All entries tagged with “heart disease”
Four Foods Proven to Lower Cholesterol
People frequently ask me what foods they can eat to help lower cholesterol. A recent study in the Journal of the American Medical Association tested two diets for their ability to lower cholesterol, providing patients with some much needed guidance on the subject. While several foods and food groups have been known to favorably impact cholesterol, these researchers put together a “portfolio” of some of the most effective foods. Patients were either placed on a control diet which was described as “low saturated fat” or a diet that included a portfolio of plant sterols, soy protein, viscous fibers and nuts. The plants sterols were ingested in the form of an enriched margarine such as Smart Balance. The soy proteins were consumed both as soy beverages and tofu. The psyllium was consumed though oats, barley and as psyllium itself (Metamucil). The nuts (tree nuts and peanuts) were typically eaten with the morning and afternoon snacks. The patients were followed for 6 months with their cholesterol measured at baseline and at the end of the study. In addition, their blood pressure and body weight were followed. All patients in the study were instructed to eat 6 times daily – 3 meals and 3 snacks. Each of the meals and snacks in the study group incorporated some of the portfolio components. At the end of the study, both groups lost about 5 pounds. The control group had a reduction in the LDL (bad cholesterol) of 3.5% while the study group had a 14% reduction in the LDL. There was no significant change in the HDL (good cholesterol) or triglycerides. I think there are several take home points from this study- first, dietary changes can significantly reduce LDL cholesterol. Further, this study shows that a diet rich in specifically plant sterols, soy protein, viscous fiber and nuts is considerably more effective at reducing cholesterol than a typical low saturated fat diet. However, the magnitude of the change in LDL (14% reduction) is modest in comparison to medications like statins, some of which can reliably lower LDL by over 50%. Nonetheless, there are patients whose LDL cholesterol is borderline and dietary changes such as these may be all that is needed. Also, it is estimated that every 1% reduction in LDL translates into a 1% reduction in the risk for heart disease, so even patients already on cholesterol medication could benefit from these dietary changes. For more information on the specifics of the dietary components, feel free to email me at meimer@cagemedical.com 
Simplifying Cholesterol Numbers: “All that is not good is bad”
Those of you that have been checking and following your cholesterol numbers over the years have probably felt confused at some point about what the optimal values are or even what values to follow. The basic components of the cholesterol panel have not changed- total cholesterol is a sum of HDL (good cholesterol) + LDL (bad cholesterol) and Triglycerides. What has changed is which of these entities is the primary focus of our attention and where to set the goals for these values. Initially, patients were told that an ideal cholesterol level meant a total cholesterol less than 200. This approach fell out of favor as it was then appreciated that HDL cholesterol was protective and that high levels of HDL (which raised the total cholesterol) was associated with a lower risk of heart disease. Likewise, patients with low HDL (which would result in a lower total cholesterol) were at increased risk of heart attack. The focus then shifted to primarily worrying about the level of LDL cholesterol as many large studies suggested that the level of LDL cholesterol was the most important predictor of a person’s risk for heart disease. Once there was general consensus that the LDL was the most important measure, researchers sought to define the optimal level of LDL cholesterol. The optimal level of LDL for patients with heart disease has dropped from 130 to 100 and now to 70 based on data that each subsequent reduction further reduces the risk for heart attack. However, there are several problems with an “LDL-centric” approach to cholesterol. First, patients with low LDL are still at some risk of heart attack which has been termed “residual risk” suggesting that LDL is not the whole story. Second, there is currently an epidemic of patients who are overweight with diabetes (“metabolic syndrome”) who are clearly at high risk for heart disease, despite a relatively normal LDL. In addition to normal LDL these patients will typically have elevated triglycerides and low HDL. An idea that is gaining traction in the cardiovascular prevention community is to simply dichotomize cholesterol into good and bad. In other words, if HDL is the only good cholesterol then everything else (termed “non-HDL” cholesterol) must be increasing the risk of heart attack. Non-HDL also includes cholesterol particles that are not routinely assessed like very low density LDL or VLDL. In fact, many large studies have already proven that non-HDL is actually better than LDL at predicting the risk of heart disease. In terms of what the ideal non-HDL level should be, guidelines suggest that a level 30 points higher than your goal LDL (which can be determined by your doctor) is probably optimal.
Cardiac Rehab Slashes Risk of Dying by 50%
In the early days of cardiology, patients with heart disease were advised to rest for weeks to months after a heart attack. In the 1960s the prevailing theory was challenged and the modern concept of cardiac rehabilitation was begun. In the modern era, cardiac rehab is a 12 week structured exercise program that is put on by the hospitals. It is covered by most insurance plans within 1 year of the cardiac event. It focuses on aerobic exercise with close monitoring of the heart rate, blood pressure and symptoms to allow the cardiac the patient the opportunity to gradually increase exercise. It also places a heavy emphasis on education of the patients with regard to preventing future heart problems through lifestyle changes. A recent study out of the Mayo Clinic looked at over 2000 patients who had stents placed in blocked arteries. The patients were followed for an average of 6 years. Some of the patients enrolled in cardiac rehab (40%) and some did not. Over the follow up period, the patients who enrolled in cardiac rehab enjoyed a whopping 50% decrease in the risk of dying. This held true for men, women, old and young patients. The take home message from this study is clear- that patients should enroll in cardiac rehabilitation programs after having a stent placed. Unfortunately, the majority (60% in this study) of patients do not take advantage of this opportunity. The reasons for this are not clear but why miss out on a "free" 50% reduction in mortality?
Are You Healthy Enough to Exercise?At first glance the question seems kind of ridiculous. You are exercising to get healthy so how could exercise itself NOT be healthy? The truth is that there is some risk of having a heart attack... More »
fat is good for youThis comes from spacedoc.net which I think is a great blog: Does the thought of a steak, bacon and eggs, or real milk make you cringe thinking you're instantly clogging up your arteries? How many... More »
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