Lifestyle & Heart Health: Important 2009 Studies

January 4, 2009 Dallas, TX - The American Heart Association (AHA) chooses important 2009 research papers on heart health and lifestyle choices. One provides insights into obesity prevention and the "best diets." The other cautions that cardiovascular risk-factor control isn't just for older people. A third reviews the significant role of laws restricting smoking in public places to sharply lower the incidence of hospital admissions for heart attacks.

These selections emerged from a process led by the AHA immediate past president, president and president-elect. The choices were based on nominations from the organization's scientific councils. The chairs of the councils had been charged with recommending the year's "most meritorious, most substantial, most significant" papers in cardiovascular medicine, according to AHA current president Dr Clyde W Yancy (Baylor University Medical Center, Dallas, TX). Several of the studies in the final cut, he told heartwire, had been backed by multiple scientific councils.

No Best Diet

In a randomized comparison in more than 800 overweight adults of four "reduced-calorie" dietary interventions consisting of fat, protein, and carbohydrate intake in different proportions, such as 40%, 15%, and 45%, respectively, or 20%, 25%, 55%, respectively(1).

Participants lost about the same amount of weight over six months, an average of 6 kg, regardless of which group they were in; in general, metabolic risk factors also improved in all four groups.

In its coverage when the study was published, Dr Robert Eckel (University of Colorado Health Sciences Center, Denver) stated that the study affirms that people who are successful at losing weight are those who stick to a specific program. "Ownership, by the patient, of the weight-loss program is what proves successful, not the type of diet you chose," he said.

It really dismissed the notion that there's something clever about weight loss, showing that it really is about calorie consumption. "We all thought the statement made in that study was pretty profound," Yancy said. "It really dismissed the notion that there's something clever about weight loss, and that it really is about calorie consumption or, to make it even more straightforward, portion control. You can spend a lot of time wringing your hands about which diet and the composition of which diet, but it really is a simple equation of calories in and calories out."

Another analysis based on multiple studies that together indicated a 17% drop in estimated one-year risk of hospital admissions for acute MI in North American and European communities that adopted strong laws restricting smoking in public places, compared with rates in those communities before implementation of the restrictions (2). The risk declined steadily with increasing follow-up time.

And a combined analysis from the Coronary Artery Risk Development in Young Adults (CARDIA) study and Multi-Ethnic Study of Atherosclerosis (MESA) suggested that young adults with a low risk of developing heart disease over the short term (within 10 years) by conventional measures can be classified into high- and low-lifetime-risk groups [4]. Those with low short-term but high long-term risk were described as having a greater degree of atherosclerotic disease progression (3).

"This study is an important look at how the presence of risk factors early in life can be crucial to the lifetime risk of cardiovascular disease," according to the AHA. In its coverage of the analysis, heartwire quoted lead author Dr Jarett Berry (University of Texas Southwestern, Dallas), who said that even at younger ages, less than 50 years, "the clock is ticking" for many adults who are unaware that they already have progressive atherosclerosis.

Kardea Nutrition Serious Nutrition for Cardiovascular Health

Reference

(1)Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009; 360:859-873.

(2)Lightwood JM, Glantz SA. Declines in acute myocardial infarction after smoke-free laws and individual risk attributable to secondhand smoke. Circulation 2009; 120:1373-1379.

(3)Berry JD, Liu K, Folsom AR, et al. Prevalence and progression of subclinical atherosclerosis in younger adults with low short-term but high lifetime estimated risk for cardiovascular disease: the Coronary Artery Risk Development in Young Adults study and Multi-ethnic Study of Atherosclerosis. Circulation 2009; 119:382-386.

Looking Beyond Lowering LDL Cholesterol

The risk of developing cardiovascular diseases is typically assessed based on a standard cholesterol test measuring LDL (low-density lipoprotein) and HDL (high-density lipoprotein) levels and then factoring advanced age, gender, family history of heart disease, high blood pressure, diabetes, and smoking. Taking these factors into account, LDL lowering targets can then be established, and a program of therapeutic changes in lifestyle and nutrition can be established. If these changes are unable to bring cholesterol levels in line, medications are routinely provided.

However, studies indicate that these risk factors can account for only a portion, perhaps 50%, of the incidence of coronary artery disease. The scientific community has continued its investigations, and is finding that a number of other risk factors can be identified through blood test. On its website, Berkeley Health Lab, a leading medical lab with an integrated program for cardiovascular treatment, identifies many of these important factors including:

Size of LDL Particles: Some LDLs Are Worse Than Others

• Small LDL particles can cause plaque build up to progress much faster because they can enter the artery wall easier than large LDL particles
• Too many small LDL particles can increase your risk for a heart attack beyond any other risk factors you may have, such as smoking, high blood pressure, diabetes, etc.
• Certain medications, proper nutrition, and regular exercise can help your body produce fewer small LDL particles

Size of HDL Particles: Some HDLS Are Better Than Others

• HDL helps to protect against progression of plaque build-up in the artery wall
• HDL2b is the workhorse of all of the HDL particle types. It has the ability to pick up and remove cholesterol
• Certain medications, improved nutrition, loss of body fat, stopping tobacco use, and increased physical activity are some ways that HDL-C and HDL2b can be improved

Apolipoprotein B: Accurate LDL Particle Number

• ApoB is a direct measurement of the amount of LDL ("bad" cholesterol) particles
• A high apoB number indicates increased risk for heart disease
• Improved eating habits, increased physical activity, and loss of body fat are some lifestyle changes that improve apoB
• Your physician uses apoB to determine if certain medications are needed and to monitor their effectiveness

C-Reactive Protein-hs (CRP)

• High levels of CRP indicate inflammation within the body due to infection or tissue injury; it can also predict heart disease risk levels
  Certain medications may help reduce this risk
  Certain foods have anti-inflammatory benefits

ApoE Genotype

• ApoE is a genetic test that plays a role in helping to identify how people respond to different amounts of dietary fat. Your body's response to dietary fat impacts the formation of small or large LDL particles
• There are 3 types of apoE genotypes: apoE2, apoE3 and apoE4
• People with an apoE4 have a greater risk for heart disease
• ApoE can be used to help guide the right nutrition plan for you

Other risk factors measurable through blood tests also are discussed on this site.

Overall, most of us typically receive the standard test for cholesterol, with these more thorough tests reserved for those individuals at high risk. Yet, for those of us interested in the information needed to optimize our long term health, this more complete assessment can be very useful. Check with you healthcare provider about obtaining these more extensive blood test to better direct your unique course for optimizing your health.

Foods with Plant Sterols

Plant sterols are an effective nutritional tool for lowering LDL cholesterol by 10-15%. As part of a diet that is both low in saturated fats, trans fats and cholesterol, and high monounsaturated fats and soluble fiber from oats, beans, barley or psyllium, individuals can achieve cholesterol reduction of 30%+.

In nature, small quantities of plant sterols can be found in a range of foods, particularly vegetable oils. The average plant sterol intake 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 or supplements are typically required to obtain these levels.

Click for Chart of Foods with Plant Sterols

kardea - gourmet nutrition for cholesterol management

Cholesterol Management: Beyond Disease Prevention

The guidelines of the National Cholesterol Education Program define LDL cholesterol below 100mg/dl as optimal for otherwise healthy people. Yet, as a matter of disease prevention, these same guidelines suggest that substantially higher levels of LDL cholesterol may be acceptable. These standards are used as a baseline for determining the appropriateness of cholesterol-lowering medications.


Many doctors also are well aware that the non-optimal LDL standards are only a baseline. These doctors are apt to prescribe a cholesterol-lowering medication to achieve the more optimal level.

Here at Kardea, we look to natural cholesterol management to achieve the more optimal levels. Yes, medications may be needed by some, but a nutritional approach has proven as potent as many pharmaceutical therapies. And we recognize that cholesterol management extends well beyond simply lowering LDLs. Our prior blog posts and the numerous links and articles found on our resources page explore this more comprehensive approach.

The important point: cholesterol management is consistent with good health, not simply disease prevention. Whatever your currents levels ---- even if you believe that your cholesterol is not at risky levels ---- consider the benefits of pursuing a more integrated and comprehensive approach.