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.

Cardiovascular Disease: The Number 1 Killer of Women

So you think that cardiovascular disease is primarily a problem for men. Think again: More than 500,000 women in the U.S. die each year of cardiovascular disease, making it their No. 1 killer.

In fact, for a variety of complex reasons, the condition is more often fatal in women than in men and is more likely to leave women severely disabled by a stroke or congestive heart failure.

True, women don't usually start showing signs until their 60s--about 10 years after men first develop symptoms. And hormones seem to play a protective role in women before menopause.

But the common belief that premenopausal women are immune to heart problems is just plain wrong. Heart attacks strike 9,000 women younger than 45 each year.

The more scientists learn about a woman's heart and what can go wrong with it, the more they realize that females aren't just small males. There are subtle but important differences in how women's cardiovascular systems respond to stress, hormones, excess saturated fat and toxins like tobacco. There are also some pretty big differences in how aggressively doctors treat women with heart trouble--even in the emergency room when they are in most desperate need of help.

"The vast majority of heart attacks in women could be prevented with a combination of lifestyle modifications and medication," says Dr. JoAnn Manson at the Brigham and Women's Hospital in Boston. "Just making use of existing information could nearly eradicate the disease."

Of course, neither men nor women can do anything about their age or the genes they were born with. (If your father had a heart attack before 55 or your mother had a heart attack before 65, you should pay special attention to your heart health.) And it's still unclear why heart disease seems to strike men and women so differently. Structurally, their hearts and arteries are basically the same; women's hearts are smaller, but in proportion to their bodies. So doctors are pretty sure that any differences are matters of degree rather than kind.

Cardiologists are confident that they understand how heart attacks occur in men. The trouble usually begins when a fatty deposit or plaque, which has taken decades to build up on the inside of a coronary artery, becomes unstable and bursts, triggering a clot that blocks a blood vessel. Doctors can see these plaques during a fairly invasive procedure called an angiogram, in which a catheter is threaded through an artery in the groin or leg up to the arteries of the heart and a dye is then released to make any blockages easier to spot.

Although the research is controversial, some evidence suggests that bursting plaques may not be as important for women as for men. Doctors have long puzzled over the fact that some of their female heart-attack patients--usually those who have not yet gone through menopause--show few signs of artery-clogging plaques on their angiograms. Perhaps their blockages don't occur in the major arteries of the heart, where angiograms are performed and bypasses are most effective. Perhaps blood flow is restricted in the smaller vessels that branch off the coronary arteries. And perhaps the problem isn't plaques at all but the fact that these smaller blood vessels are somehow more prone to spasm, snapping shut at the slightest stress or trigger, cutting off the flow of blood to parts of the heart.

It's also possible that plaques--whether in the main coronary arteries or the smaller vessels--behave differently in women. Unlike men, women tend to distribute all the "garbage" associated with atherosclerosis--such as saturated fat and oxidized waste products--more evenly throughout the arteries. The process is analogous to the way men and women gain weight, says Dr. Noel Bairey Merz of the Cedars-Sinai Medical Center in Los Angeles. "When men get fat, it all goes to their belly," she says. "When women get fat, they tend to get fat all over--fat at the ankles, fat in the sides, fat in the upper arms." So although women generally avoid the monster plaques that kill so many men in early middle age, the continuing buildup in women's arteries may come back to haunt them in their 50s, 60s, 70s and 80s.

Plaques are another reason for women to throw away their cigarettes, as smoking seems to turn stable plaques into unstable ones. "If you look at the plaque under a microscope, it doesn't appear to be the kind of plaque that can become unstable and rupture," says Dr. Robert Bonow of the American Heart Association. "But the surface has become eroded, exposing the material beneath the surface to the blood, which causes blood clots. And it turns out that the women who have this plaque erosion tend to be women who smoked." Those clots can travel through the bloodstream, wreaking havoc in the heart or the brain.

Kardea Nutrition--Delivering Therapeutic Nutrition for Cardiovascular Health, Naturally.

Plant Sterols: What Are They? How Do They Work?

Plants produce plant sterols. Animals produce cholesterol. Structurally similar, both bind to sites in our intestines where the cholesterol produced in our livers and consumed in our foods are absorbed into our blood.

Yet, our bodies have evolved the ability to distinguish between these types of sterols. On average, we absorb about 55% of cholesterol and less than 1% of the plant sterols. Plant sterols work to lower cholesterol by filling the "absorption gateways," thus blocking the cholesterol from entering the blood stream. Blocked cholesterol is execreted along with most of the plant sterols.

In nature, small quantities of plant sterols can be found in a range of foods, particularly vegetable oils (sources of plant sterols). The average plant sterol intake in the U.S. is about 250 milligrams. Vegetarians consume in a range of 400 to 750 milligrams. Plant sterol intake in traditional diets has been estimated to be about 1g (1000mg). Medical studies have concluded that 2-3g (2000-3000mg) effectively lower cholesterol. Fortified foods are typically required to obtain these levels.

The effectiveness of plant sterols will vary from person-to-person. Many people absorb cholesterol more effectively than others. For these individuals, the impact of plant sterols may be more significant.

Overall, plant sterols are an important component of a nutritional system designed to promote healthier cholesterol and blood lipid levels. Achieving maximum benefits from natural cholesterol management may require other nutrients---including the soluble fibers found in oats, beans, fruit and psyllium, certain types of niacin, Omega-3s, monounsaturated fats in place of saturated fats----all in the context of balanced nutrition, calorie-mindfulness and physcial activity.

Kardea Nutrition's Natural Bars for Cholesterol Management

O.K. I have gone off on a policy & political tangent over the past view days. I do think that the events and debates of last week regarding cholesterol medications required that I chime in.

Focusing back to the core goal of Kardea: to develop nutritional tools that enable natural cholesterol management. As a formulation standard we look to multiple product attributes: delicious, convenient, natural, calorie-mindful and therapeutic.

To optimize these attributes, I started looking at those foods that I am likely to eat everyday. If I was already eating, I was likely to keep eating it. If I wasn't already eating, I did not want to add a new source of calories. The trick was how to keep it something I crave while being effective, being therapeutic.

The nutritional bars were a really convenient place to start. Before founding Kardea, I had spent the last 12 years of my life running a specialty chocolate company. I had developed a habit--a craving--for a daily piece piece of dark chocolate (with a late morning cup of coffee--this has to be one of nature's great taste combinations!).

Certainly, dark chocolate is getting good reviews for its cardiovascular benefits. I certainly have tracked this, and discussed it with some people over at the Yale Medical School. This science seems promising, but I am not sure I would yet incorporate chocolate into my program for natural cholesterol management. Instead, I looked to develop a substitute for my morning craving. The Kardea bars achieved this goal, and then some.

First off, I think these bars really are tasty. All natural ingredients such as almond butter, authentic spices like nutmeg, clove or cardamom, real fruit and full flavors.

These bars also provide meaningful levels of plant sterols (1 full gram), fiber (7 grams; 3 grams of heart hearthy soluble fiber) and protein (7 grams total and close to 4 grams of soy protein). The FDA has endorsed these nutrients for their ability to help improve blood lipid profiles including a lowering of LDL (bad) cholesterol.

While only 150 calories each, these bars are more satisfying that the morning chocolate fix. I suspect this is a tribute to the protein and fiber levels.

Further, the bars are sweentened with lower glycemic agave syrup and brown rice syrup. Couple these with the fibers which slow glucose uptake, and I feel that I evened out the sugar spike. So by lunch, I no longer have the urge to eat too fast and too much.

The whole family has been eating the samples through the development process. We all ---friends and family--really enjoy them. Our first production run is now scheduled for mid-February, and they will be available to ship at the end of this month.

To get a product availability alert with an introductory 25% coupon, sign up for our newletter, UpBeat. http://visitor.constantcontact.com/email.jsp?m=1101913937814&p=oi

For additional product information: http://shop.kardeanutrition.com/merchant.mvc?Screen=SFNT&Store_Code=KNFNCM

"Cholesterol Drug Bombs"-New York Times Editorial Misses Opportunity

Yesterday, the New York Times editorial board wrote "there have long been suspicions, but it was still very disturbing to learn this week that a heavily promoted cholesterol-lowering drug had flunked a clinical trial of its effectiveness in reducing fatty deposits in arteries....The drug, Zetia, and a combination pill that contains it, Vytorin...generated more than $5 billion in sales last year."

You probably know the ads for Vytorin. They have run on T.V., in magazines and on-line. They certainly are clever, creative and very expensive. According to Nielsen Monitor-Plus, in 2006 the companies spent $136.3 million to advertise Vytorin and $115 million from January to October of 2007.

Vytorin combines Zocor, a statin produced by Merck (and also marketed by generic drug manufactures and sold at lower prices) with the Schering-Plough's Zetia. Statins work by reducing the production of cholesterol in the liver. Zetia works to reduce the absorption of dietary and liver-produced cholesterol from the intestines into the blood stream.

The study compared the effects of treating patients with Vytorin, the combination drug, with a statin alone. The patients all had abnormally high LDL cholesterol. In the study, LDL cholesterol was reduced more significantly by Vytorin than with the statin alone. These results are consistent with the results of a number of other studies.


It also was hypothesized that the added cholesterol-lowering effect of Vytorin would lead to a more significant reduction of arterial plaque growth. This relationship did not hold. The lower cholesterol achieved by the Vytorin did not yield a reduction in plaque build-up as compared to the statin only. In fact, the Vytorin group was found to have a more rapid development of plaque than the statin-only group.

The Times reports that these companies had been “cynically sitting on the results for more than a year” while spending hundreds of millions of dollars to convince consumers that the Vytorin is a preferred cholesterol drug. This certainly is a very legitimate criticism.

The Times continued that "the findings also raise doubts about the current belief that lowering cholesterol is the key to cardiovascular health. The study showed that Vytorin reduced bad cholesterol significantly more than Zocor alone. The problem was that it failed to reduce the formation of plaque."


And here is perhaps were the Times should have been somewhat more careful. This study now represents a single set of data among a sea of data that concludes lower LDL cholesterol lowers the risks of heart attacks and strokes. Numerous studies also indicate that LDL cholesterol above 100mg/dl will lead to the development of arterial plaque.

Instead of casting doubt on the general wisdom of cholesterol management, the Times would have served the public well by offseting the barrage of pharmaceutical advertising and reinforce the well-documented science regarding natural alternatives to cholesterol management. An extensive NIH report (http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.htm), for instance, concludes that the "amount of LDL reduction from Therapeutic Lifestyle Changes compares well with many of the cholesterol-lowering drugs." Among the recommendations are the consumption of certain positive nutrients such as plant sterols, soluble fibers, monounsaturated fats in place of saturated and trans fats, and Omega-3s. Needless to say, weight management and exercise is part of the NIH recommendations.

For more information on natural cholesterol management nutritients: http://www.kardeanutrition.com/cholesterol/program.aspx

Soluble Fiber--From Hype to Health

Take a walk through the grocery aisle, and you will quickly find many products claiming to be heart healthy.

For many of these products, the heart healthy claims flows from two essential nutritional characteristics. They are low in saturated and trans fats, and they deliver levels of soluble fiber sufficient to meet certain FDA-allowed heart health claims. To make these claims, the FDA requires that the products deliver in each serving at least .75 grams of soluble fiber from oats or barley, or 1.7 grams of soluble fiber from psyllium.

For those of us seeking measurable improvements in our cholesterol levels, success requires consuming substantially greater levels of soluble fiber. The National Cholesterol Education Program of the National Institutes of Health recommends 10-25 grams per day. Depending on your chemistry, consumption at these levels can lower LDL cholesterol by up to 8-10%. Some studies have suggested that results could be more significant.

How much oatmeal is required to reach 10 grams of soluble fiber? Roughly 5 servings, or about 2 lbs of prepared oatmeal. For 25 grams, you would need to consume about 5 lbs of prepared oatmeal, or about 2000 calories per day from oatmeal. Nay!

While oats certainly are a good starting point, I begin the day with a heaping tablespoon (=3 teaspoons) of whole psyllium husk. Psyllium seed husks are nature's most concentrated source of cholesterol-lowering soluble fiber. Where oats are only about 5% soluble fiber, psyllium husks are about 60%. With a tablespoon of psyllium husk, I start the day with 9 grams of soluble fiber (note: start with a teaspoon and work your way up).

5-6 servings of fruits and vegetables through the course of the day gets me another 5-6 grams.

From here, I shoot for the upper levels of the cholesterol-lowering soluble fiber targets. Success typically requires some culinary creativity and an understanding of the sources of soluble fiber.



Here is one recipe that you may find a useful addition to your weekly food choices:

Barley Pilaf
4 Servings of About 1 Cup Each

Barley never came to my mind as something I would crave. Yet, I discovered that barley stands side-by-side with oats as an FDA-endorsed food for promoting heart health by lowering cholesterol. I have since set out to explore how barley could be enjoyed in something other than a malted beverage.

As it turns out, a barley pilaf can be a delicious alternative to the rice, potato or pasta “starch” in protein/starch/vegetable triad my mom insists constitutes a meal.

A pilaf can be cooked to complement any number of dishes. Adapt by incorporating any number of spices. Start with the basic pilaf and create from there.

So, you ask "why don't more people eat barley." Part of the answer lies with the fact that cooking barley can be a bit tricky. If you're not careful, you might find your pilaf with hot cereal qualities---perhaps great for a cold morning but not the best for a dinner. But if you take a bit of care, you barley pilaf can be a great nutritious alternative to high glycemic, low fiber carbs.

Ingredients
1 Cup Rinsed Pearled Barley
2 Cups Water
1 Small Onion-Finely Chopped
2 Tablespoons Extra Virgin Olive Oil (preferably fortified with plant sterols)*
½ Teaspoon Turmeric
Salt & Pepper to Taste

*to double-up on the cholesterol lowering abilities of this dish, I formulated an extra-virgin olive oil with added plant sterols. This olive oil is available through the Kardea Nutrition website
http://www.kardeanutrition.com/products/food.aspx . If you want to reduce total fat, cut recipe to 1 tablespoon of oil.


Direction
Heat a sauce pan over medium heat. When pan is hot, add olive oil and chopped onion. Saute for a few minutes. Add rinsed pearl barley and saute for 5 or so minutes, stirring regularly and making sure that barley does not burn or stick to bottom of pan. Add turmeric and then water to the hot barley and stir. Cover, lower heat and cook until tender but still a bit chewy (30 minutes). Remove cover and on very low heat, let steam escape. Periodically fluff to prevent sticking to bottom of pan. Serve when barley appears about the consistency of steamed rice. This all may sound a bit cumbersome, but it works. The turmeric also give the barley a beautiful yellow color, accenting the visual appeal of an entire meal.


Nutritional Facts
(about a cup of cooked barley pilaf)
Calorie: 240 Calories from Fat: 70
Total Fat: 8g from olive oil; monounsaturated: 5.7g; polyunsaturate fat: 1.15g; saturated fat: 1.15g (4.3% of total calories); Trans fat: 0.0g.
Cholesterol: 0.0
Total Carbohydrates: 40g; Total Fiber: 8g; Soluble Fiber: 2g.
Protein: 5g.
Plant Sterol: .25g

Stepping-Up
You can try adding any number of spices. Try curry or cumin when serving lean meats or roasted root vegetables. Try ginger and currents when serving fish. Serve with a kidney bean chili or black bean salad (recipe in next blog) to create a meal that delivers 3-4g of soluble fiber.

Do You Have A Great Barley Recipe? Can you improve this recipe? Post your thoughts and recipes to this blog to share with the Kardea community.