Even Small Improvements in Cholesterol, Blood Pressure Help Prevent Heart Attack

Serena Gordon wrote . . . . . . . . .

Small, lasting changes in cholesterol and blood pressure levels can dramatically reduce the risk of heart disease and strokes over a lifetime, new research suggests.

The large study found that a combination of a drop in LDL cholesterol (the bad type) of 14 mg/dL and a 5 mm Hg drop in systolic blood pressure (the top number in a blood pressure reading) cut the lifetime risk of heart disease and stroke in half.

And, the more those levels fell, the greater the reduction in heart disease and stroke risk.

“Small changes in blood pressure and cholesterol over decades can lead to huge benefits. Changes that are doable with a healthy diet and exercise can cut cardiovascular risk by 50%,” said Dr. John Osborne, a spokesman for the American Heart Association and director of cardiology at State of the Heart Cardiology, in Dallas.

Osborne wasn’t involved in the new study, but is familiar with the findings.

A number of past studies have shown that lowering blood pressure or cholesterol for five years or so can have an impact on cardiovascular disease. But it’s been difficult to know how a lifetime of these changes could affect the risk of heart disease and stroke.

The new research included almost 440,000 people, average age 65, enrolled in a long-term study in the United Kingdom. Fifty-four percent were women.

The study participants were recruited between 2006 and 2010. The follow-up lasted through 2018. During that time, almost 25,000 people had a non-fatal heart attack, a stroke caused by a blood vessel blockage (ischemic) or a heart disease death.

The researchers looked for study participants who had genetic variants that led to them having lower LDL cholesterol and systolic blood pressure throughout the study. Using a statistical technique called Mendelian randomization, the investigators were able to estimate lifetime effects of lower cholesterol and systolic blood pressure compared to people without these gene variations.

The study found the combination of an LDL reduction of 39 mg/dL and a 10 mm Hg lower systolic blood pressure could decrease the lifetime risk of cardiovascular disease by 80%. The same combination also lowered the lifetime risk of death due to heart disease by more than two-thirds.

Osborne said that much of a reduction might be tough to achieve with just diet and exercise, but it’s “doable” with medications.

“In clinical trials, we’re often just looking at five or six years. Now, we can appreciate the effect of those changes over decades of life,” he said.

Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City, also reviewed the findings.

“We know that elevated bad cholesterol and elevated blood pressure are two independent, modifiable risk factors for heart disease. The combination of the two elevate this risk further,” he explained.

But, Bhusri said, this study revealed that “even a modest decline had a major impact on the diagnosis of heart disease.” He added that this study also shows what happens if someone adheres to a healthy lifestyle or medications to lower these risk factors over a lifetime.

“Adherence to lifestyle changes and to medications is a major predictor of heart disease,” Bhusri said.

The study was presented at the European Society of Cardiology meeting in Paris. It was simultaneously published online in the Journal of the American Medical Association.

Source: HealthDay


Today’s Comic

Study: Cholesterol in Eggs Tied to Cardiac Disease, Death

The risk of heart disease and death increases with the number of eggs an individual consumes, according to a UMass Lowell nutrition expert who has studied the issue.

Research that tracked the diets, health and lifestyle habits of nearly 30,000 adults across the country for as long as 31 years has found that cholesterol in eggs, when consumed in large quantities, is associated with ill health effects, according to Katherine Tucker, a biomedical and nutritional sciences professor in UMass Lowell’s Zuckerberg College of Health Sciences, who co-authored the analysis. The study was published in the Journal of the American Medical Association.

The study results come as egg consumption in the country continues to rise. In 2017, people ate an average of 279 eggs per year, compared with 254 eggs in 2012, according to the U.S. Department of Agriculture.

Current U.S. Dietary Guidelines for Americans do not offer advice on the number of eggs individuals should eat each day. The guidelines, which are updated every five years, do not include this because nutrition experts had begun to believe saturated fats were the driving factor behind high cholesterol levels, rather than eggs, according to Tucker. However, prior to 2015, the guidelines did recommend individuals consume no more than 300 milligrams of cholesterol a day, she said.

One large egg contains nearly 200 milligrams of cholesterol, roughly the same amount as an 8-ounce steak, according to the USDA. Other foods that contain high levels of cholesterol include processed meats, cheese and high-fat dairy products.

While the new research does not offer specific recommendations on egg or cholesterol consumption, it found that each additional 300 milligrams of cholesterol consumed beyond a baseline of 300 milligrams per day was associated with a 17 percent higher risk of cardiovascular disease and an 18 percent higher risk of death.

Eating several eggs a week “is reasonable,” said Tucker, who noted they include nutrients beneficial to eye and bone health. “But I recommend people avoid eating three-egg omelets every day. Nutrition is all about moderation and balance.”

Research results also determined that study participants’ exercise regimen and overall diet quality, including the amount and type of fat they consumed, did not change the link between cholesterol in one’s diet and risk of cardiovascular disease and death.

“This is a strong study because the modeling adjusted for factors such as the quality of the diet,” Tucker said. “Even for people on healthy diets, the harmful effect of higher intake of eggs and cholesterol was consistent.”

Source: EurekAlert!


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Red and White Meats Are Equally Bad for Cholesterol

Flying in the face of popular belief, new research suggests both red meat and white meat can drive up your cholesterol levels.

The study was conducted by researchers from the Children’s Hospital Oakland Research Institute (CHORI), part of the University of California, San Francisco. The analysis is reportedly the first to comprehensively compare the impact that red and white meat have on cholesterol.

Red meat, such as beef and lamb, has become unpopular in recent years because of its association with heart disease, and government nutrition guidelines have encouraged consumers to eat poultry as a healthier alternative, the researchers noted.

“When we planned this study, we expected red meat to have a more adverse effect on blood cholesterol levels than white meat, but we were surprised that this was not the case,” said study senior author Dr. Ronald Krauss. “Their effects on cholesterol are identical when saturated fat levels are equivalent.”

Krauss is senior scientist and director of atherosclerosis research at CHORI.

After tracking how red meat, white meat and plant protein all impacted cholesterol levels, Krauss and his team determined that both red and white meat prompted higher blood cholesterol levels than diets containing an equivalent amount of plant protein. (Grass-fed beef, fish and processed meat products such as bacon were not included in the analysis.)

The finding held up even after accounting for a high intake of saturated fats, investigators noted, and it suggests that the best way to keep cholesterol under control is to turn to non-meat proteins, such as vegetables, legumes and dairy products.

“Our results indicate that current advice to restrict red meat and not white meat should not be based only on their effects on blood cholesterol,” Krauss noted in a university news release. “Indeed, other effects of red meat consumption could contribute to heart disease, and these effects should be explored in more detail in an effort to improve health.”

The findings were published in the American Journal of Clinical Nutrition.

Source: University of California San Francisco


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Could Very Low ‘Bad’ Cholesterol Bring Stroke Danger?

Alan Mozes wrote . . . . . . . . .

Despite years of being told that the lower your LDL cholesterol the better, is it possible that levels that are too low might harm you?

Yes, say researchers who now report that women who have excessively low LDL (“bad”) cholesterol levels may face a higher risk for a bleeding stroke.

The finding runs counter to government guidelines that state people should strive to keep their LDL levels below 100 milligrams per deciliter (mg/dL).

But after tracking nearly 28,000 women aged 45 and up for two decades, investigators determined that women with LDL levels of 70 mg/dL or lower were more than twice as likely to experience a bleeding (“hemorrhagic”) stroke than those with LDL levels in the range of 100 to 130 mg/dL.

A similar dynamic was seen with blood fats known as triglycerides. Women with the lowest fasting triglyceride levels (74 mg/dL or less) also saw their bleeding stroke risk double when compared to women with the highest levels (156 mg/dL and up).

Still, one heart expert urged caution in interpreting the results.

Dr. Gregg Fonarow is co-director of the preventative cardiology program at the University of California, Los Angeles. He stressed that the increased risks “are small in absolute terms,” and there is a far greater risk that a patient with high LDL levels might experience a blood clot, an “ischemic” (clot-caused) stroke or a heart attack.

Prior research indicates that “there is not significant increases in hemorrhagic stroke, and the risk of ischemic stroke is significantly reduced [with low LDL levels],” Fonarow noted.

How to explain the latest finding?

“The full mechanisms by which very low levels of LDL cholesterol or low triglycerides increase the risk of hemorrhagic stroke are not known yet,” said study author Pamela Rist. She is an assistant professor of medicine at Harvard Medical School and Brigham and Women’s Hospital in Boston.

But Rist pointed to the theory that low LDL and triglycerides might weaken blood vessel walls. And that could raise the risk for a bleeding stroke, though the study did not prove a cause-and-effect relationship.

Though far less common than ischemic strokes, bleeding strokes — which occur when a blood vessel bursts and bleeds into the brain — are trickier to treat and often more deadly.

Rist said prior studies suggest that the same risk might also affect men, though her team did not explore that possibility.

Rist’s team also did not explore the link between very low LDL levels and the risk for experiencing an ischemic stroke, which accounts for 87 percent of all strokes, according to the American Stroke Association.

The findings were reported online in the journal Neurology.

All of the women in the study had been part of the Women’s Health Initiative, a long-term national study that tracked both HDL (“good”) and LDL cholesterol levels, as well as triglycerides. Levels were measured just once, at the beginning of the study.

Interestingly, no increased risk was seen with variations in either total cholesterol (LDL and HDL levels combined) or HDL levels alone, the researchers reported.

Rist pointed out that, unlike prior work that explored the role of statins in stroke risk, most women in this study were not taking statins. That means that the cholesterol-lowering drugs likely played no role in driving down LDL levels.

Nevertheless, “these women may have an increased risk of experiencing a hemorrhagic stroke,” said Rist. “Therefore, it is important to manage other risk factors for hemorrhagic stroke, such as hypertension [high blood pressure] and smoking.”

Source: HealthDay


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As Eggs Make A Comeback, New Questions About Health Risks

Allison Aubrey wrote . . . . . . . . .

Eggs have made a big comeback. Americans now consume an estimated 280 eggs per person per year, according to the U.S. Department of Agriculture. And that’s a significant increase compared with a decade ago.

Part of the renewed appeal stems from the dietary advice we got back in 2016. That’s when the U.S. Dietary Guidelines dropped a long-standing recommended limit on dietary cholesterol. The move was seen as a green light to eat eggs.

But a new study published in the medical journal JAMA reopens a long-standing debate about the risks tied to consuming too much dietary cholesterol.

“What we found in this study was that if you consumed two eggs per day, there was a 27 percent increased risk of developing heart disease,” says researcher Norrina Allen, an associate professor in the Department of Preventive Medicine at Northwestern University.

“It was surprising,” Allen says.

The researchers behind the JAMA study tracked the health of about 30,000 adults enrolled in long-term studies. On average, participants were followed for about 17 years.

Prior studies have come to competing conclusions. But overall, there has not been strong evidence that limiting consumption of cholesterol-rich foods lowers the amount of artery-clogging LDL cholesterol that ends up in our blood.

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Nutrition experts at the Harvard T.H. Chan School of Public Health conclude that dietary cholesterol and cholesterol in the blood are only weakly related. But Allen says that “we don’t know as much as we’d like to about how the cholesterol you consume in your diet is translated into the blood.”

The new study is an observational study, so it doesn’t prove that cholesterol caused the increased risk of heart disease that the researchers documented. “These new findings provide one piece of evidence,” Allen says. But it’s possible that other lifestyle or dietary habits may be responsible for the increased risk.

One shortcoming of the study is that participants were asked only one time about their diets. So, this one snapshot may not have accurately captured their eating habits over time. “We hope that in future studies we can look at how changes in diet over the long term may be impacting this risk for heart disease,” Allen says. Future studies could also explore how the risks linked to dietary cholesterol may vary from person to person.

“So much data have already been published on this topic, which generally show that low-to-moderate egg consumption (no more than one egg per day) is not associated with increased risk of heart attack or stroke,” Frank Hu, a professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health, said in an email.

Hu says that when it comes to healthful eating, the best strategy is to focus on a well-rounded diet that includes a variety of foods such as fruits, vegetables, whole grains, nuts and seeds.

Thomas Sherman, a professor at Georgetown University’s School of Medicine, agrees. “I tell my students that eating a protein-rich breakfast is one of the best ways of preventing getting hungry,” Sherman says. “So I’d hate for them to come back to me and say, ‘Oh, no! We’re not supposed to be eating eggs.’ ”

Sherman says if you’re in the habit of eating a healthy diet, full of lots of plant-based, fiber-rich foods, then “eggs are a welcome part of the diet.” Just don’t overdo it.

But the findings may reopen the debate about whether to reinstate a recommended limit on dietary cholesterol. A committee of experts was named this year to begin the process of revising the U.S. Dietary Guidelines. And Allen says, “I do think that guideline committees will have to take the evidence [from this study] into account when they’re trying to understand what a healthy — or a moderate — amount of cholesterol would be.”

Source: npr