Re: 'Normal' levels of bad cholesterol may be too high
- From: "Joan F \(MI\)" <jjfahl@xxxxxxxxxxxxxxxxxxxxxxx>
- Date: Sun, 1 Feb 2009 20:16:29 -0500
Sounds like another push to sell more statins.
Jim Higgins wrote:
| 'Normal' levels of bad cholesterol may be too high
| http://www.usatoday.com/news/health/2009-02-01-bad-cholesterol_N.htm
|
| The bottom isn't just dropping out of the stock market. It's also
| giving way in a critical measure of heart risk.
|
| Two new studies indicate that the threshold of what doctors consider
| "normal" levels of bad cholesterol, or LDL, may be too high, leaving
| thousands of people vulnerable to heart attacks and strokes.
|
| One of the studies, led by Gregg Fonarow of UCLA, examined 131,000
| hospital admissions for heart disease and found that at least half of
| the patients had normal LDL levels. The other study, called JUPITER,
| involved 18,000 people. It showed that giving a cholesterol-lowering
| statin to older people with normal LDL cut their risk of heart attack
| and stroke in half.
|
| HOSPITALS NEAR YOU: Compare on heart attack, heart failure death rates
| http://www.usatoday.com/news/health/hospitals-graphic.htm
|
| BETTER LIFE: Avoid risks to heart health
| http://blogs.usatoday.com/betterlife/heart_of_the_matter/index.html
|
| Taken together, doctors say, the studies suggest that accepted notions
| of normal LDL are wrong ? and that current treatment guidelines miss
| at least half of those who should be getting a statin.
|
| Millions untreated
|
| JUPITER suggests that millions more older people ? as many as 11
| million, Yale researcher Erica Spatz reported this month ? should be
| getting statins. That would bring the total to about 45 million
| people,
| or 80% of all men older than 50 and all women older than 60.
|
| But UCLA's Fonarow, whose study was published in the American Heart
| Journal, says there's another possibility. "There are two potential
| implications," he says. "Either the threshold of what was set as an
| ideal LDL was set outrageously high, thus allowing the vast majority
| of patients to be missed, or LDL isn't much of a risk factor.
|
| "It's got to be one of the two."
|
| Current guidelines recommend that doctors prescribe a statin for
| anyone whose LDL is 100 milligrams per deciliter of blood or higher.
| Doctors
| may treat patients with lower LDL at their discretion. But Fonarow
| notes that "half of all heart attacks are occurring below 100
| (mg/dl)."
|
| Sidney Smith of the University of North Carolina-Chapel Hill, an
| authority on treatment guidelines and one of Fonarow's co-authors,
| says
| the study supports the wisdom of a push to drive LDL even lower, in
| many cases down to 70 mg/dl.
|
| JUPITER offers a crucial clue to another potent risk factor,
| inflammation, that is gaining wider recognition. That's because the
| study was designed to find out whether statins can prevent heart
| attacks and strokes in people who have normal cholesterol but whose
| arteries
| show signs of being inflamed. The findings offer strong evidence that
| statins relieve inflammation.
|
| If LDL is cardiovascular dynamite, inflammation is the fuse. Here's
| why: LDL carries cholesterol into the bloodstream, where it collects
| in
| artery walls. Inflammatory cells sometimes attack these deposits,
| causing them to burst. When that happens, blood clots and other debris
| float downstream into the arteries that nourish the heart. A blockage
| in
| a critical vessel may cut off the heart's blood supply.
|
| "If we understand the biology of this disease, there are two
| fundamental components: cholesterol and inflammation," says Paul
| Ridker of Brigham
| and Women's Hospital in Boston and JUPITER's lead author. "When we
| make that leap, so many other things become simple."
|
| Making the leap has been anything but simple. Some critics have
| challenged Ridker's emphasis on inflammation and the validity of the
| test he helped to develop. Ridker has disclosed that he holds patents
| on the test, which measures C-reactive protein (CRP), a signal of
| artery inflammation.
|
| The accepted view of heart risk stems from the Framingham study, a
| long-term government-funded evaluation of the residents of a
| Massachusetts community dating to 1948.
|
| Constellation of risks
|
| The Framingham study identified age, gender, smoking, blood pressure,
| diabetes, blood fats and family history as key risk factors that can
| be used to calculate a person's odds of having a heart attack or
| stroke in
| the next 10 years.
|
| "LDL is one of a constellation of risk factors," says Framingham's
| director Daniel Levy, adding that the new research is bringing into
| clearer focus the many factors that influence heart risk and how best
| to lower it. "This is a jigsaw puzzle," he says. "Even before the last
| piece is in place, we have a good idea of what we're looking at."
|
| The question, he says, is deciding whom to treat. "In theory,
| ultra-aggressive treatment might reduce (heart attack and stroke)
| rates
| in the general population," Levy says, "but the reality is we can't
| target everyone for that kind of therapy."
|
| Ridker asserts that testing for inflammation simplifies the picture.
| It appeared, in JUPITER, to trump such accepted traits as obesity as a
| predictor of heart-attack risk.
|
| "If you were a thin person with high CRP or an obese person with high
| CRP, the risk was identical," he says. "Inflammation was the common
| driver."
.
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- 'Normal' levels of bad cholesterol may be too high
- From: Jim Higgins
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