‘Good’ Cholesterol Alone May Not Cut Heart Disease Risk

The long-standing advice about “good” vs. “bad” cholesterol has become a little more complicated.

According to some recent studies, we’re learning that good cholesterol alone has little ability to lower the risk of heart disease, and more is not necessarily better.

Instead, avoiding “bad” cholesterol while favoring “good” is only effective when combined with an overall healthy lifestyle that includes exercise and not smoking.

As most people know by now, bad cholesterol (low-density lipo­protein, or LDL) deposits excess cholesterol in your arteries, where it can build up into plaque, increasing the likelihood of heart disease and blood clots. Good cholesterol (high-density lipo­protein, or HDL) carries surplus cholesterol back to your liver so that it can be excreted.

To prevent heart disease, we’ve been told to keep our bad cholesterol level down and our good cholesterol level up—with 45 milligrams per deciliter usually offered as a good target.

Sounds pretty straightforward, right? But the picture is more complicated than it once seemed.

Here’s what you need to know about the current thinking, along with some healthy-heart guidelines that are unlikely to change even if our understanding of cholesterol does.

The New Evidence on HDL

The first clue that the role of good cholesterol was more complicated than previously thought emerged when scientists tried to develop medications to raise HDL levels.

The drugs they tested—niacin and cholesteryl ester transfer protein inhibitors—boosted HDL in the blood but failed to reduce cardiovascular-disease risk.

Those results surprised doctors. We know that certain lifestyle changes, such as exercising more and quitting smoking, drive HDL levels up and heart-disease risk down.

But increasing HDL levels arti­fi­cially, without behavioral changes, doesn’t reduce risk at all. “It turns out that HDL is not a very good therapeutic target,” says Dennis Ko, M.D., a cardiologist and senior scientist at the Institute for Clinical Evaluative Sciences in Ontario, Canada.

What’s more, Ko’s own research suggests that above a certain threshold, more HDL could increase health risks.

His team looked at 631,762 people and found that those with an HDL level greater than 70 mg/dL (in men) or 90 mg/dL (in women) were more likely to die—for reasons ­unrelated to cardiovascular disease.

Getting Good Cholesterol Up

As researchers work to figure out what these findings mean in the quest to keep hearts healthy, your doctors might still use your HDL level (in conjunction with measurements of LDL and total cholesterol) to help predict your cardiovascular-disease risk.

Our experts say that a very low HDL level can be a sign of trouble, but that the only meaningful way to raise it is through lifestyle changes.

“There is no evidence for a benefit from any HDL-raising drug,” says Steven Nissen, M.D., a cardiologist with the Cleveland Clinic. “It’s still important to pay attention to the numbers, but the main focus should be on making healthy choices.”

In other words, whether your HDL is low, high, or somewhere in the middle, the prescription for a healthy heart will be the same: Don’t smoke, drink alcohol only in moderation, exercise regularly, and stay away from trans fats, which are found in fried foods, baked goods, and other items made with partially hydrogenated oils.

As Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser, notes, “Everyone agrees with the pursuit of a healthy lifestyle.”

Bringing Bad Cholesterol Down

In 2016, the U.S. Preventive Services Task Force recommended that a vastly larger group think about taking statin medications, which lower LDL cholesterol.

If you’re 40 to 75 and have diabetes, or high cholesterol or blood pressure, or you smoke, you’re now advised to have a doctor estimate your chance of a major cardiovascular event within 10 years. If chances are 10 percent or greater, the task force suggests a statin. For a risk of 7.5 to 10 percent, it suggests that you consider one.

Our current advice is that for those whose 10-year risk is lower than 10 percent, diet and lifestyle changes should be the first steps. They could lower your risk enough that you are no longer a candidate for a statin, which has well-­established adverse effects.

Source: Consumer Reports

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Aerobic Exercise May Mildly Delay or Slightly Improve Alzheimer’s Disease Symptoms

Alzheimer’s disease (AD) is a brain disorder that destroys memory and thinking skills over time. It is the most common form of dementia in older adults. There is presently no cure for the condition, though treatment options are available. Today, some 5.3 million Americans live with AD, and it is now the sixth leading cause of death in the United States. The number of older adults who will develop AD is expected to more than triple by 2050.

Geriatrics experts have suggested that exercising can improve brain health in older adults. The World Health Organization (WHO) has recommendations for how much older adults should exercise. They suggest that older adults perform 150 minutes a week of moderate exercise (such as brisk walking), 75 minutes a week of vigorous aerobic training, or a combination of the two types. The WHO also recommends older adults perform muscle-strengthening exercises on at least two or more days a week.

However, not all studies of exercise and older adults have proven the benefits of exercise. We don’t know for sure whether exercise slows mental decline or improves older adults’ ability to think and make decisions.

A team of researchers designed a study to learn whether exercise could delay or improve AD symptoms. They reviewed 19 studies that examined the effect of an exercise training program on cognitive function in older adults who were at risk for or diagnosed with AD. The studies included 1,145 older adults, most of whom were in their mid-to late 70s. Of the participants, 65 percent were at risk for AD and 35 percent had been diagnosed with AD.

The researchers published their findings in the Journal of the American Geriatrics Society.

As the researchers examined the studies, they discovered that older adults who did aerobic exercise by itself experienced a three times greater level of improvement in cognitive function than those who participated in combined aerobic training and strength training exercises. The researchers also confirmed that the amount of exercise WHO recommends for older adults was reinforced by the studies they examined.

Finally, the researchers found that older adults in the no-exercise control groups in the studies faced declines in cognitive function. Meanwhile, the older adults who exercised showed small improvements in cognitive function no matter what type of exercise they did.

The research team concluded that this study may be the first to show that for older adults who are at risk for or who have AD, aerobic exercise may be more effective than other types of exercise in preserving the ability to think and make decisions.

The researchers note that their findings need to be confirmed in future studies.

Source: The AGS Foundation for Health in Aging


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Arm Exercise Improves Walking Ability after Stroke

A new study shows that arm exercises may improve walking ability months and even years after having a stroke. The study, the first to test the influence of arm training on post-stroke leg function, is published ahead of print in the Journal of Neurophysiology. It was chosen as an APSselect article for February.

Researchers from the University of Victoria in British Columbia, Canada, worked with a group of older adults who had had a stroke between 7 months and 17 years prior to the study. The volunteers participated in three 30-minute, moderate-intensity arm cycling training sessions each week for five weeks. The research team measured the volunteers’ physical abilities before and after arm training using several standardized scales and tests of physical function, including:

  • Six Minute Walk, which measures how far a person can walk in six minutes;
  • Timed 10 Meter Walk, which measures how quickly a person can walk 10 meters; and the
  • Timed Up and Go, which measures the time it takes to stand up from a seated position, walk 10 feet, turn around, walk back and sit down again.

The researchers also tested electrical activity in the muscles and stretch reflexes in the lower legs and wrists during both arm cycling and walking tests.

The participants improved their performance significantly on all of the walking tests—as much as 28 percent in the Timed Up and Go test. Several volunteers had less tightness in their muscles after completing the arm cycling trial, but there was no significant change in grip strength. Nerve activity increased during arm cycling as well. “Arm cycling training activated interlimb networks that contribute to the coordination of rhythmic walking,” the researchers wrote. In other words, nerves in the arms activated and adapted to improve function of the spinal cord in other areas of the body, such as the legs, affected by stroke.

These results could have a large impact on stroke rehabilitation, even years after injury. “Although improvements in walking may not be as robust as those from other training modalities, they do highlight the integral role that training the arms can have on rehabilitation of human locomotion,” the research team wrote.

Source: American Physiological Society


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Infographic: The Nutrition of Mental Health

See large image . . . . .

Source: Your Brain Health

Workouts May Boost Life Span After Breast Cancer

Longer survival after breast cancer may be as simple as staying fit, new research shows.

In the new study, regular exercise appeared to reduce breast cancer survivors’ risk of heart disease, diabetes and possibly even the odds for breast cancer’s return.

One breast cancer specialist said the findings should give survivors hope.

“A common question asked by patients who have recently completed treatment is ‘What can I do to prevent this from happening again?’ ” said Dr. Alice Police. She is regional director of breast surgery at Northwell Health Cancer Institute in Sleepy Hollow, N.Y.

“We now have one more very well done study that supports the idea that exercise — as opposed to weight loss alone — is very important in preventing breast cancer recurrences,” Police said.

The new research was led by Christina Dieli-Conwright, assistant professor of research, in biokinesiology and physical therapy at the University of Southern California (USC).

Her team tracked outcomes for 100 breast cancer survivors who’d received cancer treatment less than six months before entering the study.

Nearly half of the participants were obese and 77 percent had developed metabolic syndrome. That’s a group of health conditions — high blood pressure, excessive body fat and high blood fat levels — that raises a person’s odds for heart disease.

“Many people don’t know the No. 1 cause of death for breast cancer survivors is heart disease, not cancer,” Dieli-Conwright noted in a USC news release.

“In breast cancer patients, metabolic syndrome is exacerbated by obesity, a sedentary lifestyle and receipt of chemotherapy,” Dieli-Conwright explained.

In fact, she added, women with metabolic syndrome are 17 percent more likely to develop a breast cancer, three times more likely to have breast cancer recurrence, and twice as likely to die from breast cancer, compared to women without the syndrome.

In the new study, women were randomly assigned to either a non-exercise (“control”) group or to a group that undertook three one-on-one exercise sessions each week for four months.

The workout program included resistance training with weights as well as moderate-intensity aerobic exercise.

At the end of the four months, rates of metabolic syndrome were 80 percent in the non-exercising group, but they’d dropped to just 15 percent in the exercise group, the findings showed.

In addition, the women in the exercise group lost fat, gained muscle and reduced their risk of heart disease, the investigators reported. Also, among those in the exercise group, blood pressure levels fell by 10 percent and blood levels of “good” HDL cholesterol rose by 50 percent.

The bottom line, according to Dieli-Conwright: “Exercise is a form of medicine.”

Police agreed. And while the study couldn’t prove that regular workouts might thwart cancer’s return, she said the theory makes sense.

“Exercise promotes changes in our bodies that go beyond how we look, and make all of our cells and organs happier so that we can remain cancer free,” Police said.

Breast cancer specialist Dr. Stephanie Bernik is chief of surgical oncology at Lenox Hill Hospital in New York City. She said the study is important because “many cancer patients — especially those undergoing chemotherapy — become sedentary, and these habits often persist once treatment is completed.”

But getting back into a workout routine is key to long-term survival, Bernik said, and “women that eat right and exercise are more likely to have a normal longevity.”

The study was published in the Journal of Clinical Oncology.

Source: HealthDay


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