Wednesday, April 11, 2012

Cardiology Perspectives: Effective Management of Cholesterol is pleased to present an excerpt from our 2 hour educational video; Cardiology Perspectives: Effective Management of Cholesterol, featuring John Kane, MD; Alan Chait, MD; John LaRose, MD; Tom Bersot, MD; Stephen G. Young, MD; Gustav Schoenfeld, MD and Virgil Brown, MD. The full length video is available on DVD or VHS from and discusses the importance of controlling cholesterol in patients with heart disease and other high risk individuals.

High cholesterol is a well-known risk factor in heart disease, the number one killer of both women and men in the United States, with more than a million heart attacks and about a half million deaths annually.
High cholesterol doesn't cause overt symptoms, and many people are unaware of elevated cholesterol levels and how it may influence their cardiac risk. To complicate matters, high cholesterol is not the only predictor of cardiovascular events such as heart attack and stroke; somewhere between 30-50 percent of first heart attacks occur in people with normal cholesterol levels, but it is essential to test and monitor cholesterol levels, especially for anyone with a family history of heart disease. Lowering high cholesterol does seem to lessen the risk for developing heart disease, and reduces the chance of a heart attack or dying of heart problems if you already have them. However, some research has indicated that all-cause mortality (that is, dying from any disease, not just heart disease) actually increases when cholesterol is lowered in those over age 65.

Genetics and lifestyle both combine in individuals to create high levels of cholesterol in the blood. Those who are overweight tend to have increased cholesterol.
Diet is an important component of controlling cholesterol ratios and maintaining heart health. Recent evidence indicates that added sugar and overabundance of flour in the diet are probably greater contributors to heart disease than saturated fat; certain components of full-fat dairy foods may be cardio-protective.
However, a chemically altered type of fat known as trans fatty acids (TFAs) can worsen cholesterol ratios. TFAs are mostly found in animal fats and vegetable oils, and are also created in the hydrogenation process that makes fats more stable, giving them a longer shelf-life.
In addition to diet, LDL cholesterol levels appear to be heavily dependent on genetic factors. Anyone at increased risk of heart disease should have tests for LDL particle size in addition to the basic lipid profile. Best results show low numbers of LDL particles overall.
A different cholesterol problem is present when one shows a tendency towards low HDL cholesterol and high triglycerides. This pattern, sometimes called “Syndrome X,” is associated with insulin resistance. It is frequently influenced by diet and lifestyle, but is also genetically driven and appears to affect at least 30 percent of the population. It carries with it an increased risk of high blood pressure and diabetes as well as heart disease. Dietary and nutritional supplement treatments are often quite effective in treating this pattern, but are a bit different from those for high total and LDL cholesterol levels.

High cholesterol is treated conventionally with lifestyle changes focusing on diet, physical activity and weight management. For patients seen in busy medical practices this approach is frequently difficult to fully implement and utilize. If lifestyle changes are not effective, drug therapy is often recommended. Statin drugs are commonly used to lower cholesterol and protect against heart disease and heart attacks by blocking an enzyme that is necessary for the synthesis of cholesterol in the liver. They can be very effective, and there is growing medical enthusiasm for them because they also seem to provide antioxidant and anti-inflammatory properties. These drugs can reduce plaque formation in coronary arteries by preventing the oxidation of LDL ("bad") cholesterol, and their anti-inflammatory properties may help prevent plaque from rupturing.
Despite their benefits, they do have adverse effects including liver toxicity: physicians need to monitor liver function carefully in patients with liver disease of any kind.