Cholesterol Updates on Prevention, Recommendations & Management

What's the new buzz all about?
A. Cholesterol and medication - Statins
Statins are drugs that inhibit the generation of cholesterol in the body and lead to a reduction of LDL cholesterol in the blood. For many high-risk patients especially those with a genetic predisposition and those who do not respond to diet and exercise these drugs are vital in controlling cholesterol levels.

However, over the past few year’s studies have revealed that Statins are usually associated with side effects, like memory, sleep and muscular problems.

Because of the risk of muscle damage the FDA issued a safety notice limiting the on the use of specific statins:

The U.S. Food and Drug Administration (FDA) is recommending limiting the use of the highest approved dose of the cholesterol-lowering medication, simvastatin (80 mg) because of increased risk of muscle damage. Simvastatin 80 mg should be used only in patients who have been taking this dose for 12 months or more without evidence of muscle injury (myopathy). Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug. In addition to these new limitations, FDA is requiring changes to the simvastatin label to add new contraindications (should not be used with certain medications) and dose limitations for using simvastatin with certain medicines.

B. Cholesterol and foods -

• Oryzanol
  Oryzanol is a phytochemical found essentially in rice bran oil. Rice bran is a rich natural source of B complex vitamin as well. Several studies have shown that Oryzanol can reduce LDL cholesterol levels significantly and possesses antioxidant properties. Not only this, it help to raise the levels of good cholesterol i.e. HDL too.
• Green Tea
  The role of green tea as a hypocholesterolemic agent has been controversial. A large meta analysis of fourteen randomized controlled trials showed that the consumption of green tea significantly lowered total cholesterol levels. There was no significant change in HDL levels.
• Plant extracts
  A recent small study published in the American Journal of Cardiology, showed that daily supplements containing red yeast rice, policosanols (derived from sugarcane), and artichoke leaf extract may reduce cholesterol levels by as much as 14%. The main ingredient in red rice is lovastatin, which inhibits HMG Co A which plays a role in cholesterol production. Red yeast rice is a staple in many countries in Asia and may be cardio protective.
• Oil Blends
  Much has been said about using more than one type of oil, which we can get by combining/ blending of 2 or more vegetable oils. This renders an optimal ratio of PUFA and MUFA and the ideal ratio is 1:1.
  Here are a few examples of mixing 4-5 oils to get maximum benefit:
  • Groundnut/Sesame/Rice bran + Mustard/Canola
  • Sunflower/Safflower + Olive/Sesame/Groundnut/Rice bran

Good Cholesterol - Is it good enough?
A recent study published in The Lancet (May 2012) points out that simply raising the level of HDL cholesterol cannot prevent heart diseases. Researchers at Harvard School of Public Health have found that when the surface of HDL bears a small protein called Apo lipoprotein C- III (apoC-III), there is an increased risk of heart disease and when it is absent the HDL is especially heart protective. If these finding are confirmed by the ongoing studies, it will lead to better and more accurate risk evaluation for heart disease in individuals.
There are multiple mechanisms involved in risk reduction. HDL cholesterol is an excellent marker to predict the risk of having a heart disease in the future but it cannot be assumed that raising HDL levels can prevent such an event.

However, there is more to HDL than meets the eye. The Women’s Health Study (December 2011) links increasing HDL cholesterol levels with decreasing risk for CVD eventsamong women, regardless of their LDL cholesterol level. Several steps can help women raise their HDL cholesterol levels, including exercise, weight loss, smoking cessation, and diet changes.

C. Managing Cholesterol – Diet & Lifestyle are the best option!
Just as one can develop high cholesterol levels, it can also be corrected by healthy diet, active lifestyle and/or drug therapy.
The fact that cholesterol can be prevented and controlled is evident from the latest CDC statistics. The Centre for Disease Control conducted a survey in 2009-2010 covering 6000 adults which showed a decline of 27% in the incidence of heart disease in last 10 years, bringing the rate to 13.4%. A similar survey done in 1999-2000 had revealed 18.3% adults had high cholesterol.
Cholesterol is a two-way street; you just need to know which direction is the heart healthy one.

So, what role can you play in controlling your cholesterol levels?

• If you are patient of heart disease, lowering your cholesterol can decrease your risk for having a heart attack, needing heart bypass surgery or angioplasty, and dying from heart disease.
• Even if you are young and not a patient of heart disease, you can reduce your risk of developing it by lowering your cholesterol.
• Exercising, eating a healthy diet, and not smoking go a long way in improving cholesterol levels.
• Since high cholesterol does not have symptoms it is a good practice to get regular blood tests done to check for abnormalities.

By. Pallavi Sharma, Poonam Vaswani