Cardiology Perspectives: Effective Management of Cholesterol

Medivision.com 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 health-e-mall.com 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.

Salt in the News

Despite long recognized health concerns, our love affair with salt hasn't abated. If anything it's gotten worse: Current news reports detail popular restaurant meals with as much as 4 times the recommended maximum daily salt levels.

Source: Center for Science in the Public Interest (CSPI) "Heart Attack Entrées with Side Orders of Stroke" Overly Salty Restaurant Meals Present Long-Term Health Risks for All, and Immediate Danger for Some.

Since at least 6000 BC people have used salt as a preservative, seasoning, dietary supplement and even as currency. In fact, the two major components of salt - Chloride and Sodium - help regulate the fluid balance of the body and are necessary for the survival of all known living creatures, including humans.
However the reality is that we only need about 460 - 920 milligrams (mg) of salt per day. Most health organizations recommend a maximum of about 2400 mg, and people with high blood pressure, African Americans and people middle-aged and older should consume no more than 1,500 mg of sodium daily according to the government’s dietary advice.
Currently the average consumption in the US is as much as 4800 mg per day- twice the recommended maximum. So why are we eating so much?
A large part of the problem is our society's reliance on processed and prepared foods. According to a recent report by the Center For Science in the Public Interest (CSPI) , 85 out of 102 meals from popular US restaurant chains contained more than the recommended maximum sodium level in a single serving, with some containing as much as 4 times the amount. For example, the "Admiral's feast" from the Red Lobster chain of restaurants contains app. 7,106 mg of salt.

The health risks:
Your kidneys regulate the amount of sodium kept in your body. When levels are high, they excrete the excess amount in urine. If your kidneys can't eliminate enough sodium it begins to accumulate in your blood, increasing the blood volume and subsequently the pressure in your arteries. Certain diseases such as congestive heart failure, cirrhosis and chronic kidney disease can lead to an inability to regulate sodium.
According to the American Heart Association, "... a 1200 mg decrease in daily sodium intake would result in 6 percent fewer cases of new heart disease, 8 percent fewer heart attacks, and 3 percent fewer deaths per year. Even larger health benefits are projected for African Americans, who are more likely to have high blood pressure and whose blood pressure may be more sensitive to salt. Among African Americans, new heart disease cases would be reduced by 10 percent, heart attacks by 13 percent and deaths by 6 percent."
In addition, new studies have linked dietary factors -including sodium intake- to a sudden increase in kidney stones in pediatric patients as well as adults.
Up to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. The two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.
Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.

How to cut sodium:
You can cut your sodium intake in several ways:

• Eat more fresh foods and fewer processed foods. Fresh fruits and vegetables are naturally low in sodium, and fresh meats are much lower in sodium than processed luncheon meat, bacon, hot dogs, sausage and ham.
• Opt for low-sodium products. If you do buy processed foods, select those that have reduced sodium.
• Remove or reduce salt from recipes whenever possible. You can leave out the salt in many casseroles, stews and other main dishes. Providing a shaker on the table will allow guests to use as much - or as little- as their tastes require.
• Limit your use of salty condiments. Salad dressings, sauces, dips, ketchup, mustard and relish all contain sodium.
• Use herbs, spices and other flavorings to enhance foods.
• Use salt substitutes carefully. Some salt substitutes or light salts contain a mixture of table salt (sodium chloride) and other compounds. To achieve that familiar salty taste, you may use too much of the substitute and actually not use less sodium. In addition, many salt substitutes contain potassium chloride, which can be harmful if you have kidney problems, congestive heart failure or high blood pressure that cause potassium retention.

Your taste for salt is acquired, so it's reversible. If you decrease your use of salt gradually your taste buds will easily adjust. Start by using no more than 1/4 teaspoon (1 milliliter) of added salt daily, and then gradually decrease that to as little as possible. As you use less salt, your preference for it lessens, allowing you to enjoy the taste of food itself.