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August 29, 2010
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September 25, 2010

Does Lowering your Cholesterol Lower your Risk for CHD?

Did you know that over half of the Americans who suffered heart attacks had normal cholesterol levels?  Did you know heart disease kills 8 times as many women as breast cancer? Here is a doozy: 300 patients on cholesterol drugs for 1 year will see at most 1 less cardiovascular death.

Heart disease is still a major killer for both genders.  If you have normal cholesterol you still may be at risk.  If you have cholesterol controlled by a statin drug like Lipitor, your risks are really not much lower.

What to do?  Thankfully you have a few new techniques that can better gauge your risk and, if the risk is high, it can be lowered by natural means.

LDL-C/LDL-P

The story of cholesterol starts with the Framingham study.

“In 1948, the Framingham Heart Study embarked on an ambitious project in health research. At the time, little was known about the general causes of heart disease and stroke, but the death rates for (heart disease) had been increasing steadily since the beginning of the century and had become an American epidemic.

The researchers recruited 5,209 men and women between the ages of 30 and 62 from the town of Framingham, Massachusetts, and began the first round of extensive physical examinations and lifestyle interviews that they would later analyze for common patterns related to heart disease. “ Framingham Study

As time went on, we learned that the predictive value of cholesterol tests could be improved by studying certain fractions of cholesterol.  Ever use whole milk from the farm?  You know how the cream rises to the top?  That is because there are different densities of fats inside the milk and the lighter ones float on top of the heavier ones.  Cholesterol fractions are just like this.  HDL is high density lipoprotein, it is heaviest.  This is the one called good cholesterol.  I’m always happy when a patient has lots of HDL – think of it is happy cholesterol.  LDL is low density lipoprotein; it is the lightest, just like the cream.  Also like the cream, it is the one that gunks up the blood vessels.  It is the lousy cholesterol you want less of.  At least that has been the consensus up until now.

Large amounts of data are poised to change this.  LDL can be thought of as little balls.  Some are larger than others.  The smallest LDL particles enter nicks in the blood vessels and get trapped in the inner layers.  If enough get trapped, the vessels simply narrow and have less room to carry blood. Eventually critical tissues like those of the heart get so little blood they die.  Bad deal!  At a medical conference in June, I heard a prominent cardiologist say that without knowing LDL size, total cholesterol and even cholesterol ratios have little or no predictive value for heart disease.

Thankfully these tests are now available by local laboratories and are covered by most insurance policies.  They also depend less on being in a fasting state than the older cholesterol tests did.  Click here for more info on this test.

Coronary Artery CT Scans

Heart disease affects all blood vessels, but occurs first in the areas that have the most blood flow and the most blood turbulence.   You’ve probably heard of the coronary arteries or of someone having a coronary.  The heart itself is a muscle and needs a constant supply of blood. In fact, your heart is only about 5% of your body’s mass yet it uses up to 25% of your body’s blood.

Since the coronary arteries, which bring blood to the heart, are always carrying lots of blood, they are often the first site of plaque buildup.  They are also one of the more dangerous sites for plaque buildup.  For about a decade, there has been a special high resolution CT scan that measures how much calcified plaque is in these arteries.  A recent study showed that the CT scan does have useful predictive value in determining risk of regardless of other known risk factors such as age, gender and cholesterol levels.  More info on the study here.

The test has also become more affordable recently.  Several years ago the test cost anywhere from $500 – 750, but now it can be done for $99.  I consider it a good screening exam for any adult who has not had one.  About 80% of people doing the test have no measurable plaque, their arteries are perfectly clear.  In these cases it is worth repeating in another 10 years.  For those that have measurable plaque, steps such as chelation therapy can reverse the plaque and bring the scores back to normal.  More info on coronary artery CT scans in general can be found here.

Finally, here is an easy thing you can do every day to help your heart regardless of your risk status.  Have a few ounces of pomegranate juice each day.  In general I prefer fruit over fruit juices.  When pomegranates are in the store, buy lots of them and clean a bunch at once.  The seeds freeze well and work great in smoothies.  The rest of the year, a few ounces of the always available juice is reasonably low in sugar and calories and full of heart protective flavonoids.  They have even been shown to speed exercise recovery.  Here is a great summary of all the things pomegranates are known to help.

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