journal of the Federation of European Biochemical Societies.
“The study found that certain lipids can increase the toxicity of amyloid beta peptides, which are thought to play a role in the development of Alzheimer’s disease,” said Kurouski, an assistant professor and primary investigator for the study, Bryan-College Station. “Specifically, we discovered that the interaction between amyloid beta and lipids can cause the formation of small, toxic clusters called oligomers.”
Additionally, the study showed these lipids can alter the basic shape, or the secondary structure, of amyloid beta peptides, which can further increase their toxicity.
“This provides new insights into the mechanisms behind the toxic effects of amyloid beta in the brain,” Kurouski said.
He said the results of the study show a strong connection between Alzheimer’s disease and the change in the lipid composition of neuronal membranes, which, in turn, can be affected by a person’s diet.
About Alzheimer’s disease
Alzheimer’s disease causes the brain to shrink and brain cells to eventually die. It is the most common cause of dementia — a gradual decline in memory, thinking, behavior and social skills — affecting a person’s overall ability to function.
Alzheimer’s is characterized by protein fragments called amyloid beta, which deposit in the spaces between nerve cells. These protein fragments can clump together to form amyloid plaques thought to be a factor in the onset of senility.
“While the precise mechanisms underlying Alzheimer’s disease are not fully understood, there is evidence to suggest that the buildup of amyloid beta peptides in the brain plays a role in the development of the disease,” Kurouski said. “Specifically, it is thought that the aggregation of amyloid beta into plaques can disrupt communication between neurons and ultimately lead to cell death.”
He said the relationship between amyloid beta plaques and Alzheimer’s disease is complex, and other factors such as inflammation and the accumulation of another protein called tau are also thought to be involved.
“Amyloid peptides, including amyloid beta, are known to interact with lipids in the brain,” Kurouski said. “These interactions can play a role in the formation of amyloid plaques and the pathology of Alzheimer’s disease.”
While not all amyloid peptides necessarily interact with lipids in the brain, the study found the oligomers formed in the presence of lipids were more toxic than other forms of amyloid beta.
“This suggests the interaction may be particularly important in regard to the harmful effects of amyloid beta in Alzheimer’s disease,” he said.
Study results
The study showed three different lipids — phosphatidylcholine, cardiolipin and cholesterol — strongly accelerated the rate of fibril formation compared to the rate of amyloid beta aggregation when no lipids were present. It also showed that cardiolipin allowed for the strongest acceleration of amyloid beta aggregation.
Futhermore, phosphatidylcholine, cardiolipin and cholesterol each uniquely altered the secondary structure of early, middle- and late-stage amyloid beta aggregates, Kurouski said.
“Specifically, cardiolipin and cholesterol drastically increased the amount of amyloid beta oligomers and fibrils grown in the presence of these lipids,” he said. “This caused a significant increase in the toxicity when compared to the toxicity of aggregates formed in a lipid-free environment.”
Dietary implications
Kurouski said the results allowed them to conclude that the secondary structure of amyloid beta fibrils directly depends on the lipid present in the protein solution upon their formation.
He also said there is evidence to suggest that dietary factors may influence the lipid composition of neuronal membranes.
“In the convergence of nutrition and human health, a diet that limits the amount of cholesterol, especially low-density lipoprotein cholesterol, and phospholipids can be important in reducing the ability of these lipids to react with the amyloid beta peptides,” he said.
Kurouski said research has shown that certain dietary fats, such as omega-3 fatty acids, have been shown to be important for maintaining the integrity and function of neuronal membranes.
“Additionally, studies have shown that dietary interventions, such as calorie restriction, can alter the lipid composition of neuronal membranes in animal models.”
He said study results may also support the idea that therapeutics be directed not on the amyloid beta peptide itself, as has been done to date, but more specifically on the interactions between lipids and amyloid beta peptides.
“Such interactions lead to the formation of highly toxic protein-lipid complexes that are far more toxic than amyloid beta oligomers themselves,” he said.
Study limitations
Kurouski said one limitation of the study is that it was conducted in cell-based assays rather than in living organisms, so it is not clear how the findings will translate to the complex environment of the brain. Additionally, the research only investigated a limited number of lipids, so it is possible that other types of lipids may also play a role in the harmful effects of amyloid beta.
“The next step of the study is to further investigate the underlying molecular mechanisms of the interaction between amyloid beta peptides and lipids,” Kurouski said.
He said that demonstrating the connection between toxicity and Alzheimer’s disease progression would require extensive testing on humans. However, before such studies can be conducted, preclinical studies in animal models would need to be performed to establish the safety and efficacy of any potential therapeutic interventions.
“It is important to note that while this study provides valuable insights into the role of lipid interaction in amyloid beta toxicity, additional research is needed before any clinical applications can be developed,” Kurouski said.
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Monday, November 21, 2022
Study challenges “good” cholesterol’s role in universally predicting heart disease risk
Lower levels of HDL cholesterol were associated with increased risks for heart attacks in white but not Black adults, and higher levels were not protective for either group.
A National Institutes of Health-supported study found that high-density lipoprotein (HDL) cholesterol, often called the “good cholesterol,” may not be as effective as scientists once believed in uniformly predicting cardiovascular disease risk among adults of different racial and ethnic backgrounds.
The research, which published in the Journal of the American College of Cardiology , found that while low levels of HDL cholesterol predicted an increased risk of heart attacks or related deaths for white adults – a long-accepted association – the same was not true for Black adults. Additionally, higher HDL cholesterol levels were not associated with reduced cardiovascular disease risk for either group.
“The goal was to understand this long-established link that labels HDL as the beneficial cholesterol, and if that’s true for all ethnicities,” said Nathalie Pamir, Ph.D., a senior author of the study and an associate professor of medicine within the Knight Cardiovascular Institute at Oregon Health & Science University, Portland. “It’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions.”
To do that, Pamir and her colleagues reviewed data from 23,901 United States adults who participated in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS). Previous studies that shaped perceptions about “good” cholesterol levels and heart health were conducted in the 1970s through research with a majority of white adult study participants. For the current study, researchers were able to look at how cholesterol levels from Black and white middle-aged adults without heart disease who lived throughout the country overlapped with future cardiovascular events.
Study participants enrolled in REGARDS between 2003-2007 and researchers analyzed information collected throughout a 10- to 11-year period. Black and white study participants shared similar characteristics, such as age, cholesterol levels, and underlying risk factors for heart disease, including having diabetes, high blood pressure, or smoking. During this time, 664 Black adults and 951 white adults experienced a heart attack or heart attack-related death. Adults with increased levels of LDL cholesterol and triglycerides had modestly increased risks for cardiovascular disease, which aligned with findings from previous research.
However, the study was the first to find that lower HDL cholesterol levels only predicted increased cardiovascular disease risk for white adults. It also expands on findings from other studies showing that high HDL cholesterol levels are not always associated with reduced cardiovascular events. The REGARDS analysis was the largest U.S. study to show that this was true for both Black and white adults, suggesting that higher than optimal amounts of “good” cholesterol may not provide cardiovascular benefits for either group.
“What I hope this type of research establishes is the need to revisit the risk-predicting algorithm for cardiovascular disease,” Pamir said. “It could mean that in the future we don’t get a pat on the back by our doctors for having higher HDL cholesterol levels.”
Pamir explained that as researchers study HDL cholesterol’s role in supporting heart health, they are exploring different theories. One is quality over quantity. That is, instead of having more HDL, the quality of HDL’s function – in picking up and transporting excess cholesterol from the body – may be more important for supporting cardiovascular health . They are also taking a microscopic look at properties of HDL cholesterol, including analyzing hundreds of proteins associated with transporting cholesterol and how varying associations, based on one protein or groups of proteins, may improve cardiovascular health predictions.
“HDL cholesterol has long been an enigmatic risk factor for cardiovascular disease,” explained Sean Coady, a deputy branch chief of epidemiology within the National Heart, Lung, and Blood Institute (NHLBI)’s Division of Cardiovascular Sciences. “The findings suggest that a deeper dive into the epidemiology of lipid metabolism is warranted, especially in terms of how race may modify or mediate these relationships.” The authors conclude that in addition to supporting ongoing and future research with diverse populations to explore these connections, the findings suggest that cardiovascular disease risk calculators using HDL cholesterol could lead to inaccurate predictions for Black adults.
“When it comes to risk factors for heart disease, they cannot be limited to one race or ethnicity,” said Pamir. “They need to apply to everyone.”
The REGARDS study is co-funded by the National Institute of Neurological Disorders and Stroke and the National Institute of Aging and received additional support from NHLBI. To learn more about cholesterol and heart health, visit https://www.nhlbi.nih.gov/health/blood-cholesterol . To learn about heart-healthy living, visit https://www.nhlbi.nih.gov/health/heart-healthy-living . About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit https://www.nhlbi.nih.gov/ .
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .
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Zakai NA, Minnier J, Safford MM, et al. Race-dependent association of high-density lipoprotein cholesterol levels with incident coronary artery disease. J Am Coll Cardiol . 2022; doi: 10.1016/j.jacc.2022.09.027.
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Best breakfast foods to lower cholesterol - backed by research
Elevated cholesterol levels can lead to various health issues, including heart disease and stroke. your breakfast choices, though, could offer a helping hand., high cholesterol: nutritionist reveals top prevention tips.
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Firstly, make sure you are eating breakfast; research shows that skipping the first meal of the day is associated with higher low-density lipoprotein (LDL) cholesterol . The research paper was published in the Obesity research journal in April 2020, which highlighted how breakfast skippers had more "bad" cholesterol than breakfast eaters. One of the best breakfast choices you can make to lower cholesterol levels is to eat oatmeal.
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Heart UK explains: "Beta-glucan works by forming a gel in the gut which can bind with cholesterol-rich bile acids and stop them being absorbed into the body.
"You need 3g of beta-glucan a day to help actively lower cholesterol."
READ MORE: Six signs in your mouth you could be at risk of heart disease
When making oatmeal porridge, for example, even the type of milk you use can help to lower cholesterol.
According to research published in Advances In Nutrition, the main fatty acid found in almond oil (found in almond milk), known as oleic acid, has beneficial changes to blood lipid levels (i.e. cholesterol).
Another good breakfast option is avocado on toast, as the fruit is high in monounsaturated fatty acids, which lower cholesterol.
Dietitian Victoria Taylor, based at the British Heart Foundation, said: "An 80g portion counts towards your five-a-day and contains vitamins, minerals and fibre.
For people who are feeling a bit more hungry, they could add smoked salmon to their avocado on toast.
Nutritionist Nicola Shubrook says salmon contains omega-3 fatty acids, which are "essential" for the body.
Shubrook said: "The most beneficial omega-3 fatty acids, known as long chain, occur naturally in oily fish in the form of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
READ MORE: New research says people can reduce their cancer risk within minutes
"These fatty acids are thought to contribute to a healthy heart and help maintain skin, joints and hormonal balance."
For those who have a bit of a sweet tooth, apple bran muffins could do the trick.
In the British Journal Of Nutrition, the research states that whole grains, such as bran, may be associated with lower levels of LDL cholesterol.
Apple also contains fibre, which helps with maintaining healthy cholesterol levels.
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A comprehensive new study on cholesterol, based on results from more than a million patients, could help upend decades of government advice about diet, nutrition, health, prevention, and...
New Research on Cholesterol Cholesterol is a vital component of our cells, which is why our body makes all that we need…until our diet gets in the way. This episode features audio from How Do We Know that Cholesterol Causes Heart Disease? , The Best Food for High Cholesterol, and Amla vs. Drugs for Cholesterol, Inflammation, & Blood-Thinning.
New guidelines from the American Heart Association advise sitting less and moving more as the first treatment. Physical activity can reduce LDL (low-density lipoprotein, or "bad") cholesterol...
Cholesterol is a fatty substance that occurs naturally in the body. It performs several vital functions. It is needed to make the walls surrounding the body's cells and is the basic material that is converted to certain hormones. Your body makes all the cholesterol you need.
Dec. 13, 2022 — A new study suggests lipoprotein (a) cholesterol may affect relationship between hypertension and cardiovascular disease ... After Showing Early Potential, Cholesterol...
A National Institutes of Health-supported study found that high-density lipoprotein (HDL) cholesterol, often called the "good cholesterol," may not be as effective as scientists once believed in uniformly predicting cardiovascular disease risk among adults of different racial and ethnic backgrounds.
The new cholesterol guidelines from the American College of Cardiology and American Heart Association are out! These guidelines — last updated in 2013 — have been highly anticipated by the cardiology and broader medical community. They have been approved by a variety of additional professional societies, including the American Diabetes Association.
New Cholesterol Study We have a new research study evaluating the effect of a cholesterol medication compared to a placebo when used in addition to your current statin therapy at the maximum dose. The total study participation is approximately 13 months with 8 in-clinic visits.
New research from RCSI University of Medicine and Health Sciences has revealed that the link between 'bad' cholesterol (LDL-C) and poor health outcomes, such as heart attack and stroke, may...
Apr 27, 2022 Some children who experience abuse may have higher risk for high cholesterol and Type 2 diabetes as adults, new research shows. But some risks may be offset by having "well-organized" households. Categories: Heart Disease | Tags: Children, Cholesterol, Diabetes Eating walnuts every day could lower bad cholesterol in older adults
Cholesterol is a natural component in everyone's blood, and supports normal function of cell membranes, hormone levels and more. However, having too much, is considered hyperlipidemia, hypercholesterolemia or high blood cholesterol — a major risk factor for heart attack, heart disease and stroke. About 71 million Americans have high cholesterol.
New research is about targeting which therapies are better for the elderly, which therapies are better for people with cancer, things like that. New Treatments for High Cholesterol.
More clues to the genetics behind an inherited cholesterol disorder May 15, 2019 Familial hypercholesterolemia remains largely underdiagnosed and undertreated, but researchers are discovering new clues to the cause of this genetic disorder that leads to premature heart disease. Categories: Cholesterol | Tags: Cholesterol, Heart disease
New Research on Cholesterol and Heart-Health Published on February 3, 2022 Within our bodies millions of processes occur every day, such as turning the foods we eat into energy. These processes require oxygen. Byproducts of using oxygen are called oxidants, often referred to as "free radicals".
Cholesterol News and Research. Cholesterol is a waxy, fat-like substance made in the liver, and found in the blood and in all cells of the body. Cholesterol is important for good health and is ...
A new study in JAMA Network Open, found that roughly 20% of high-risk patients don't take statins, even when their doctor recommends them. Statins are a group of cholesterol-lowering medications, taken as a daily pill, that have been shown to protect against heart attacks and strokes. The new study found that one group is particularly ...
New research published on April 13 in the Alzheimer's Association journal Alzheimer's & Dementia found that high levels of "good cholesterol" (aka high-density lipoprotein or HDL) can help...
The study showed three different lipids—phosphatidylcholine, cardiolipin and cholesterol—strongly accelerated the rate of fibril formation compared to the rate of amyloid beta aggregation when...
The researchers focused on high-risk patients, with an average age of 59who either had coronary artery or vascular disease, diabetes, very high cholesterol, or had suffered a stroke. All were...
All were recommended statin medications by their physicians to reduce their risk of heart attack and stroke and reduce cholesterol levels. The retrospective study included more than 24,000 ...
The study focused on more than 24,000 high-risk patients from 2000 to 2018 who either had coronary artery or vascular disease, diabetes, very high cholesterol, or had suffered a stroke....
White meat can raise cholesterol as much as red meat, new study shows White meat, such as chicken, may raise blood cholesterol levels as much as red meat does, a new, small study details. HEALTH ...
The new study found that women were about 50 percent more likely than men to refuse a doctor's recommendation to take statins. ... and cholesterol-lowering drugs, ...
Department of Biochemistry and Biophysics study more closely connects diet and Alzheimer's disease development. February 28, 2023. Cholesterol tremendously increases the toxicity of a peptide implicated in Alzheimer's progression, according to research by scientists in the Department of Biochemistry and Biophysics in Texas A&M's College ...
News Release. Monday, November 21, 2022. Study challenges "good" cholesterol's role in universally predicting heart disease risk . Lower levels of HDL cholesterol were associated with increased risks for heart attacks in white but not Black adults, and higher levels were not protective for either group.
Both high and low LDL cholesterol is associated with an increased risk of sudden cardiac arrest. The researchers could not establish cause and effect relationship based on the study; despite this, they suggest that low LDL-cholesterol can be a surrogate marker for a high-risk group for SCA among diabetes patients.
Firstly, make sure you are eating breakfast; research shows that skipping the first meal of the day is associated with higher low-density lipoprotein (LDL) cholesterol.The research paper was ...