Vitamin D Deficiency-A Potential Role in Cardiovascular Disease Prevention

Inadequate levels of vitamin D are associated with an increase in the risk of cardiovascular disease and death, a new observational study has found. Dr Tami L Bair (Intermountain Medical Center, Murray, UT) reported the findings here at the American Heart Association 2009 Scientific Sessions.

Bair and colleagues followed more than 27 000 people 50 years or older with no history of cardiovascular disease for just over a year and found that those with very low levels of vitamin D (<15 ng/mL) were 77% more likely to die, 45% more likely to develop coronary artery disease, and 78% more likely to have a stroke than those with normal levels (>30 ng/mL). Those deficient in vitamin D were also twice as likely to develop heart failure as those with normal levels.

"We concluded that even a moderate deficiency of vitamin D was associated with developing coronary artery disease, heart failure, stroke, and death," said coauthor Dr Heidi May (Intermountain Medical Center). However, "it is not known whether this is a cause and effect relationship," she told heartwire. Because this study was observational, more research is needed "to better establish the association between vitamin D deficiency and cardiovascular disease," she noted.

Evidence so far suggestive of benefit of vitamin D

Vitamin D was the subject of much discussion in a general session on vitamins at the AHA scientific sessions. While there is strong evidence supporting the benefits of vitamin D in cardiovascular disease, there have been only a few randomized clinical trials, and previous observational studies "show no robust effects," said Dr Harald Dobnig (Medical University of Graz, Austria). The latter suffer from limitations, such as doses of vitamin D supplementation that are too low, low compliance rates, and short study duration, he noted.

There are some large randomized trials underway looking at outcomes with vitamin D; it is hoped that they will provide definitive answers in five to seven years, Dr Eric Rimm (Harvard School of Public Health, Boston, MA) explained.

"I think there's promise for vitamin D. We know that most people have insufficient vitamin D levels in their blood," Rimm says. "So although it will take five years until some of the trials that are adequately powered to look at cardiovascular disease with vitamin D will report, the epidemiology right now is suggestive that people should have 1000 or 2000 IU of vitamin D a day," he said.
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Kardea Nutrition, guided by the recommendations fo the National Cholesterol Education Program, enables each of us optimize the power of therapeutic nutrition to advance cardiovascular health, naturally and deliciously.

Beyond Bad Cholesterol---Low Good Cholesterol May Be Greater Issue

As scientific knowledge advances, we gain a better understanding of the cholesterol challenge. Total cholesterol is no longer the focus. A primary focus on the absolute levels of LDL (bad) cholesterol is evolving to heightened interest in the LDL/HDL ratios, the total levels of HDLs (good cholesterol),the composition of the LDL cholesterol itself and the levels of inflammation. Here at Kardea, we continue to provide you information on the evolving science. The report below suggest that low HDL is a critical factor ---- perhaps more important than elevated levels of LDLs. From a treatment perspective,however, we simply have more tools --- both nutritional and pharmacological---to address elevated LDLs than to raise low HDL levels.

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Taking a statin to lower LDL or ‘bad’ cholesterol is of limited use in warding off the risk of heart attacks and cardiovascular disease unless low levels of HDL or ‘good’ cholesterol are also addressed, researchers from Tufts Medical Center in Boston, US have found.

The research team led by Dr Richard Karas, professor of medicine at Tufts University School of Medicine, examined the relationship between HDL cholesterol (HDL-C) and cardiovascular disease (CVD) risk in patients taking statins. While statin therapy does reduce CVD risk, the incidence of CVD events in statin-treated patients remains unacceptably high, they observed.

Karas' team identified 20 eligible randomised controlled trials of statins, with 543,210 person-years of follow-up and a total of 7,838 myocardial infarctions. The analysis revealed a significant inverse association between HDL-C and the risk of myocardial infarction. Every 10mg/dL reduction in HDL-C was associated with 7.6 and 7.8 more MIs per 1,000 person-years respectively in patients taking statins and in non-statin controls.

At the same time, statin treatment cut the risk of MIs by a median of 4.4 per 1,000 person-years.“While statins overall prevent four heart attacks per 1,000 patient-years, these new findings demonstrate that a 10-point higher HDL-C level could save an additional eight heart attacks per 1,000 patient-years, which indicates that, even if patients are on a statin, if they have low HDL-C, they may need more than just statins to significantly reduce their risks,” Karas commented.

“We believe most clinicians will be surprised to see the magnitude of the effect of low HDL-C on heart attack risk and how little statins impact the risk associated with low HDL-C,” he said.

The analysis also explored the association between HDL-C and cardiovascular disease, as well as coronary heart disease death, CVD death and all-cause death. In all these cases, the findings indicated that risk increased as the levels of HDL-C fell, and there were minimal differences between patients who were or were not taking statins.

Data from the Tufts Medical Center study were released at the American Heart Association Scientific Sessions 2009 in Orlando, Florida.

Mixing Meds---Another Alert

Cholesterol managing medications remain the single largest class of drugs sold in the world. High blood pressure medications are not far behind. The reason: unlike a medication to treat an acute and passing infection, these medications are often taken for a lifetime.

Here at Kardea, we look to the power of therapeutic nutrition and other lifestyle changes to allow an individual achieve healthy heart results either without the medications or at least with lower dosage levels.

Our interest is motivated less by the potential power of a given medication to achieve the specific result. Rather, our interest lies with the fact that a given drug is likely to be appropriate for one health concern. Yet, as we age, we often will face multiple condition --- and we take multiple medications for each condition---sometimes simply to treat the side effects of the first medications. I certanly have been watching my 83 year old mother and 90 year old father add an another medication with each passing birthday. It is the cocktail of medications that I find alarming. The long term interactions among these drugs are uncertain....but each drug is a powerful chemical agent.

Here is a case in point:

On November 17, 2009, the Food and Drug Administration warned consumers not to take popular heartburn medications Nexium or Prilosec if they use Plavix, a widely prescribed blood thinner that guards against heart attack and stroke.

The two heartburn formulations can reduce the protective blood-thinning effect of Plavix, a medication widely advertised directly to consumers, by nearly one-half, according to a study undertaken at the request of the FDA.

Heartburn medications are commonly used with Plavix because it can cause upset stomach.

A leading medical industry watchdog welcomed the FDA's action, but said it's late and not forceful enough. The FDA should have required a more prominent "black box" warning, said Sidney Wolfe, director of Public Citizen's Health Research Group. "You're getting a less effective dose of a potentially life-saving drug," said Wolfe, who also is a member of the FDA's Drug Safety and Risk Management Committee. "This is a serious issue."

Kudos to Dr Wolfe and the FDA...but one can only guess that more than one patient taking both Plavix and on these heartburn medications was prescribed a higher dosage or this Plavix or treated with yet another medication.

High Cholesterol Under Treated in Many Americans

NEW YORK (Reuters Health) - A US study on cholesterol released today contains both good and bad news:

The good news: Between 1999 and 2006, the number of adults in the US with high levels of artery-clogging LDL cholesterol, the "bad" cholesterol, decreased by about one-third.

The bad news: A high percentage of adults still are not being screened or treated for high cholesterol levels, putting their health in jeopardy.

Adults at greatest risk for heart attack and other heart-related "events" continue to have the highest prevalence of high LDL cholesterol, Dr. Elena V. Kuklina and associates at the US Centers for Disease Control and Prevention in Atlanta found.

The researchers studied trends in the prevalence of screening, current use of cholesterol-lowering medication, and high LDL cholesterol levels across four periods: 1999-2000, 2001-2002, 2003-2004, and 2005-2006. Overall, there examined data on more than 7,000 adults.

Between 1999-2000 and 2005-2006, the prevalence of high LDL cholesterol levels fell from about 32 percent to 21 percent, the investigators report in Wednesday's edition JAMA (Journal of the American Medical Association).

The prevalence of high LDL cholesterol varied significantly by risk category, however. In 2005-2006, the prevalence high LDL-cholesterol was 59 percent in individuals at high risk for heart-related events, namely those with a history of heart disease, chest pain, heart attack, stroke or diabetes.

The prevalence of high LDL cholesterol was 30 percent in those at medium risk for heart problems and 11 percent in those at low risk. Individuals were stratified as medium or low risk depending on their number of such risk factors as cigarette smoking, high blood pressure, family history of heart problems, and LDL and "good" HDL cholesterol levels.

In the high-risk group, more than 35 percent had not been screened for high cholesterol in the last 5 years and nearly 40 percent were either untreated or inadequately treated for high cholesterol. Roughly 20 percent of high-risk subjects were candidates for statins or other cholesterol-lowering therapy but were not receiving it.

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Kardea Nutrition-enabling a scientifically-validated nutritional approach to cholesterol management and cardiovascular health---works alone or as a complement to conventional pharmaceuticals. See Kardea White Paper.

Niacin Useful In Natural Cholesterol Management

Hamden, CT Niacin available as non-prescription supplements can be an effective component of a broader natural nutritional approach to improve cardiovascular health and healthy blood lipids including cholesterol, a White Paper released by Kardea Nutrition reported.

Niacin, also known as Vitamin B3, is vital for good health. Niacin helps convert food into energy, build red blood cell counts, and synthesize hormones. For basic good health, a relatively small amount of niacin, about 20mg/day, is needed. Americans typically obtain this level from a balanced, healthy diet. Our bodies also can manufacture niacin.

At substantially higher levels—1000-2500mg/day--- a specific type of niacin significantly improves cholesterol levels. At these levels, Niacin as nicotinic acid can lower plaque-forming LDL cholesterol by up to 25%. It also has been shown to raise the healthful HDL cholesterol by as much as 35%, and lower triglyceride levels by 20% to 50%. The medical community defines these high dosages as a drug available that should be taken under a physician’s care. Nicotinic acid is available in a prescription form or as supplements.

Between the 20mg of niacin recommended to avoid a deficiency and the 1000+mg that may be prescribed by a physician lies niacin levels that has been shown to be useful in promoting a healthier cardiovascular system. The intake of nicotinic acid at 100-1000mg/day has been shown to significantly improve the levels of both HDLs and triglycerides. At these lower levels, niacin has not been shown to consistently lower LDL cholesterol levels.


Cholesterol Management: Beyond LDL Reduction

LDL cholesterol reduction has been the primary focus of the medical and pharmaceutical community. This focus is supported by the significant and extensive research confirming the positive health effects of lowered LDL, including reduced heart attacks, strokes and other cardiovascular diseases.

Increasingly, medical science now understands that LDL reduction alone is only part of solution in cholesterol management to promote cardiovascular health and wellness.

Researchers are expanding the targets to more broadly address the composition of cholesterol and triglycerides in our blood. For instance, the NIHs’ National Cholesterol Education Program (NCEP) reports that “strong epidemiological evidence links low levels of serum HDL cholesterol to increased heart disease. High HDL-cholesterol conversely conveys reduced risk.” The NCEP identifies HDLs less than 40mg/dl has a risk factor for heart disease. Levels above 60mg/dl are associated with a reduced risk of heart disease.

Low HDL levels without elevated LDL levels are fairly common. Up to 50% of patients not typically candidates for LDL lowering medications have low levels of HDLs. In patients with premature coronary artery disease, low HDL levels are the most common abnormality in blood lipids.

Many recent studies indicate that small increases in HDLs can significantly reduce the incidence of cardiovascular-related death. A 1mg/dl increase in HDL has been associated with a 2%-3% reduction in coronary artery disease. Another extensive study showed that increasing HDL by 6% in patients with low HDL cholesterol decreased heart related deaths and non-fatal heart attacks by 22%

Integrated Approach to Natural Cholesterol Management

Coupled with the HDL raising/LDL lowering benefits associated with niacin (nicotinic acid) LDL reductions can be achieved through the restricted intakes of saturated and trans fats, higher intakes of monounsaturated fats, and therapeutic levels of plant sterols and selected types of fibers (including soluble fiber from oats, barley, psyllium, beans and certain fruits) Modest weight loss and increased physical activity can further raise HDLs.

The White Paper is based on studies conducted over the past two decades and published in the various peer reviewed journals. The paper also addresses other issues associated with niacin intake including flushing and consumer confusion associated with the different types of niacin.

Aspirin, Cardiovascular Disease & Diabetes

Writing in a paper published online in Britsh Medical Journal, Dr Giogria De Berardis and colleagues conclude that "a clear benefit of aspirin in the primary prevention of major cardiovascular events in people with diabetes remains unproved."[1]

"It seems that not only in individuals with diabetes, but also in all other high-risk groups, the efficacy of aspirin for preventing the development of cardioivascular disease is lower than expected. It doesn't mean that aspirin is not effective, it means that the efficacy is lower than expected, and that means we need to select very carefully the patients who are more likely to benefit."

Nicolucci points to another issue that warrants further exploration: whether there are specific characteristics of diabetic that make aspirin less likely to function as expected.
"There's strong basic research evidence suggesting that diabetes can represent a particular situation associated with poor response to aspirin. "

De Berardis G, Sacco M, Strippoli GFM, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: Meta-analysis of randomised controlled trials. BMJ 2009; DOI:10.1136/bmj.b4531. Available at: http://www.theheart.org/article/viewDocument.do?document=http%3A%2F%2Fwww.bmj.com.

Spirits for the Heart

I often prefer a stiff drink over a glass of wine. At the end of a long week, I may seek a very dry martini or a good scotch to ease the accumulated stresses. For me, these spirits cut the edge. Neither beer nor wine provides the same remedy. One, maybe two, is all. Generally, not more than 2 times per week.

The prevailing wisdom, however, has been that wine is the healthier alternative. Wine may well be an important element in the Mediterranean diet, a way of eating associated with longer life, reduced risk of cardiovascular and cancer mortality and reduced risk of dementia and declines in cognitive function as we age. Wine contains micronutrients that are beneficial.

A study released by researchers at the Harvard Medical School and the Harvard School of Public Health found that liquors and beer deliver some of the same health benefits as wine (1). The study focused on the relationship between moderate alcohol intake and a reduction in inflammation.

Normally, inflammation is part of a healthy immune response that heals injury and fight infection But chronic inflammation is very different. Cancer, diabetes, depression, heart disease, stroke, Alzheimer's—these seemingly diverse diseases--are increasingly thought to have inflammation as a common denominator.

And the concerns around cholesterol and cardiovascular health also center on inflammation. LDL cholesterol, the type of cholesterol that can clog your arteries, is most seriously an issue when the arteries are inflamed.

A marker for inflammation is the compound C-reactive protein (CRP) that can be measured through blood tests. Assessing CRP levels is currently recommended for those at increased risk of heart disease. High levels of CRP are associated with future heart attacks and strokes.

Prior to the Harvard study, much research did indicate that moderate levels of alcohol consumption led to reductions in CRP levels. Most studies examining this relationship focused on a single type of alcoholic beverage. As a result, it remained uncertain whether the impact differed by the type of alcoholic beverage consumed.

The Harvard study compared CRP levels and alcohol consumption of 11,815 women. Some were beer drinkers. Others drank wine. And others drank liquors. Still others enjoyed some each. Overall, the association between alcohol and CRP levels were found to be related to alcohol consumption rather than the type of alcohol consumed.

Needless to say, the power of alcohol consumption was found to be less than the power of good eating habits, lower weight and physical activity. The results, however, are consistent with the general recommendation. Alcohol, in moderation, may well be a useful component in a healthy lifestyle. Cheers!

American Heart Association Recommendations: At this point, the AHA does not recommend drinking alcohol, but if you drink, AHA emphasizes moderation. Moderation means not more than one to two drinks per day for men and one drink per day for women. Too much can increase weight, triglycerides and blood pressure. Excessive drinking can lead to other serious heart problems.

(1) Levitan, B, Emily, "Association Between Consumption of Beer, Wine, and Liquor and Plasma Concentration of High-Sensitivity C-Reactive Protein in Women Aged 39 to 89 Year" The American Journal of Cardiology Volume 96, Issue 1, July 1, 2005, pp 83-88.