Cardiovascular Disease Prevention: Between Healthy Habits and Prescription Medications

With cardiovascular disease the largest cause of death and disability in the United States, the scientific community continues intense investigations into approaches for prevention. In the New England Journal of Medicine, Doctor Mark Hlatky of Stamford University School of Medicine, writes, "The aphorism 'prevention is better than cure' makes perfect sense when applied to healthy habits such as following a sensible diet, maintaining an ideal body weight, exercising regularly, and not smoking. But increasingly, prevention of cardiovascular disease includes drug therapy, particularly statins to lower cholesterol levels."

In this editorial, Dr. Hlatky is reponding to the growing interest in prescribing cholesterol-lowering medications to a much larger segment of the American population---including those with cholesterol levels well below the risk standards established by the National Cholesterol Education Program of the National Institutes of Health. These medications already are the single largest class of drugs sold in the U.S. today, exceeding $30 billion/year.

There is mounting evidence that lowering LDL cholesterol below the NCEP risk-adjusted standards is reducing the incidence of cardiovascular events such as heart attack and strokes. Further, recent studies, notably the JUPITER study published in the New England Journal of Medicine, reinforces the evidence that statin medications not only favorably alters cholesterol levels but also reduce the level of inflammation in the arteries. In addressing inflammation, the medication may reduce a root cause of arterial plaque development.

Yet, what remains lost in the discussions between healthy habits and drug treatment is the positive, therapeutic power of nutrition. Nutritional solutions extends beyond the restriction of saturated fats, trans fats and cholesterol to nutrients that actively improve cholesterol levels and reduce inflammation. For many, these nutritional tools can allow the individual to achieve target cholesterol levels and serve as an effective statin alternative. For others, the nutritional approach offers an opportunity for reductions in the dosages and number of medications required to achieve heart healthy targets.

The tragedy: compared with the funding for pharmaceutical studies, an incredible small amount of money is being spent to advance the nutritional science. With few major studies reporting on the benefits of nutritional cholesterol management, the news media reports on the pharmaceutical studies. The extensive and widely reviewed understanding of the nutritional solution is then overshadowed.

Here at Kardea, we are working to provide you with both the knowledge and the natural products that advance heart health. We are only one source. For others, discuss with your medical providers. Also, check out our the resource page on the Kardea Nutrition website or for great recipes for cholesterol management, click over to Kardea Gourmet .

Another good source of information: http://cholesterol.about.com/od/treatments/u/Treatments.htm

Kardea Nutrition, Heart Healthy & Inspired.

Zetia/Vytorin Study: A Perspective

You may have heard the considerable debate regarding the cholesterol-lowering medication, Zetia. Unlike statins which affect your cholesterol production, this drug blocks the absorption of both dietary and biliary (liver-produced) cholesterol into the blood stream. The drug is intended to provide individuals who cannot reduce LDL cholesterol using diet and exercise with an alternative to high dosages of statin medications. It also was developed for those who simply cannot tolerate statins.

In a recent controversial study reported in the New England Journal of Medicine, the effects of taking Zetia and the statin, Zocor, combined (together known as the drug Vytorin) was compared to the effects of taking Zocor only.

Here are results:

The group taking the two drugs experienced an LDL cholesterol decline that was 27% greater than the Zocor-only group.

Despite the increased lowering of LDL cholesterol in the group that received both medications, both groups saw arterial plaque build at rate that was similar (although those on the combination drug saw a somewhat larger, but not statistically significant, increase).

This finding is at odds with our traditional understanding of the favorable relationship between lower LDL cholesterol and atherosclerosis.

The trial, however, did not directly address whether lowering of LDL cholesterol with the combination drug reduces heart attacks, strokes and other cardiovascular “events.” The combination drug may or may not provide an additional benefit.

So how is the medical community responding?

An editorial in the New England Journal of Medicine observes that “it seems prudent to encourage patients whose LDL cholesterol levels remain elevated despite treatment with an optimal dose of a statin to redouble their efforts at dietary control and regular exercise,” leaving Zetia for special situations. Yet, well trained, qualified doctors continue to prescribe the combination drug more broadly, believing that a single study does not unseat established wisdom.

The human body is profoundly complex, and we simply do not know with certainty how any particular approach will affect our long term health and longevity. We can only play the odds as we know them today. This requires that each of us take an educated approach to our health. Kardea aims to enable the members of its community to make more informed decisions about cholesterol management and natural nutrition.