Have People Strived Hard to Lower Their Bad Cholesterol?

When people’s bad cholesterol or low-density lipoprotein (LDL) is high, they actually have a much higher risk of developing high blood pressure, stroke and even heart disease. As such, it is advisable for them to lower their LDL level.

A recent study by researchers from the University of California, San Francisco showed that over the last decade, the number of patients who have lowered their LDL to the recommended level has nearly doubled in 9 countries, namely Brazil, Canada, France, Mexico, the Netherlands, South Korea, Spain, Taiwan and the United States.

Published in the American Heart Association's journal Circulation on June 22, 2009, the findings revealed that patients in the United States, Brazil, France and South Korea had accepted a combination of medical treatment and lifestyle changes to improve their bad cholesterol.

In the study, close to 10,000 people with an average age of 62 were surveyed. The number of patients, who had successfully reached their target LDL level, was found to rise from 38 percent to 73 percent over the last 10 years.

On the other hand, only 30 percent of the high-risk patients, who have existing coronary artery disease or risk factors such as obesity, diabetes or smoking, had successfully reached their target LDL of 70mg per deciliter or less.

Although there is still some room for improvement, particularly in very high-risk patients, the results did indicate that LDL-lowering therapy has been applied much more successfully than it had been a decade ago.

The target LDL level in the United States depends on how many risk factors are present in the patient.

For patients without coronary artery disease, diabetes, or other cardiovascular risk factors, the ideal LDL is 160 mg/dL or less. People without either coronary artery disease or diabetes but with at least 2 other risk factors should keep their LDL level to less than 130 mg/dL

Patients who have cardiovascular diseases or diabetes should keep their bad cholesterol level no higher than 100 mg/dL, and should try to maintain a level lower than 70 mg/dL if they also have other risk factors.

How Effective Is Crestor In Preventing Heart Disease?

Being manufactured by AstraZeneca, Crestor is a cholesterol-lowering medicine that aims to reduce levels of bad cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood, and in the meantime increase levels of good cholesterol (high-density lipoprotein, or HDL). It has been approved for use in over 95 countries with nearly 15 million patients being prescribed presently worldwide.

By lowering the bad cholesterol, it is possible to help prevent heart disease and hardening of arteries. These two conditions can develop heart attack, stroke, as well as vascular disease. Nevertheless, how effective is this medicine?

Presented during November 2008 at an annual meeting of the American Heart Association in New Orleans and published online by the New England Journal of Medicine, the study known as “JUPITER” revealed that Crestor could actually reduce by 44 percent the risk of heart problems among patients who currently do not face a high risk of getting a heart disease.

The study involved 17,802 men and women, of the age of 50 and more, who took 20 milligrams of Crestor on a daily basis. It was found that the combined risk of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes was reduced by 44 percent as compared with placebo among men and women with elevated hs-CRP but low to normal cholesterol levels.

By the way, CRP is a protein that is produced by the liver. It plays an important role in inflammatory processes and serves as a biological marker to measure the risk of artery blockage.

Also shown in the study, patients who took Crestor also had the combined risk of heart attack, stroke or death from heart disease reduced by 47 percent. Meanwhile, their risk of heart attack was cut by more than half, the risk of stroke was reduced by nearly half and the total mortality of the participants was lowered by 20 percent.

It was also recorded in the study that a daily dose of 20 milligrams of Crestor was well tolerated in nearly 9,000 patients during the course of the trial, and there was no difference between treatment groups for major adverse events, including cancer or myopathy.

No Trans Fat Is Allowed In All New York Restaurants!

Trans fat has been classified as bad stuff that not only increases LDL (bad cholesterol) but also reduces HDL (good cholesterol). People with such pattern of cholesterol level are at higher risk of heart disease, and several other medical ailments.

Foods with trans fat can be found almost everywhere. Besides candy, noodles, cookies, chips, there are hundreds of other processed products available in supermarket do contain trans fat in different amounts. Despite its unhealthy nature, most foods with trans fat are favored by both children and adults.

On July 1, 2008, the artificial trans fat can no longer be presented in the menu in New York restaurants. In this way, the authorities in New York help remove a major cause of heart disease from their residents’ diets.

Last year, the authorities had already banned all restaurants from using frying oil and spreads containing trans fats. Now, the restriction will apply to all types of food, including the fat used by bakers and pastry chefs.

For all foods served, including baked goods, oils, shortenings and margarine used for baking, and pre-prepared items, the amount of artificial trans fat, must not be more than 0.5 grams of trans fat per serving. However, foods served in the manufacturer's original, sealed packaging, such as candy and crackers, can still be exempted for the time being.

According to the health department in New York, there was widespread acceptance of its last year's ban, with more than 98 percent of inspected restaurants were in compliance as at June 2008. Many restaurants had gone even further to voluntarily cut down the amount of saturated fat.

As confessed by the owner of one of the restaurants in New York, the transition he made 7 months ago by cooking his patties and baked goods with replacement shortenings has hurt neither the products nor his business. Meanwhile, he feels happy that the move is healthier for his customers.

The Food and Drug Administration (FDA) has pointed out that trans fat, which is made by adding hydrogen to vegetable oil. This increases "bad" cholesterol levels, raising the risk of coronary heart disease.

New York was the first city in the United States to start banning trans fats in restaurants, followed by Philadelphia last year.

Lower Bad Cholesterol with Dietitian’s Support!

It is not uncommon nowadays to find people with high level of cholesterol, even among the young ones. Person having high cholesterol, especially the bad cholesterol or in short LDL, has a greater chance of getting stroke, high blood pressure, and heart disease.

Doctors will usually ask you to watch your diet if they find your bad cholesterol level reach a certain high level. Unfortunately, it seems that diet alone usually would not help reduce the cholesterol level for most people. Therefore, as the last resort, doctors would have no choice but to put you on medication to cut down your bad cholesterol.

A new study by the University of Michigan Health System in Ann Arbor reported during March 2008 that with the support from dietitian, some people might be able to bring down their bad cholesterol levels without drugs.

The researchers followed 51 registered dietitians who implemented the 1998 Medical Nutrition Therapy Hyperlipidemia Protocol with their patients. You may ask, “What is this protocol?”

The protocol recommends people to:

- eat more fruits and vegetables,
- eat fish twice weekly,
- take more good fats such as olive oil,
- consume less saturated and trans fat,
- exercise more.

Meanwhile, the patients were supposed to meet with a dietitian for an initial one-hour visit, followed by at least 2 or 3 half-hour appointments. More visits may be recommended by the primary care doctor, if necessary. Dietitians have to check the patients’ blood work at the outset of the study and 3 months later.

The study took in 377 patients who met the criteria. Follow-up data was available for 74.3 percent, while 42.9 percent participated in 3 to 4 visits with the dietitian as recommended.

On average, patients working with dietitians cut their fat consumption to less than 30 percent of total calories. Furthermore, they did lose weight and exercise more.

Among the 175 patients whose initial triglyceride levels were below 400 mg/dL, 44.6 percent of them reported a 15 percent drop in their LDL or reached their goal for reducing LDL.

While the protocol only recommended 3 to 4 weeks between appointments, the actual intervals were in fact longer, ranging from an average of 8 weeks between the first and second appointments to nearly 13 weeks between the third and fourth.

Many patients did not make follow-up appointments, or keep scheduled appointments because of the lack of insurance reimbursement or their inability to pay.

The researchers did have difficulty in carrying out the study. Not many registered dietitians wanted to participate because they could not obtain necessary lab tests or lacked time and administrative support.

Knowing Heart Disease Risk May Prompt You Adopting Heart-Healthy Lifestyle

In order to reduce the risk of a heart attack and heart-related death, one should try to lower levels of bad cholesterol (LDL) while raising levels of good cholesterol (HDL). Regretfully, most patients do not obediently follow recommendation from their doctors so as to change their lifestyle or taking their cholesterol reducing medications.

However, when the doctor tells the patients who are at risk of coronary heart disease exactly what their risk is and how they can help lower their risk, they seem to respond better to preventive treatment. This is the findings of a recent study conducted by a group of researchers at the McGill University in Montreal, Quebec and published in the Archives of Internal Medicine.

The researchers actually found that people who had discussed openly with their doctor about their coronary risk profile achieved better improvement in their cholesterol levels than those who did not discussed with their doctor. As found out by the study, about one-third of people, who are not convinced that they need their cholesterol medications, stop taking them.

In order to ascertain whether boosting patients' knowledge of their heart risk profile might help them to adopt heart-healthy lifestyle, the researchers randomly assigned 3,053 adults being treated for cholesterol problems into 2 groups: one group received usual care while the other group received a 1-page computer printout displaying the probability that they will develop heart disease in the next 8 years based on their current lifestyle, blood pressure, cholesterol levels, and other risk indicators. The printout group also received ongoing feedback on how much they could cut their risk through lifestyle modification and drug therapy.

There were 2,687 patients completed the 12-month study. Those in the intervention group who kept track of their heart risk profile had small but significantly greater improvements in their cholesterol profiles.

In addition to communicating risk, there are also other means that can be used to improve adherence to heart-healthy lifestyle. These include enhancing self-monitoring and using support of family and friends.

Let’s Talk About Fats Again – Trans Fats

Being of no health benefits at all, trans fat is often a pervasive and often hidden ingredient in many food items.

It clogs the arteries and makes them more rigid. It not only increases the bad cholesterol (LDL) but also decrease the good cholesterol (HDL).

Eating too much trans fat will make one become possible victim of coronary heart disease and Type 2 diabetes. Therefore, people are advised to consume no more than 2 g of trans fat a day, as recommended by The World Health Organization (WHO).

Though a small amount is naturally found in some animal-based foods such as meat and diary products, trans fat is mainly found in processed foods such as:

• Shortening
• Margarine
• Snack foods like crackers and cookies
• Fried food like French fries
• Fast food
• Baked goods
• Dairy creamer or coffee creamer
• Sweets
• Instant noodles, which are fried in palm oil

These foods are always sources of saturated fat as well.