How Stuff Works: How Cholesterol Works

Mclatchy-Tribune News Service.
12-09-09
Heart disease is the No. 1 killer in the United States. According to the CDC, "About every 25 seconds, an American will have a coronary event, and about one every minute will die from one." One per minute works out to over half a million people dead from heart problems per year.
One of the leading causes of heart disease is cholesterol. The fact that cholesterol is the leading cause of the leading killer makes cholesterol important. So let's take a look at how cholesterol works.
What is cholesterol? It is a chemical that is essential to the cells in your body. If you were to hold a blob of pure cholesterol in your hand, it would look and feel waxy. Cells use cholesterol to make their membranes (the outer envelope that holds each cell together).
Because cholesterol is essential to your body, your liver and several other organs make the cholesterol you need - on the order of a gram per day. Then you add some extra cholesterol to the mix in your food - maybe 300 milligrams a day. Therefore plenty of cholesterol is floating in your bloodstream for your cells to use. When cells need it, cholesterol is readily available from a nearby capillary.
If cholesterol is essential to your body, how can cholesterol be bad? The very simplest explanation: cholesterol collects on artery walls and eventually clogs them up. When it clogs up the arteries on the heart, you have a heart attack which is frequently fatal. Why, you might ask, are the arteries on the heart so susceptible? They are not - all the arteries are clogging. It's just that the heart is one place where a clog causes an immediate and often deadly effect. If an artery in your leg clogs, it is known as peripheral artery disease. It's a problem, but not one that will kill you in a few minutes.
Because of the troubles associated with cholesterol, it is something your doctor thinks about. After all, a doctor's goal is to keep people from dying, and cholesterol is a leading cause of death. This is why you get tested for cholesterol. It used to be there was just one number - the amount of cholesterol in the blood, measured in milligrams per deciliter - and you needed to keep it below 200. Then came the differentiation between "good" and "bad" cholesterol, and then all the stuff with density and triglycerides, to the point where today a cholesterol report looks like a confusing bowl of alphabet soup.
But it is interesting, because it is the result of a better and better understanding of what actually seems to be going on with cholesterol inside the human body. The lipoproteins are there to transport things like cholesterol in the blood. Remember that cholesterol is waxy, and blood is watery. Wax and water don't mix, so cholesterol can't flow in the bloodstream and get where it needs to go without help. Lipoproteins provide the help. Low-density lipoproteins (LDL) are what cause artery walls to clog, and are therefore "bad". High-density lipoproteins (HDL) seem to prevent clogging, and are therefore "good". So you doctor is trying to keep overall cholesterol in the good range while decreasing LDL and increasing HDL.
What can you do about cholesterol? Your doctor can prescribe drugs like statins. Statins break a chain in the liver that creates cholesterol, so the amount of cholesterol goes down. They also can lower LDL levels.
In addition you have some dietary steps you can take. Eating low cholesterol foods and avoiding high cholesterol foods can help to some degree, although the body continues making cholesterol and will sometimes make more when you eat less.
There are also several foods you can start eating that affect cholesterol levels. You have probably heard about oat bran. It lowers LDL because it contains soluble fiber. So do fruits like apples. Walnuts also help. In some people, walnuts make a big difference. They contain "good fats" that push cholesterol numbers down. Omega-3 fatty acids, found in things like salmon, flax seed and fish oil pills, also help. And olive oil is a good thing to eat, especially if it is replacing unhealthy fats.
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New study questions effectiveness of popular cholesterol drugs

washingtonpost.com
11-16-09
A widely prescribed and expensive cholesterol drug is not as effective as niacin, a cheap vitamin, in helping to unclog coronary arteries in people already taking statins, the standard medicines used to lower cholesterol, according to a new study.
The research, which appears Monday in the New England Journal of Medicine, is sending rumbles through the medical community because it is the third recent study to raise questions about the effectiveness of Zetia and its sister drug, Vytorin, highly profitable pharmaceuticals made by Merck & Co.
"This is the third strike," said Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. "The studies are telling us that it doesn't appear to produce benefits. This is a drug used by millions of Americans, a very big seller, in a health-care system where costs are a major issue. And the question has to be, is this the right approach?"
Vytorin and Zetia are among the most popular prescription drugs. Last year, physicians in the United States wrote a total of more than 29 million prescriptions for them, and worldwide sales totaled $4.56 billion, according to Merck.
Although the drugs have been shown to reduce cholesterol, there is no evidence that they prevent heart attacks, strokes and other cardiovascular problems.
Top Merck executives are vigorously defending their drugs and have dismissed the new research as limited.
"I don't think a clinician or a doctor or a patient should use this as the basis for any decision-making whatsoever," said Richard Pasternak, vice president of Merck research laboratories. "I worry that people might unnecessarily come off a drug that is approved and accepted."
He and other critics said the study appearing Monday involved just 200 patients, was ended early, and examined what is known as a surrogate marker -- the amount of plaque on artery walls -- rather than evaluating the rate of heart attacks and stroke.
Because plaque can clog arteries and restrict blood flow to the heart and brain, cardiologists view plaque as a good indication for the risk of heart attack and stroke.
The study has been highly anticipated by the medical community and financial analysts, and is the buzz at the annual meeting of the American Heart Association, which began Sunday in Orlando.
Introduced in 2002 and 2004 amid heavy direct-to-consumer marketing, Zetia and Vytorin became blockbusters for Merck and Schering-Plough, which had collaborated on their development. The companies recently merged.
But new research has placed the drugs under greater scrutiny and the number of written prescriptions has been slipping, although together they still represent big business for Merck.
Last year, a study released by Merck showed that Zetia did not reduce plaque in arteries compared with patients taking only statins, which are much less expensive and available in generic form. Although released in January, the study had been completed in 2006, prompting a class-action lawsuit alleging that Merck intentionally withheld unfavorable results of a clinical trial. The company paid $41.5 million in August to settle the claims.
Another study published last year showed a potential increase in cancer among patients taking Zetia and Vytorin, compared with those taking only statins.
Taken as a whole, the new research is unnerving, said Harlan Krumholz, a Yale University cardiologist. "The accumulating evidence isn't giving you any confidence," he said. "This is a very expensive drug being used without any strong evidence that it's benefiting patients." Zetia and Vytorin should be "drugs of last resort, if used at all," Krumholz said. "And anyone who uses it should make sure patients are informed that they're taking a gamble."
Statins, such as Lipitor, have long been used to lower cholesterol and reduce cardiovascular disease. They inhibit the production of LDL, or low-density lipoprotein, often called "bad" cholesterol, which can lead to plaque buildup in arteries.
Zetia, the brand name for ezetimibe, uses a different mechanism. It blocks the absorption of cholesterol from food in the intestines. It has been shown by Merck to lower LDL by 18 percent on average. It is designed for patients who cannot tolerate statins, or for whom high-dose statins are not working.
Vytorin is Zetia combined with a statin, simvastatin, in one pill.
The study released Monday followed about 200 patients who were already taking statins. Some were also given Niaspan, a modified form of Vitamin B, or niacin. The rest took Zetia. Researchers took images of the artery leading to the brain to measure the thickness of the artery walls over 14 months.
The patients who took Niaspan had less plaque in their arteries and also had higher levels of high-density lipoprotein or HDL. Known as "good" cholesterol, HDL is believed to remove cholesterol from the arteries and carry it back to the liver, where it is passes from the body.
The patients who took Zetia had more plaque in their arteries but lower levels of LDL. They also had more heart attacks, strokes and other cardiovascular problems than the patients taking niacin. Merck President Peter Kim said the fact that Zetia lowers LDL cholesterol makes it valuable. "It's very well established that lowering LDL saves lives," he said.
Roger S. Blumenthal, a cardiologist at Johns Hopkins, criticized the new study in an editorial also published Monday in the New England Journal of Medicine. Blumenthal, who has been a paid speaker for Merck, noted that the new study was halted early, which meant results from 40 percent of the participants were not included in the final analysis.
The study's author, Allen J. Taylor of Walter Reed Army Medical Center and Washington Hospital Center, said the trial ended early because the results were quickly apparent. "It couldn't be more clear," Taylor said. "It would have been unreasonable to continue the experiment because the trial had met its objective -- niacin is superior to ezetimibe."
Kim said any conclusions about Zetia and Vytorin should wait until Merck completes a large-scale clinical trial. It involves 15,000 patients and is not expected to yield results until at least 2012.
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Heart disease, stroke, heart failure, and premature death all linked to insufficient vitamin D levels

The results of a study presented on November 16, 2009 at the American Heart Association's Scientific Conference in Orlando, Florida, confirmed a strong association between the presence of reduced vitamin D levels and a greater risk of coronary artery disease, stroke, heart failure and dying over follow-up in men and women 50 years of age and older.
Brent Muhlestein, MD and his colleagues at Intermountain Medical Center in Salt Lake City followed 27,686 subjects with no history of heart disease for an average of 1.2 years. Serum 25-hydroxyvitamin D levels obtained during routine clinical care were classified as normal at over 30 nanograms per milliliter (ng/mL), low at between 15 to 30 ng/mL or very low at less than 15 ng/mL.
Over the follow-up period, 2,614 participants developed coronary artery disease, 1,742 developed heart failure, 314 experienced a stroke and 1,193 deaths occurred. Those with very low vitamin D levels were 45 percent likelier to develop heart disease, twice as likely to develop heart failure, 78 percent more likely to experience a stroke,and 77 percent likelier to die than those with normal levels. Subjects whose vitamin D levels were classified as "low" as opposed to "very low" also had greater risks of these conditions, however, the increase compared to those with normal levels was not as great as the very low group.
"This was a unique study because the association between Vitamin D deficiency and cardiovascular disease has not been well-established," commented Dr Muhlestein, who is the director of cardiovascular research of Intermountain Medical Center's Heart Institute. "Its conclusions about how we can prevent disease and provide treatment may ultimately help us save more lives."
"Utah's population gave us a unique pool of patients whose health histories are different than patients in previous studies," he remarked. "For example, because of Utah's low use of tobacco and alcohol, we were able to narrow the focus of the study to the effects of vitamin D on the cardiovascular system."
"We concluded that among patients 50 years of age or older, even a moderate deficiency of Vitamin D levels was associated with developing coronary artery disease, heart failure, stroke, and death," noted coauthor Heidi May, PhD, MS, who is an epidemiologist with the Intermountain Medical Center research team. "This is important because vitamin D deficiency is easily treated. If increasing levels of vitamin D can decrease some risk associated with these cardiovascular diseases, it could have a significant public health impact. When you consider that cardiovascular disease is the leading cause of death in America, you understand how this research can help improve the length and quality of people's lives."
"We believe the findings are important enough to now justify randomized treatment trials of supplementation in patients with Vitamin D deficiency to determine for sure whether it can reduce the risk of heart disease," Dr Muhlestein added.

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Body Mass Index maybe not the best guage of obesity

Body mass index (BMI) readings may not be the best gauge of obesity in older adults, according to new research from UCLA endocrinologists and geriatricians. Instead, they say, the ratio of waist size to hip size may be a better indicator when it comes to those over 70 (see also University of California - Los Angeles).
In a new study published online in the peer-reviewed journal Annals of Epidemiology, researchers from the David Geffen School of Medicine at UCLA found that the waist-to-hip circumference ratio was a better yardstick for assessing obesity in high-functioning adults between the ages of 70 and 80, presumably because the physical changes that are part of the aging process alter the body proportions on which BMI is based.
"Basically, it isn't BMI that matters in older adults - it's waist size," said Dr. Preethi Srikanthan, UCLA assistant professor of endocrinology and the study's lead investigator. "Other studies have suggested that both waist size and BMI matter in young and middle-aged adults and that BMI may not be useful in older adults; this is one of the first studies to show that relative waist size does matter in older adults, even if BMI does not matter."
Using data from the MacArthur Successful Aging Study - a longitudinal study of high-functioning men and women between the ages of 70 and 79 - researchers examined all-cause mortality risk over 12 years by BMI, waist circumference and waist-hip ratio. They adjusted for gender, race, baseline age and smoking status. The average age of participants was 74.
Obesity is often associated with premature mortality because it leads to an increased risk of diabetes, heart attack, stroke and other major health problems, the study authors say.
The researchers found no association between all-cause mortality and BMI or waist circumference; the link was only with waist-hip ratio. In women, each 0.1 increase in the waist-hip ratio was associated with a 28 percent relative increase in mortality rate (the number of deaths per 100 older adults per year) in the group sampled. Thus, if the waist-hip ratio rose from 0.8 to 0.9 or from 0.9 to 1.0, it would mean a 28 percent relative increase in the death rate. Put another way, if hip size is 40 inches, an increase in waist size from 32 to 36 inches signaled a 28 percent relative death-rate increase.
The relationship was not graded in men. Instead there was a threshold effect: The rate of dying was 75 percent higher in men with a waist-hip ratio greater than 1.0 - that is, men whose waists were larger than their hips - relative to those with a ratio of 1.0 or lower. There was no such relationship with either waist size or BMI.
The study may have some limitations, the authors noted. For instance, participants' BMI may be underestimated because height and weight were self-reported and older adults tend to report those numbers from their younger, peak years. Also, waist-hip ratios, waist circumference and BMI numbers were based on single measurements, limiting the researchers' ability to gauge how changing body size in old age can affect mortality risk.
Keywords: Aging, Bariatrics, Endocrinology, Epidemiology, Obesity, Obesity and Diabetes, University of California - Los Angeles.
This article was prepared by Obesity & Diabetes Week editors from staff and other reports. Copyright 2009, Obesity & Diabetes Week via NewsRx.com.

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Study: Type 2 diabetics forgo dietary guidelines

Study: Type 2 diabetics forgo dietary guidelines
Winston-Salem Journal, N.C.
09-04-09
Sep. 4--Many people with Type 2 diabetes may be jeopardizing their health by not following national dietary guidelines for the disease, according to a study from the Wake Forest University School of Medicine.
The study, released yesterday, appears in the August issue of the Journal of the American Dietetic Association.
The connection between Type 2 diabetes and being overweight has been well-documented.
The American Diabetes Association said that in 2007, 23.6 million Americans, or nearly 8 percent of the population, had diabetes. About 24 percent of those with diabetes have undiagnosed cases.
According to the National Institutes of Health, more than 85 percent of Type 2 diabetics are overweight.
The Wake Forest study, conducted on a national basis, included 2,757 participants. It focused on food-intake recommendations outlined in the 2000 version of the Food Guide Pyramid.
"I thought we were going to find people who, because they have a chronic disease, were more educated about and more motivated than the average American to eat healthy," said Mara Vitolins, an associate professor in the department of epidemiology and prevention.
"But that's not the case. The most important thing about controlling diabetes, especially Type 2 diabetes, is being able to manage energy in and energy out. The best way to do that is through the diet."
The Wake Forest study showed that 93 percent of participants exceeded the recommended percentage of daily calories from fat, while 85 percent exceeded the saturated-fat recommendation, and 92 percent consumed too much sodium in their regular diets.
The study also found that less than half of the participants met the minimum recommended daily servings of fruit, vegetables dairy products and grain. Those foods also have been shown to prevent heart disease -- the leading cause of death in people with Type 2 diabetes.
Only a limited number of participants met nutrient intake recommendations for total fat, saturated fat, sodium and fiber. Overall, the participants consumed a diet that provided about 44 percent of calories from carbohydrates, 40 percent from fat and 17 percent from protein.
Vitolins said that there are several reasons why Type 2 diabetics are overweight, including cultural food preferences, busy work schedules, and not having enough money to buy more nutritious foods.
Many studies have found positive results when Type 2 diabetics lost weight through diet and exercise.
For example, the Diabetes Prevention Program, a large clinical study sponsored by the National Institutes of Health, found that losing 5 percent to 7 percent of body weight and doing moderate-intensity exercise for 30 minutes a day, five days a week, may prevent or delay the onset of Type 2 diabetes.
Vitolins said that the study "clearly illustrates a need to provide ongoing nutrition education for people with diabetes, regardless of the amount of time they've had the disease."
"Day to day, the foods they are eating should be considered a vital part of their treatment. A proper diet and exercise can be as powerful as medication."



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More obesity blues

More obesity blues
NewsRx.com
09-04-09
Obesity is on a rampage, with the World Health Organization pegging the numbers at more than 300 million worldwide, with a billion more overweight. With obesity comes the increased risk for cardiovascular disease, Type II diabetes, and hypertension (see also University of California - Los Angeles).
Now comes more discouraging news. In the current online edition of the journal Human Brain Mapping, Paul Thompson, senior author and a UCLA professor of neurology, and lead author Cyrus A. Raji, a medical student at the University of Pittsburgh School of Medicine, and colleagues compared the brains of people who were obese, overweight, and of normal weight, to see if they had differences in brain structure; that is, did their brains look equally healthy.
They found that obese people had 8 percent less brain tissue than people with normal weight, while overweight people had 4 percent less tissue. According to Thompson, who is also a member of UCLA's Laboratory of Neuro Imaging, this is the first time anyone has established a link between being overweight and having what he describes as "severe brain degeneration."
"That's a big loss of tissue and it depletes your cognitive reserves, putting you at much greater risk of Alzheimer's and other diseases that attack the brain," said Thompson. "But you can greatly reduce your risk for Alzheimer's, if you can eat healthily and keep your weight under control."
The researchers used brain images from an earlier study called the Cardiovascular Health Study Cognition Study. Scans were selected of 94 elderly people in their 70s who were healthy not cognitively impaired-five years after the scan was taken. To define the weight categories, they used the Body Mass Index (BMI), the most widely used measurement for obesity. Normal weight people were defined as having a BMI between 18.5-25; overweight people between 25-30, and obese people greater than 30. The researchers then converted the scans into detailed three-dimensional images using tensor-based morphometry, a neuroimaging method that offers high resolution mapping of anatomical differences in the brain.
In looking at both grey matter and white matter of the brain, they found that the people defined as obese had lost brain tissue in the frontal and temporal lobes, areas of the brain critical for planning and memory, and in the anterior cingulate gyrus (attention and executive functions), hippocampus (long term memory) and basal ganglia (movement). Overweight people showed brain loss in the basal ganglia, the corona radiata, white matter comprised of axons, and the parietal lobe (sensory lobe).
"The brains of obese people looked 16 years older than the brains of those who were lean, and in overweight people looked eight years older," says Thompson.
"It seems that along with increased risk for health problems such as type 2 diabetes and heart disease, obesity is bad for your brain: we have linked it to shrinkage of brain areas that are also targeted by Alzheimer's," said Pittsburgh's Raji. "But that could mean exercising, eating right and keeping weight under control can maintain brain health with aging and potentially lower the risk for Alzheimer's and other dementias."
Keywords: Alzheimer Disease, Bariatrics, Cardiology, Cardiovascular Disease, Diabetes, Hypertension, Neurology, Non-insulin Dependent Diabetes Mellitus, Obesity, Obesity and Diabetes, Type 2 Diabetes Mellitus, Urology, University of California - Los Angeles.

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Add Walnuts to your diet for health

Abuja, Sep 18, 2009 (Daily Trust/All Africa Global Media via COMTEX) -- Nuts generally have become popular as all round source of nutrition and are favoured by those who exercise regularly as a good source of protein and energy. Walnuts which are popularly known as awusa or asala in Yoruba, arinsa in Igbira add extra nutrition, flavor and crunch to one's meal.
These nuts, which are harvested in December and are available all year round come from an ornamental tree that is highly priced for its beauty. The walnut kernel consists of two bumpy lobes that look like abstract butterflies. The lobes are off white in colour and covered by a thin, light brown skin. They are particularly attached to each other while the kernel is enclosed in round or oblong shells that are brown or black in colour and they are hard.
Although the nuts are said to have a high fat content, it plays a role in the provision of a balance diet; with beneficiary nutritional contents covering all the important food groups.
When it comes to their health benefits, walnuts definitely are regarded as a "brain food" not only because of the wrinkled brain like appearance of their shells but because of their high concentration of omega 3 fats.
A nutritionist, Dr Kabir az-Zubair, Director, Molecular Biology & Bioinformatics of National Biotechnology Development Agency, Federal Ministry of Science & Technology, said the human brain is made up of more than 60% structural fats and for the brain cells to function properly, these structural fats need to be primarily the omega 3 fats which are mostly found in walnuts.
"Walnut is an excellent source of omega 3 essential fatty acids, a special type of protective fat the body cannot manufacture. It has many health benefits ranging from cardiovascular protection, to the promotion of better cognitive function and the anti-inflammatory benefit that is useful for Asthma patients, rheumatoid arthritis and inflammatory skin diseases such as Eczema and psoriasis; walnuts also contain an anti-oxidant compound called ellagic acid that supports the immune system and appears to have several anti-cancer properties," he said.
These nutritious nuts are also important source of monounsaturated fats amounted to 15% of the fats found in walnuts so adding it to ones diet is an important step in improving cardiovascular health. Studies on the dietary value of walnut show that increasing the dietary intake of walnuts as favourable effects on high cholesterol levels and other cardiovascular risk factors.
In addition to their heart protective monounsaturated fats, walnuts concentration of omega-3 essential fatty acids is also responsible for the favourable effects walnut consumption produces on cardiovascular risk factors.
Omega-3s benefit the cardiovascular system by assisting in preventing erratic heart rhythms, making blood less likely to clot inside arteries (which is the proximate cause of most heart attacks) and improve the ratio of good (HDL) cholesterol to potentially harmful (LDL) cholesterol. Omega-3s also reduce inflammation, which is a key component in the processes that turn cholesterol into artery clogging plaques.
Walnuts also contain relatively high levels of L-arginine, an essential amino acid which becomes a special import in hypertensive persons. Human body according to experts converts l-arginine into nitric oxide, a chemical that helps keep the inner walls of blood vessels smooth and allows blood vessels to relax. Since individuals with hypertension find it difficult to maintain normal nitric oxide levels which may also lead to other significant health issues such as diabetes and heart problems, walnuts can serve as a great addition to their diets.
In a research published by the British Journal of Nutrition which identified several nuts among plant foods with highest total antioxidant content, suggests that walnuts and chestnuts have the highest antioxidant content of tree nuts with walnuts delivering more than 20mmol antioxidant per 3ounces (100gm).
The research concluded that, consumption of nuts at least 4 times in a week showed a 37% reduced risk of coronary heart disease while each additional serving of nuts per week shows 8.3% reduced risk of cardiovascular and coronary heart disease, intake of a handful of walnuts at least 4times in a week is recommended for persons suffering from these diseases.
Prevention and control of high blood pressure is also one of the benefits derived from eating walnuts because it is gathered that individuals whose diets provide greater amount of omega-3 polyunsaturated fatty acid have lower blood pressure than those who consume less and walnuts has been identified as an excellent source of this essential fats.
It also improves the cholesterol profile in persons with type 2 diabetes. In patients with type 2 diabetes, a daily ounce of walnuts in a diet in which 30% of calories came from fat related into a significant improvement in subject's cholesterol profile. The nuts are found to reduce levels of several molecules that promote atherosclerosis.
Preventing gallbladder disease may be as easy as having a handful of walnuts as part of ones diet or tossing some walnuts on salad because it helps in prevention of gallstones in women. For a better night sleep, sprinkling ones dinner with a handful of walnuts is good because it is a source of bio-available melatonin - a hormone produced by the pineal gland, which is involved in inducing and regulating sleep and it's also a powerful antioxidant in bio - available form, making the perfect evening meal for a natural good night sleep.
Apart from the dietary benefit of walnuts, straw-coloured clear oil can also be extracted from fresh walnuts which must be protected from the light and oxidant agents because it becomes rancid easily. This oil is used as a tonic for children and aged people as well as a dry agent for painting for the rapidity by which colours dry in it.
The nutritional value of walnuts can be likened to that of cheese because of its high content of proteins and fats. Walnuts have a high source of essential unsaturated fatty acids such as alfa-linoleic acid and their contents in proteins and vitamins are good, especially in vitamins B and E groups.
Maintenance of healthy levels of melatonin is important for everyone over the age of 40 since the amount of the hormones produced by the human body decreases significantly as humans age. This reduction in antioxidant protection may be related to the development of free radical related diseases later in life; thus walnuts are highly recommended for everybody for healthy living.
by Romoke W. Ahmad

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