Cholesterol Solutions Today:The Good & The Bad

We’re talking about cholesterol and high blood pressure meds used by people between the ages of 20 and 44 years old. For cholesterol meds, the rate rose from 2.5 percent in 2001 to slightly more than 4 percent in 2006, which translated into a 68 percent jump. And for blood pressure drugs, the rate rose to 8 percent, a 21 percent increase, according to a new analysis by Medco Health Solutions, the big pharmacy benefits manager. And the usage appears to be growing at a faster pace than among older Americans.
Why? Well, experts point to higher rates of obesity, high blood pressure and high cholesterol problems among young people, the Associated Press reports. Also, docs are getting more aggressive with preventive treatments. “This is good news, that more people in this age range are taking these medicines,” said Dan Jones, president of the American Heart Association, tells the AP.
Still, he says many more people should be on the drugs that lower cholesterol or blood pressure and which have been shown to reduce risks for heart attack and stroke. In other words, cholesterol pills will become life-long companions to much of the population. Imagine a college graduation ceremony - for a gift, a newly minted grad is given a year’s supply, which may have real value if the next generation of pills is as expensive as Lipitor.
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I recently got a copy of the new Gary Taubes book, Good Calories Bad Calories, which a lot of us have been waiting for with high hopes.Alas, this was not the book I had hoped it would be. Taubes has done a heroic job of studying and analyzing the history of 75 years worth of dietary research. No one with a shred of intellect can read this book without coming away convinced that the Politics of Personality caused nutritional research to go where the data never led it and to spend 40 years wandering in that high carb/low fat desert. But the Taubes book is 600 pages of some of the densest writing I’ve encountered in a long life of reading popular science. How dense? Well, I managed to sprain a finger reading it, that was how heavy it was. And the prose is just as dense as the paper. Long convoluted sentences that just don’t come up for air, and explanations of technical issues so impenetrable that they left me scratching my head trying to figure out what the heck was he talking about. And I’m someone who reads a lot of big fat information dense books. For example, I just this week read, and loved Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver by Arthur Allen which covered as much controversial medical research history as Taubes does and was a similar length. But where I was reading the Allen book with the kind of excitement with which I read a good detective story, because Allen made his line of argument very clear no matter how much data he introduced, with the Taubes book every fifty pages or so I found myself taking deep gulping breaths and skimming despite myself because Taubes had just plain buried me under the weight of his data. And if I had that reaction–a person who reads at least a dozen health and nutrition research reports every week and often more–I cannot imagine what Joe Public would make of this book. Indeed, as someone who led a long and happy career in nonfiction publishing I am bewildered as to who exactly it was written for. To me it seemed as if the target reader was envisioned to be someone who reads Science at the breakfast table and then digs into Nature on the train to work. If there are enough of those folks to make this book a success, I’m all for it. But my impression just looking at the title, cover and packaging is that Good Calories Bad Calories is being marketed to the diet book buyer. Who is going to get about 25 pages into this book and then fall dead from exhaustion. That is probably why it is looking like this book is only getting discussed online by the hard core diet wonks who already know what it is that Taubes is trying to document: that the mainstream dietary advice that blames saturated fat for heart disease and recommends a high carb/low fat diet as “healthy” was never based on good scientific research and that carbs in general and fructose in particular are probably what is causing the so called “obesity epidemic.” But if the only people reading the book are those who already know what it has to teach us, it’s a failure. Which is tragic. Because its core message is VERY important. Fat has never been proven to do any of the things “everyone knows” it does and high carb/high sugar diets are just plain killing people. If I had a buck for everyone who told me they are eating a low fat diet to lower their cholesterol and prevent heart disease I’d be rich. Ditto all the doctors convinced that saturated fat is what causes heart disease. Reading this book could cure that. But I can’t see those people reading this book.So I came away wishing that there was some way that Taubes could come up with “Taubes Lite”–a 250 page book that would extract the “pearls for practice” buried in his data and pitch that book to the person trying to figure out what a “healthy diet” might be. Something that would help people with diabetes understand why the ADA insistence that they should eat all the sugar they want is dangerous, and get the media to understand that obesity is not caused by overeating. It is caused by eating foods that short circuit the metabolic systems our body uses to keep our weight in homeostasis, foods high in carbs and fructose. But it ain’t going to happen with this book, and that’s a damn shame. (Source: Diabetes Update)

Stroke occurs when a blood vessel in the brain becomes blocked or ruptures. The most common form of stroke is due to blockage of a blood vessel. Blood vessel blockage is caused by a condition known as
atherosclerosis, commonly known as “hardening of the arteries.” This is the most common type of stroke. Stroke is one of the three major leading causes of death in the United States. The other two are heart attack and cancer. Stroke is the leading cause of disability in the U.S. It is for this reason that it is much wiser to focus on stroke prevention in the first place rather than trying to limit the damage with stroke treatment after event has occurred. High blood pressure (hypertension) is the single biggest, treatable risk factor for stroke. In the 1970s, there was a push by the medical community to aggressively treat high blood pressure to lower the risk of stroke, premature heart disease and kidney failure. One cannot feel that their blood pressure is elevated but the damage to major body organs (heart, brain, kidneys) continues on. It is only when these organs start to fail or a stoke occurs, will it become apparent that a given individual may have hypertension. On occasion, patients with untreated hypertension may have headaches. Fortunately checking one’s own blood pressure is easy. This can be done at your doctor’s office, pharmacies or the local fire department. If you have high blood pressure with the top number greater than 150 or the lower number greater than 85, you need to see a physician for treatment. Fortunately there are many different types of medication to treat high blood pressure. Many patients can be successfully treated with a single drug, for mild hypertension. Individuals with moderate to more severe hypertension, multiple drug therapy may be necessary. With the
aggressive push to treat high blood pressure, the rate of stroke in the United States has dropped dramatically over the past two decades. There is a class of blood pressure medication, the ACE inhibitors, that have been shown in well designed clinical studies to significantly reduce the risk of stroke independent of their ability to lower blood pressure. Current evidence based medicine strongly suggests that addition of an ACE inhibitor should be done in patients with high blood pressure, even if their blood pressure is adequately controlled on other agents. Ideal blood pressure range should be with the upper number (systolic) being less than 130 and the lower number (diastolic) less than 80.
It has been well known for several decades that aspirin thins out the blood. Cardiologists have used aspirin extensively for 30 years to lower the risk of having a heart attack. Aspirin slows down the formation of clots by blocking the clumping of platelets to form blood clots. In 1994 a hallmark study, the Antiplatelet Trialists’ Collaboration, was published demonstrating the clear benefit of aspirin in the prevention of stroke and transient ischemic attacks (TIA, “mini strokes”.) In 1998, the FDA approved labeling of aspirin for the prevention of TIA and stroke. Dosage recommendations in the range of 81-325 mg daily should be used. Unfortunately aspirin does not entirely prevent stroke or TIA from occurring. Other blood thinning agents can be used in patients who fail aspirin therapy. The other two agents are Plavix and Aggrenox. Either agent can be used in patients who have had a TIA or stroke while taking aspirin. In patients who have no history of heart disease, Aggrenox is the preferred agent. Plavix is preferred in those patients who have known coronary artery disease.
Lastly, high cholesterol has been implicated in the development of accelerated atherosclerosis. There have been studies that have shown some correlation of high cholesterol with the increased risk of having a stroke. Multiple, double-blind, placebo controlled studies have shown that the use of cholesterol lowering statin drugs for cholesterol reduction results in an average of a 27% overall secondary risk decrease in stroke. Studies are ongoing to show if statins may help in primary prevention of stroke and TIA. At this time, it is prudent to be on a statin drug, for cholesterol reduction. The currently available statins include: Lipitor, Zocor, Pravachol, Crestor or Mevacor if you have a cholesterol over 200. The marked benefit of this class of drugs on the reduction of stroke and cardiac events (35%) is dramatic and strongly supports more aggressive treatment for high cholesterol (hyperlipidemia.) The objective is to have a total cholesterol less than 180, good cholesterol (HDL) of greater than 50 and bad cholesterol (LDL) less than 100. A recent study published in the journal Stroke reported that discontinuing statin therapy in the year after a stroke is associated with a significant increase in the risk for death, even in the absence of heart disease.
Medications are not the only treatment for stroke prevention. Smoking is associated with a 2-3 times greater risk of stroke and bleeding in the brain. Smoking also contributes to the accelerated development of heart disease, emphysema and peripheral artery disease. Chantix is a new medication that received FDA approval to help stop smoking. Exercise is important in maintaining overall body conditioning and weight control. This in turn leads to an overall lowering of blood pressure and cholesterol. In summary, stroke prevention is much easier and cost effective than fixing the problem after someone has a stroke. This approach to stroke reduces mortality and disability for the entire United States population. The cost saving are in the hundreds of billions of dollars over stroke treatment. If you feel that you are at risk for stroke, contact a neurologist for evaluation and treatment. (Source: Sarasota Neurology)

by Pat Salber Perhaps the folks over at Hardee’s fast food haven’t heard the country is in the midst of an obesity epidemic.  They have just unveiled a new breakfast offering, the Country Breakfast burrito.  It consists of a two egg omelet filled with bacon, sausage, diced ham, cheddar cheese, hash browns and sausage gravy.  Surrounding this protein load is a flour tortilla.  The burrito weighs in at 920 calories.  That’s right, 920 calories, about half of what you should ingest in a day.  This little baby also has 60 grams of fat.  All those calories and all that fat will only set you back $2.69.According to a story by the Associated Press, Brad Haley, Hardees’ marketing chief, says that the burrito offers the sort of big breakfast item normally found in sit-down restaurants with an added advantage.  “It makes this big country breakfast portable,” he said.Other Hardee offerings include the Monster Thickburger, a 1,420-calorie sandwich that contains two 1/3-pound slabs of beef, four strips of bacon, three slices of cheese and mayonnaise!  Want a healthy alternative?  Try the Hardees’ chicken salad –it is only 1,100 calories and 83 grams of fat.  Supposedly, the chain does offer some low-calorie options, including roast beef and chicken sandwiches.AP reports that the Center for Science in the Public Interest, a Washington-based advocate for nutrition and health, has called the Hardee’s line of Thickburgers “food porn.” I love it, food porn!Jayne Hurley, senior nutritionist at the Center, said the burrito is “another lousy invention by a fast-food company.”  The “country breakfast bomb,” as she called it, represents half a day’s calories and a full day’s worth of saturated fat and salt, to say nothing of cholesterol.  “That’s all before 10 o’clock in the morning,” she said.Hardees’ Haley makes no apologies:  “We don’t try to hide what these are,” he said. “When consumers go to other fast-food places they feel like they’ve got to buy two of their breakfast sandwiches or burritos to fill up. This is really designed to fill you up.”Way to go, Hardees.  Keep on fillin’ us up. (Source: The Doctor Weighs In)

Statins are known to be good for lowering cholesterol and maybe even fighting dementia, and now they have another reported benefit: they appear to slow decline in lung function in the elderly- even in those who smoke. According to researchers in Boston, it may be statins’ anti-inflammatory and antioxidant properties that help achieve this effect.

Lipitor™ (atorvastatin calcium) is the #1 selling medication used to lower high cholesterol. Drug Topic lists it as being the top selling brand name drug in 2006 with retail sales of almost $6.6 billion. Lipitor blocks a cholesterol producing enzyme in the liver forcing the liver to use up its reserves and thus lowers over all cholesterol level. It is prescribed to patients with multiple risk factors for heart disease like age, family history, high blood pressure, low HDL or smoking to lower the risk of heart attack and stroke. There has been some legal action against Pfizer regarding Lipitor and claims that there has been a cover-up of the seriousness of its side effects. The claims include accusations of previously undisclosed side-effects such as "lasting, debilitating muscle and nerve problems, including memory loss." A former NASA scientist has even set up a web site to detail his, and other peoples', experiences that they associate with having taken Lipitor. As with an prescribed medication, your doctor will evaluate your health and decide if you will benefit from taking this or any other medication.   (Source: PharmaGazette)

A long term study of the world's top selling medication found that cholesterol-lowering statin drug help prevent heart attacks for up to 10 years after patients stop taking them.The original study showed that men taking Pravachol for five years lowered their risk of heart attack and death from heart disease. The same men were followed for another 10 years after most had stopped taking the medication and compared to the men that had taken a placebo for the original 5 year period. There was a reported 25% decrease in heart attack and heart disease among those that had taken the statin."Dr. Michael J. Domanski of the National Heart, Lung, and Blood Institute said the study's biggest weakness is the fact that after the study ended, more of the original statin patients took the drugs than those in the placebo group. Domanski wrote in an editorial that the study clearly shows the benefit of statin use "is durable over the long term" and that there now can be no doubt reducing levels of LDL cholesterol has a role in preventing and treating heart disease."The follow up study was, in part, funded by the makers of Pravachol, Bristol-Myers Squibb Co.( NYSE:BMY) and Daiichi Sankyo Inc.(TYO:4568), maker of the statin WelChol, and all but one of the researchers reported receiving financial remuneration for 5 other pharmaceuticals, four of which sell statins.[Source: Yahoo News] (Source: PharmaGazette)

That’s the conclusion of a new study that says the cholesterol-lowering meds help prevent heart attacks for at least a decade after people stop taking them. And this is the first long-term study of the world’s top-selling type of medication, by the way, the Associated Press reports. The research is a follow-up to a study in Scotland showing that men taking Pravachol for five years substantially lowered their risk of heart attack and death from heart disease.
They were followed for another 10 years after most stopped taking the drug. That group was compared with a group of men who were given dummy pills during the five-year study, the AP writes. There was a 25 percent lower risk of heart attack or death from heart disease among those in the statin group, when compared with the placebo group. The study participants were middle-aged men who had never had a heart attack but who had a very high average level of LDL, or bad cholesterol - 192.
While the study found protection lasted after statin use stopped, the drugs usually are prescribed indefinitely, especially for people with known heart disease. Federal guidelines say these drugs are very safe and may be used by people with LDL levels as low as 130, or even 100 if they are at very high risk of heart attack, the AP writes. The new results, based on medical records from more than 90 percent of the men in the original experiment, appear in the latest issue of The New England Journal of Medicine (subscription may be required).
The researchers concluded that the statin’s protective effect was probably because existing plaque was stabilized and the progression of coronary artery disease was slowed. “Continuing treatment after five years may be beneficial,” they wrote. Pravachol is sold by Bristol-Myers Squibb, which provided some funding for the study, as did Daiichi Sankyo, which makes WelChol, another statin. All but one of the researchers reported receiving consulting fees, lecture fees or research grants from a total of five other drugmakers, four of which sell statins.
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So far, at least. The drugmaker is reporting that its experimental cholesterol med, which is in the same class as Pfizer’s fabulous flop, had dramatic results in a small clinical trial, and didn’t exhibit the sort of safety problems that killed torcetrapib. Merck’s CETP inhibotor raised HDL by 139 percent and cut LDL levels by 40 percent during an 8-week trial, in 589 patients, according to data presented at the Drugs Affecting Lipid Metabolism meeting in New York.
By contrast, the current best-selling drugs to boost HDL - whose active ingredient is niacin - typically raise good cholesterol by only 20 to 30 percent, Reuters reminds us. Just as significant, the Merck drug - code-named MK-859 - didn’t cause a rise in blood pressure, which was a big issue with Pfizer’s torcetrapib and may have caused an increased number of deaths that ultimately ended further development.
“As hard as we looked, we couldn’t find any increase in blood pressure,” Daniel Bloomfield, a senior Merck research told Reuters. “The data really point out you can inhibit CETP with MK-859, and substantially reduce LDL and increase HDL, and importantly not raise blood pressure…The data suggest any does would be safe to go forward with.” Four doses - 10 mg, 40 mg, 150 mg and 300 mg, were tested against placebo.
The incidence of side effects among patients taking the Merck drug, at whatever dose, was similar to those seen among patients given placebos. But Bloomfield cautioned that the safety won’t really be known until the drug goes through much larger studies, which typically take 4 to 7 years and focus on the risk of heart attacks and death. And despite the effects on LDL and HDL cholesterol, he believes the FDA is unlikely to approve MK-859 until such studies are completed.
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By Dov Michaeli MD, Ph.DHere are three headlines from today’s paper:Front page: “GOP Losing Grip On Core Business Vote”. For obvious reasons.Opinion page: “Immigration Losers” by Richard Nadler, President of Americas Majority Foundation, a Midwest public policy think tank (and I might add, a Republican organization in the mold of the Taft dynasty): “ …Republicans need to repudiate… the immoral, uneconomical goal of mass deportation”.Opinion page: “The Future of Bioenergy”, by Juan Enriquez, managing director of Excel Medical Ventures, cofounder of Synthetic Genomics, and founding director of Harvard Business School Life science Project.The first article Chronicles the takeover of the Republican party by the social conservatives, and the virtual disappearance of the fiscal conservatives/social moderates from the party. The second decries the xenophobic and punitive stance of the Republican party with regard to immigration issues. The last one calls for innovative approaches, using biology to solve the energy and global warming dilemmas we are confronted with.Quiz: which newspaper was I reading?The New York Times.The Washington Post.The Los Angeles Times.Answer: none of the above. It was the Wall Street Journal, the bastion and mouthpiece of conservative (read: regressive) ideology, and a fierce opponent of anything liberal, such as fiscal responsibility and global warming. The editorial page had labeled the global warming issue as a liberal hoax, a figment of liberal scientists’ imagination, invented out of whole cloth and computer models.But the purpose of this posting is not to harangue one particular political view. I want to highlight the salient points made in Enriquez’s article as to what Biology can bring to the table in solving our energy and climate problems. I had intended to write about this issue for a long time and this article was the catalyst.A paradigm shift One of the deepest thinkers of the history of science was Thomas Kuhn who, in 1962, published his seminal book “The Structure of Scientific Revolutions”. In it he argued that we all share a certain view of the world (paradigm) at a given time, on which the science of the time is based. But then and insight occurs, which shakes the foundation of our old world view and on which a new paradigm is founded. For example, until the 17th century Anatomy and Medicine were based on the writings of Galen, a Greek physician from the 2nd century. For 15 centuries scientists and physicians did not bother to dissect an animal in order to observe and verify the Galenic dogmas handed down to them since antiquity. But then William Harvey, a British physician, had an insight: why not observe how blood flows– which led to the discovery of the circulation. But more happened: the demonstration that Galen’s writings about blood flow were wrong led other scientists to question his other assertions, test them through direct observations- which led to the modern sciences of Anatomy and Physiology. In fact, the revolution did not stop there; people learned to view with suspicion “received wisdom” handed down by higher authorities. These momentous changes in world view were a “paradigm shift”.We are changing our world view,againWhen our agricultural practices, inherited from the time we began to cultivate crop plants about 10,000 years ago, no longer sufficed to feed an exploding population we invented better ploughs, bigger machines, synthetic fertilizers, powerful insecticides. But this solution finally reached its inherent limitations. In the 20th century the world could not feed the hungry multitudes of China, India and Africa. Malthus was triumphant. But then another revolution took place.‘We began to apply more Gregor Mendel and less Henry Ford. Plant geneticists like Nobel Prize winner Norman Borlaug found that altering plants biologically was even more powerful and efficient than brute-force mechanical solutions. By altering seeds, harvest cycles and climate range, Mr. Borlaug and his colleagues launched the green revolution. Poor farmers in China and India, who could never afford a mechanical solution, became net exporters using a biological solution.’The new world view is that the cleanest and most efficient solutions to our environmental and energy problems will be provided by Biology.Consider coal, the most abundant and most polluting source of energy we have. Hydrocarbons are, in essence, sunlight concentrated in plant, animal or bacterial matter. Be it coal, gas or oil, what we are extracting and burning is bioenergy concentrated in carbon. Molecular Biology, the science that launched a thousand medical advances, is now enabling us to convert coal into ethanol in the ground; no more mining, no more environmental degradation, no more millions of tons of carbon emission, no more global warming. And how is this miracle going to be accomplished? By genetically engineering bacteria that will break down the hydrocarbons of coal (or oil, for that matter) and convert it into ethanol. This is eminently doable, the technology is already here—all we need to do is change our thinking from big engineering solutions to clean and elegant biological ones.You ain’t seen nothing yetIn the August 3 2007 issue of Science, an article titled “ Genome Transplantation in Bacteria: Changing One Species to Another” was published by scientists from the Craig Ventner Institute in Bethesda Maryland . (In its previous incarnation as the Celera Corporation, it was one of the two teams that deciphered the human genome). The article begins thus: “ As a step toward propagation of synthetic genomes, we completely replaced the genome of a bacterial cell with one from another species by transplanting a whole genome as naked DNA” (italics mine). The significance of this simple statement is hard for the layman to fathom. In fact, it is almost impossible to grasp the enormity of the consequences of such a statement. What it means is that it will be possible in the not too distant future to synthesize new organisms. Not preexisting ones—completely synthetic new species! Now think of it: · Synthetic bacteria whose whole mission in life is to convert coal and oil into ethanol at a rate faster than we could extract the hydrocarbons from the ground. And much cleaner and enormously cheaper, to boot. · Synthetic bacteria that will consume any pollutant or toxic material we manage to create. · Synthetic bacteria that will consume prodigious amount of carbon dioxide from the atmosphere, and convert it into ethanol—a two’fer. · Synthetic bacteria that will course our blood vessels and convert LDL into HDL particles, and consume triglycerides while they are at it. · Synthetic bacteria that will be able to sense glucose levels in the blood and release the appropriate amount of synthetic insulin in response. Need I go on? The possibilities of this scientific revolution are mind boggling. Our world view will become totally biological. Sounds like science fiction or at least a distant dream: not at all. In an interview Craig Ventner stated that his team will have the first synthetic bacterial “species” in 5-10 years!There is an ancient Chinese curse “may you live in interesting times”. Science will convert the curse into a blessing.Dov Michaeli MD, Ph.D is in the Biotech industry. (Source: The Doctor Weighs In)