Lowering Cholesterol Early in Life Protects Against Heart Disease Later

New research from UT Southwestern Medical Center indicates that lowering “bad” blood cholesterol earlier in life, even by a modest amount, confers substantial protection from coronary heart disease.

The new findings, appearing in the March 23 issue of The New England Journal of Medicine, found that people with genetic variations affording them lower low-density lipoprotein (LDL) cholesterol in their blood from birth were significantly less likely to develop coronary heart disease later in life than those without the variations. These variations exist in a recently discovered gene called PCSK9.

Based on 15 years of data tracking more than 12,000 multiethnic subjects ranging in age from 45 to 64, the researchers found that people who had cholesterol-lowering genetic variations that lowered their LDL level by about 40 milligrams per deciliter were eight times less likely to develop coronary heart disease than those without the mutations. Those with genetic profiles lowering their LDL by about 20 mg/dl from average had a twofold reduction in heart disease.

“These data indicate that a moderate, life-long reduction in LDL cholesterol is associated with substantial reduction in the incidence of coronary events, even in populations with a high prevalence of other cardiovascular risk factors,” said Dr. Helen Hobbs, the study’s senior author, director of the Eugene McDermott Center for Human Growth and Development and an investigator in the Howard Hughes Medical Institute at UT Southwestern. She also directs the Donald W. Reynolds Cardiovascular Clinical Research Center at UT Southwestern. Dr. Hobbs coauthored the study with Dr. Jonathan Cohen, professor of internal medicine and researchers from the UT Health Science Center in Houston and the University of Mississippi Medical Center in Jackson.

Dr. Scott Grundy, director of the Center for Human Nutrition at UT Southwestern, served as chairman of the National Cholesterol Education Program’s Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, which in 2001 set guidelines for the clinical use of cholesterol-lowering medications to reduce the risk of cardiovascular disease. “This study demonstrates the great importance of high blood cholesterol in causing coronary heart disease,” said Dr. Grundy.

“It also shows the benefit of maintaining a low cholesterol level throughout life. The foundation for keeping low blood cholesterol is a reduced intake of saturated fats and cholesterol and maintaining a desirable body weight. But in some people it may be necessary to add drugs to reduce cholesterol levels. Fortunately, newer cholesterol-lowering drugs have been developed that are both effective and safe for most people.

Previous research has established that people with a high level of LDL cholesterol in their blood are at greater risk of developing coronary heart disease. The present study further documents that life-long reductions in LDL cholesterol can actually help prevent heart disease.

Previous findings by Dr. Hobbs and colleagues at UT Southwestern had identified specific mutations in the gene called PCSK9 that are associated with lower LDL cholesterol levels in people who have the mutations. Those genetic studies were based on data gathered from the UT Southwestern-directed Dallas Heart Study, a groundbreaking multiyear investigation of cardiovascular disease involving 6,000 Dallas County residents.

The new findings are based on data obtained from subjects drawn from the Atherosclerosis Risk in Communities Study (ARIC), which tracked the health of participants from four communities in Mississippi, Minnesota, North Carolina and Maryland for 15 years, beginning in 1987. UT Southwestern’s collaborators at the UT Health Science Center in Houston analyzed blood samples from those participants to determine who carried the cholesterol-lowering genetic variations. The researchers then tracked the subjects’15-year health history and found the association between lower long-term LDL levels and lower risk of heart disease.

The PCSK9 gene produces an enzyme that normally controls the number of LDL receptors lining the surface of liver cells. These LDL receptors latch on to LDL and remove it from the blood. Dr. Hobbs and co-workers previously found that genetic mutations that inactivate PCSK9 result in lower levels of the PCSK9 enzyme, leading to higher levels of LDL receptors. By increasing the amount of “bad” cholesterol the liver cells can remove from the blood, LDL levels are lower in the blood of people with the mutations.

High levels of PCSK9 tend to raise the blood concentrations of LDL. Currently statins are the standard class of drugs prescribed to lower LDL in patients. However, statin treatment may increase the production of the PCSK9 enzyme, Dr. Hobbs said, which in turn may limit the effectiveness of these drugs. Developing new therapies that inhibit PCSK9 activity not only should lower LDL levels, but in addition, might enhance the effectiveness of statins, she said.

Research Links Soy Protein with Heart Health

Cardiovascular diseases kill more than 16 million people worldwide and account for some 30 percent of all deaths each year. In the United States, heart disease and stroke, the main components of cardiovascular disease, account for nearly 40 percent of all adult deaths. Physicians have known for many years that lifestyle change helps prevent heart attack and stroke. Only recently, however, have scientists studied how a diet low in fat and rich in soy protein helps lower cholesterol and may help reduce one’s risk of heart disease.

Soy Protein’s Role in Lowering Cholesterol

Two daily servings of soy protein can lower blood cholesterol levels by as much as 9 percent, according to a new study by a scientist at the University of Kentucky – Lexington. (1) More than 40 other studies have also found that adding soy protein to the diet, or replacing animal protein with soy, lowers blood cholesterol. (2,3) In a 1995 meta-analysis of 38 clinical studies, researchers found that soy protein resulted in a 12.9 percent average reduction in LDL (“bad”) cholesterol levels. (4)

1 Anderson, JW. University of Kentucky. 2005. 2 Carroll KK. J Am Dier Assoc, 91:820, 1991. 3 Sitori CR, Even R, Lovatt, MR. Ann NY Acad Sci, 676:188, 1993. 4 Anderson JW, Johonstone BM, Cook-Newell ME. N Engl J Med 333:276, 1995.

American Heart Association, FDA Endorse Soy Protein

A strong body of research into soy protein and heart disease prevention has prompted many health experts to endorse the value of soy protein within a low fat, low cholesterol diet. In 1999, The Food and Drug Administration (FDA) approved an unqualified health claim in support of soy’s heart health benefits, which came in response to a body of scientific evidence compiled, reviewed and presented by The Solae Company. The claim is based on scientific evidence from more than 50 independent studies, many of which included soy protein from The Solae Company.

This month, the American Heart Association publicly acknowledged that soy protein was a high quality, heart healthy protein source. Many foods containing soy protein are considered beneficial because of their high content of polyunsaturated fats, fiber, vitamins, minerals and low content of saturated fat.

Additional Health Benefits of Soy

Researchers have found other ways in which soy protein may help reduce a person’s risk for cardiovascular diseases. Blood clots, for example, can completely block an artery that has already been narrowed by atherosclerosis. Research findings suggest that certain bioactive properties found in soyfoods may help prevent these blockages from occurring, thereby reducing the chances of heart attack or stroke. (5,6) Still more research has indicated that soy protein may be linked to lower blood pressure. (7) Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure and/or kidney failure. More research is still needed, and scientists continue to examine soy protein’s affect on a variety of heart health issues.

Potassium-enriched salt may cut heart risks

Replacing regular salt with a potassium-fortified alternative may help lower older adults' risk of dying from cardiovascular disease, new research suggests.

In a study of nearly 2,000 elderly Taiwanese men, researchers found that those given a potassium-enriched salt substitute were 40 percent less likely to die of heart disease or stroke over the next two to three years.

The salt alternative, which was half sodium chloride, half potassium chloride, helped the men make a moderate cut in their sodium intake and a substantial increase in their potassium consumption.

This potassium boost may have been largely responsible for the lower risk of cardiovascular death, the researchers conclude in the American Journal of Clinical Nutrition.

Like sodium, potassium is an electrolyte needed for maintaining the body's fluid balance. It's also involved in proper nerve and muscle control, as well as blood pressure regulation. A number of studies have suggested that diets high in potassium -- from foods like raisins, bananas, melon, beans and potatoes -- may help maintain a healthy blood pressure.

The new findings suggest the mineral may also help lower the risk of dying from heart disease or stroke -- possibly by protecting blood vessel function, according to study co-author Dr. Wen-Harn Pan, a researcher at the Institute of Biomedical Sciences, Academia Sinica in Taipei.

While the study looked at a potassium-enriched salt, Pan told Reuters Health she suspects that a diet high in potassium-rich fruits and vegetables could be even more beneficial.

The study included 1,981 elderly men who were residents of a veterans' retirement home. Half of the men were randomly assigned to eat meals prepared with the potassium-enriched salt, while the rest had meals made with regular salt.

Over the next 30 months, the researchers found, men given the salt alternative were 40 percent less likely to die of cardiovascular disease.

The findings are in line with general nutrition advice for controlling blood pressure and lowering heart risks: eat more fresh fruits and vegetables, beans and low-fat dairy, while limiting salty processed foods.

An advantage of whole-food sources of potassium is that they contain other nutrients important to overall health, Pan noted. Still, potassium-enriched salt offers a "convenient and fast way" to alter the diet's sodium-potassium ratio, she added.

It is possible, however, for the body's potassium levels to get too high, particularly in older people who have kidney dysfunction or are taking certain medications -- including blood pressure drugs called ACE inhibitors.

Older adults should check with their doctors before using potassium-enriched salt substitutes or potassium supplements.

Work Stress Leads to Heart Disease and Diabetes

Chronic stress at work and the metabolic syndrome: prospective study BMJ Online First

Stress at work is an important risk factor for the development of heart disease and diabetes, finds a study published online by the BMJ today.

Stress at work has been linked with heart disease, but the biological processes were unclear. This study provides new evidence for the biological plausibility of the link between work stress and heart disease.

Researchers examined the association between work stress and the metabolic syndrome (a cluster of factors that increases the risk of heart disease and type 2 diabetes) in 10,308 British civil servants aged between 35 and 55, over a 14 year period.

Work stress was measured on four occasions between 1985 and 1999. Components of the metabolic syndrome, such as obesity, high blood pressure, and high cholesterol levels, were measured between 1997 and 1999. Social position and health damaging behaviours, such as smoking, heavy alcohol consumption, and lack of exercise, were also recorded.

A dose-response relation was found between exposure to job stress and the metabolic syndrome, even after adjusting for other risk factors. For example, men with chronic work stress were nearly twice as likely to develop the syndrome than those with no exposure to work stress. Women with chronic work stress were also more likely to have the syndrome, but they formed a small group.

Both men and women from lower employment grades were more likely to have the syndrome, confirming previous reports that the syndrome has a social gradient.

The association between the metabolic syndrome and exposure to health damaging behaviours was stronger among men than women. Poor diet (no fruit and vegetable consumption), smoking, heavy alcohol consumption, and physical inactivity were all associated with higher odds of the syndrome.

Despite some study limitations, a dose-response relation exists between exposure to work stress and the metabolic syndrome, even after other risk factors are taken into account, say the authors.

One possible explanation is that prolonged exposure to work stress may affect the nervous system. Alternatively, chronic stress may reduce biological resilience and thus disturb the body’s physiological balance (homoeostasis).

This study provides evidence for the biological plausibility of psychosocial stress mechanisms linking stressors from everyday life with heart disease, they conclude.

Larger Waistline Linked to Increased Risk for Heart Disease in Women

Women with waistlines of 35 inches or more are at greater risk of heart disease than thinner women, according to a new study by researchers at NewYork-Presbyterian Hospital/Columbia and Sister to Sister: Everyone Has a Heart Foundation. The study is published in today's Journal of Women's Health.

Of more than 6,000 women without known heart disease whose waistlines were measured on Women's Heart Day, February 18, 2005, the study found that 90 percent had at least one major risk factor for heart disease, and one-third had three or more. These risk factors included high cholesterol and high blood pressure, among others. Increased waist circumference was also correlated with a woman's 10-year chance of having a heart attack or dying of heart disease.

"Measuring waist circumference may be a simple method that women can identify themselves as being at increased heart-attack risk and empower them to seek further evaluation and possible treatment from their doctors," says lead author Dr. Lori Mosca, director of preventive cardiology at NewYork-Presbyterian Hospital and professor of medicine at Columbia University College of Physicians and Surgeons.

A substantial proportion of women screened were found to have major risk factors for heart disease they were unaware of. Nearly half of all women with elevated cholesterol or low HDL cholesterol ("good" cholesterol) did not report a history of being told they had abnormal cholesterol from a health-care provider. Alarmingly, 43 percent of women who participated in the screening had blood glucose above what is considered normal (< 100 mg/dL). And, 16 percent of women with no documented history of hypertension had elevated blood pressure (> 140/90 mmHg) that should receive intervention based on national standards.

According to Dr. Mosca, who also serves as the chief medical advisor for the Sister to Sister: Everyone Has a Heart Foundation, "These findings underscore the need to educate women about their personal risk of cardiovascular disease and educate them that where there is one risk factor present, there are likely more. Lifestyle is critical in treating the risk factors for heart-disease-related conditions like hypertension, high cholesterol, and diabetes that are associated with abdominal obesity and each other. Weight management, good nutrition, regular exercise, and avoidance of smoking can go a long way to lowering overall cardiovascular risk. Because so many participants in our screening program were unaware of their risk, our study makes clear that women need to ask their physician if they have any of these risk factors."

Sister to Sister: Everyone Has a Heart Foundation, Inc. is a not-for-profit grassroots organization founded in 2000 by Mrs. Irene Pollin with a mission to bring free heart-disease screenings and "heart-healthy" prevention information and support to women nationwide. Since its inception, Sister to Sister has touched the lives of thousands of women through the National Woman's Heart Day® Campaign. So far, nearly 20,000 women of all ages, races, and socioeconomic backgrounds have been screened for cardiovascular disease risk factors.

"We now know that these screenings provide an additional and unforeseen benefit," says Mrs. Pollin. "Not only have they allowed us to identify and educate women at risk, but they have provided a rich opportunity for research that will be useful in educating the millions of women who may not be able to attend the screenings in person but are at risk of heart disease."

Heavy Stress Plays Hefty Role in Heart Disease

Stress can contribute to the development of heart disease and lead to a fatal heart attack like the one reportedly suffered by Ken Lay, former chief executive officer of Enron, on Wednesday, according to a psychiatrist at Duke University Medical Center.

"Mr. Lay is an unfortunate example of the fact that stress can play a role in precipitating an acute heart attack," said Redford Williams, M.D., director of the Behavioral Medicine Research Center at Duke University Medical Center. "Stress from major life events that we can't control, such as legal difficulties, can be highly detrimental."

Williams has published more than 150 scientific articles on stress and heart disease. He is also co-author of the book Anger Kills.

"People with high-demand jobs but little control over those jobs could be at high risk for stress-related heart disease," Williams said. "Stress can play nearly as important a role in having a heart attack as high cholesterol or high blood pressure," he added.

Anyone with an underlying heart condition is much more susceptible to the effects of stress, Williams said.

Individuals who feel constantly depressed, worried, anxious or angry should visit their doctor. Fatigue, a racing heart or difficulty breathing should also prompt a call to a physician to determine if the physical factors leading to heart disease are under control, Williams said. If necessary, doctors can recommend aspirin, antihypertensive medication or drugs known as beta blockers to control or prevent potential problems.

Williams recommends talking about problems with loved ones and brainstorming about ways to alleviate stressful situations. Regular meditation or relaxation, he said, can also help reduce the amount of stress hormones and protect the mind and body from the harmful effects of extreme stress.

Green tea found to significantly reduce risk of death, heart disease

A Japanese study found that drinking green tea can lower the risk of death from a variety of illnesses, including cardiovascular disease. The Tohoku University study -- started in 1994 -- looked at 40,530 healthy adults aged 40 to 79 who lived in Northeastern Japan, where roughly 80 percent of people drink green tea and more than half drink three or more cups daily.

Over the course of the 11-year study, people who drank five or more cups of green tea per day had a 16 percent lowered risk of dying from any cause and, during the seven-year follow-up, had a 26 percent lower risk of dying from cardiovascular disease when compared to people who drank fewer than one cup a day. The study found no association between green tea consumption and death from cancer.

The study noted that women seemed to get a greater benefit from the tea than men, as the risk of death from cardiovascular disease was reduced by 31 percent in women who drank more than five cups of green tea a day.

"The most important finding is that green tea may prolong people's lives through reducing the risk of cardiovascular disease," said lead researcher Dr. Shinichi Kuriyama.

Ellen mason, a cardiac nurse at the British Heart Foundation, said the results may not apply to people who consume Western diets because the Japanese diet as a whole is recognized for its healthy properties.

"The rate of heart disease in Japan is already one of the lowest in the world, and the Japanese diet is believed to play a substantial role in keeping this low," she said. "The average British diet contains more saturated fat than the average Japanese diet, and our levels of heart disease are relatively high compared with many other countries in the world.

"It is questionable whether drinking the same amount of green tea a day in the UK would have a significant impact on levels of heart disease," Mason said, adding that subsequent clinical trials would be needed to prove whether green tea can prevent deaths from heart disease.

"I reach the exact opposition conclusion," said Mike Adams, a consumer health advocate and creator of the HerbReference.com website. "If green tea can significantly reduce the risk of heart disease in Japanese people who already have excellent cardiovascular health, the herb may be even more beneficial in Westerners who don't follow heart-healthy diets," he said. "Americans have more room for improvement."

More than 3 million tons of tea is produced annually worldwide, and it is hailed as the most consumed beverage on Earth after water. Adams cautions consumers to buy green tea only from reputable sources, as much of the green tea sold around the world is contaminated with fluoride.

Couch Potatoes Who Start Exercising After 40 Can Still Stave Off Heart Disease

Couch potatoes who start exercising in later life can still significantly cut their chances of developing coronary artery disease, suggests a small study published ahead of print in Heart.

The authors base their findings on 312 adults between the ages of 40 and 68 who had confirmed coronary artery disease and 479 volunteers matched for age and sex.

Each participant was interviewed about their level of physical activity in early adulthood, classified as the period between 20 and 39, and in late adulthood, defined as the period after the age of 40.

Unsurprisingly, known risk factors for coronary heart disease, including smoking, diabetes, and high blood pressure tended to be more common among those with confirmed disease.

Around half of those with heart disease and seven out of 10 of the healthy volunteers said that they had been moderately or very physically active in younger and older adulthood.

But around one in 10 of those with confirmed disease and around one in 20 of the healthy volunteers confessed to having enjoyed a lifetime of physical inactivity.

Those who had been active all their lives had the lowest risks. They were around 60 per cent less likely to be diagnosed with coronary heart disease.

But those who became very physically active after the age of 40 were around 55 per cent less likely to be diagnosed with heart disease than those who had embraced inactivity all their lives.

The authors conclude that while optimal health is likely to be enjoyed by those who exercise all their lives, it is not too late to start. Regular exercise, even if started in older life, still confers many benefits and substantially cuts the risk of heart disease.

But an accompanying editorial points out that only about a third of men and a fifth of women in England manage the recommended 30 minutes of moderate physical activity on most days of the week.

And these proportions fall to just 17 per cent and 12 per cent, respectively among those aged 65 and above, it says.

Prostate cancer drugs cause heart disease, diabetes

New research appearing in the Sept. 20 issue of the Journal of Clinical Oncology has found that drugs frequently used to treat prostate cancer may significantly increase the risk of developing heart disease and diabetes.

Researchers from Harvard Medical School examined data collected on more than 70,000 men with prostate cancer from the 1990s through 2002 being treated with gonadotropin-releasing hormone (GnRH) agonist drugs. Previous studies had suggested that prostate cancer patients taking the drugs gained excess weight around the abdomen and became resistant to insulin.

The Harvard researchers wanted to determine if such weight gain affected the patients' risk of heart disease and diabetes, and found that men taking the drugs experienced a 44 percent increased risk of developing diabetes, were 16 percent more likely to develop heart disease, and 11 percent more likely to have a heart attack or die from heart failure.

GnRH agonist drugs have become standard therapy for treating prostate cancer -- which is the second-most common cancer in men, after skin cancer, and kills more than 27,000 in the United States every year. They have become widely used in men whose prostate cancer may not benefit from their use.

"Given the number of people on these drugs and the fact that some of these men may not necessarily be getting any benefit, I think it's a bit concerning," says the study's lead author, Nancy L. Keating, who urges doctors to be "more cautious" in prescribing the drugs.

Natural health advocates say many cases of prostate cancer can be prevented or reversed without toxic cancer drugs, by using natural food treatments such as pomegranate juice, curry, cauliflower and capsaicin -- the compound that makes jalapeno peppers hot -- as well as omega-3 fatty acids.

Food labels should list all fats to help cut heart disease, say experts

Food labels should list trans fats as well as cholesterol and saturated fat to help reduce coronary heart disease, say researchers from the University of Oxford in this week's BMJ.

Trans fats (also known as trans fatty acids) are solid fats found in margarines, biscuits, cakes, and fast food. Scientists think that our bodies deal with these fats in the same way as saturated fats.

Both saturated fats and trans fats increase the amount of low density lipoprotein (LDL) or 'bad cholesterol' in the blood and reduce the amount of high density lipoprotein (HDL) or 'good cholesterol.' People with high levels of LDL cholesterol tend to have a higher risk of getting heart disease, while people with high levels of HDL cholesterol tend to have a lower risk.

A recent analysis of all the evidence recommended that people should reduce or stop their dietary intake of trans fatty acids to minimise the related risk of coronary heart disease.

This analysis found a 2% increase in the energy intake from trans fatty acids was associated with a 23% increase in the occurrence of coronary heart disease. In fact, the authors noted that the harmful effects of trans fatty acids were seen even when intake was really low, only 3% of total daily energy intake (20-60 calories), about 2-7 g for a person consuming 2000 calories per day.

Legislation introduced in Denmark in 2004 mandated that all oils and fats used in locally made or imported foods must contain less than 2% industrially produced trans fatty acids. This virtually eliminated trans fatty acids and had no effect on quality, cost, or availability of foods.

And in January 2006 the US Food and Drug Administration mandated that all food manufacturers provide the content of trans fatty acids and cholesterol in addition to saturated fat on nutrition labels for all manufactured foods, write the authors.

The UK Food Standards Agency is currently pressing for revision of the European directive that governs the content and format of nutrition labels on foods marketed in the United Kingdom and other European countries, so that these fats are labelled.

They believe that mandatory addition of the content of saturated fat and trans fatty acids to nutrition labels would enable consumers to make healthier food choices that could lower LDL concentrations and reduce the risk of coronary heart disease and other vascular events.

Pecans found to lower risk of heart disease, reduce LDL oxidation

A study in California, conducted by Loma Linda University researchers, found that the high vitamin E content of pecans might reduce the risk of heart disease by slowing blood oxidation.

The researchers split 23 men and women between the ages of 25 and 55 into two groups. One group was placed on the American Heart Association's "Step I" diet while the other group was placed on a pecan-enriched version developed by the scientists, in which pecans made up 20 percent of the diet's calories. After four weeks, both groups traded diets.

Blood analysis of the participants found that the pecan-enriched diets reduced unwanted lipid oxidation in the blood by 7.4 percent compared to the Step I diet, which could potentially lower risk of heart disease. The study results, published in the August issue of Nutrition Research, theorized this may be due to the pecans' high vitamin E (gamma tocopherol) content, which is thought to protect fats from oxidation, since oxidation of LDL (bad) cholesterol is linked to atherosclerosis, arterial blockage, heart attacks and strokes.

"We concluded that even though the pecan diet was high in unsaturated fats, which one may think would increase blood oxidation, that did not happen," said lead author Dr. Ella Haddad, researcher at the Seventh-day Adventist institution's School of Public Health. "We found the opposite result: the pecan diet showed reduced oxidation of blood lipids."

"These data provide some evidence for potential protective effects of pecan consumption in healthy individuals," concluded Haddad.

"These results are not surprising," said Mike Adams, author of "The Seven Laws of Nutrition." "Natural health proponents have known for a long time that nuts and seeds contain powerful medicine for protecting the heart and nervous system. Now the science is finally starting to catch up and prove what we've known for decades: Nature already provides safe, effective medicine that's hidden in plants."

The importance of this study is illustrated by the fact that health officials from the U.K and the United States say heart and circulatory disease is the number one killer in both countries.

Meals high in saturated fat impair 'good' cholesterol's ability to protect against clogged arteries

Before you bite into that burger or devour that doughnut, first chew on this: New research shows that just one meal high in saturated fat can affect the body's ability to protect itself against some of the underlying causes of heart disease and stroke.

The research, conducted at The Heart Research Institute in Sydney, Australia, appears in the Aug. 15, 2006, issue of the Journal of the American College of Cardiology.

According to the study, even a single meal high in saturated fat can reduce the ability of the body's "good" cholesterol, or high-density lipoproteins (HDL), to protect the inner lining of the arteries from inflammatory agents that promote the formation of artery-clogging plaques. A single high-fat meal also can affect the ability of the arteries to expand in order to carry adequate blood to tissues and organs.

On the other hand, according to the research, eating a meal high in polyunsaturated fat, a healthier form of fat, can increase the anti-inflammatory properties of HDL, helping to protect the inner lining of the arteries, called the endothelium, from plaque buildup.

"The take-home, public-health message is this: It's further evidence to support the need to aggressively reduce the amount of saturated fat consumed in the diet," said researcher Stephen J. Nicholls, MB, BS, PhD, now a cardiologist at Cleveland Clinic in Ohio. "This study helps to explain the mechanisms by which saturated fat supports the formation of plaques in the arterial wall, and we know these plaques are the major cause of heart attack and stroke."

Saturated fats are found in both animal and plant products, and typically are solid at room temperature. Examples include butter, lard and palm oil. The American College of Cardiology and the American Heart Association recommend that people limit their intake of saturated fat to no more than 7 percent of their total daily calories. Polyunsaturated fats, on the other hand, come mainly from plants and are liquid at room temperature. Examples include sunflower and corn oil.

For the study, Dr. Nicholls and his colleagues recruited 14 healthy volunteers and supplied them with two meals, eaten one month apart. The volunteers, ranging in age from 18 to 40, were examined and had blood drawn before eating (following an overnight fast), three hours after eating and again six hours after eating their supplied meals. Neither the participants nor the researchers knew which meal was eaten during which visit.

The meals were identical, except that one was high in saturated fat (coconut oil), while the other was high in polyunsaturated fat (safflower oil). Each meal consisted of a slice of carrot cake and a milkshake. All meals were specially prepared so that each participant consumed 1 gram of fat per kilogram of body weight – or 1 gram of fat for every 2.2 pounds. (For a 150-pound person, that's nearly the fat equivalent of eating a double cheeseburger, a large order of french fries and a large milkshake at one meal.)

In examining the volunteers, Dr. Nicholls and his colleagues found that after three hours, the saturated fat meal had reduced the ability of the endothelium to expand the arteries in order to increase blood flow. The researchers determined this by using a blood pressure cuff to restrict blood flow and then monitoring the body's response. The polyunsaturated meal also reduced this ability slightly, but the results were not statistically significant.

After six hours, researchers found the meal high in saturated fat had diminished the protective qualities of HDL, allowing more inflammatory agents to accumulate in the arteries than had been present before the volunteers ate. The polyunsaturated meal, however, seemed to boost the anti-inflammatory abilities of the body's good cholesterol, with the researchers finding fewer inflammatory agents in the arteries than before the volunteers ate.

"In putting this all together," Dr. Nicholls said, "we have a difference between the two meals regarding a number of factors that influence the early stages of plaque formation. We have a situation where consumption of a single meal containing a high level of saturated fat is associated with impairment of vascular reactivity and impairment of a normal protective property of HDL. In contrast, consumption of a meal high in polyunsaturated fat results in HDL that is more protective.

"It is a small study," he concluded, "but I think the findings have broad implication because diet and exercise are the cornerstones of all strategies for preventing heart disease."

Robert Vogel, MD, a cardiologist and professor of medicine at the University of Maryland Medical Center, did not participate in the research, but agrees it provides "one more nail in the coffin" against eating diets high in saturated fat.

"This study helps to flesh out just why we shouldn't eat too much saturated fat," Dr. Vogel said. "Traditionally, we think of unhealthy foods as raising cholesterol or raising blood pressure, but this demonstrates that depending on what you eat, you can actually change the effect of HDL – typically thought of as 'good' cholesterol – from protective to detrimental. This opens up new insights and avenues for research."

Black tea found to protect against heart disease, chronic stress

The first randomized clinical trial on the effects of black tea on stress has found that the beverage may reduce stress hormone levels and ease the burden of heart disease, say researchers at the University College London and Unilever Research Colworth.

"This has important health implications, because slow recovery following acute stress has been associated with a greater risk of chronic illnesses such as coronary heart disease," said lead researcher professor Andrew Steptoe from University College London.

The researchers recruited 75 healthy young males with an average age of 33 and put them through a four-week "washout" period during which they were not allowed to consume tea, coffee, caffeinated beverages, aspirin, ibuprofen, dietary supplements, and fruits and vegetables rich in flavonoids. Then, 37 of the men were given four cups of black tea per day for six weeks while the 38 members of the placebo group were given an identical-tasting caffeinated drink, with no active tea ingredients, for the same time period.

Both groups were asked to perform stressful tasks, including verbally responding to threats of unemployment and accusations of shoplifting while sitting in front of a camera. The researchers measured the cortisol, blood pressure and blood platelet levels, and also asked the subjects to self-rate their stress levels.

According to the results -- published in the online issue of the journal Psychopharmacology and scheduled for printing in the next physical issue -- both groups showed significant increases in blood pressure, heart rate and subjective stress levels during the tasks. However, 50 minutes after the tasks were complete, cortisol levels in the tea-drinking group had dropped by 47 percent compared to only 27 percent in the placebo group.

Additionally, the tea drinkers showed lower blood platelet activation -- which has been linked to blood clotting and subsequent heart attack risk -- and a greater degree of relaxation after the tasks.

"Tea, therefore, appears to influence the effectiveness of post-stress recovery, rather than the magnitude of stress responses themselves," wrote the researchers.

The researchers noted that previous animal and human studies have reported tea flavonoids affected sympathetic nervous systems in rats; human brain wave activity was stimulated by the amino acid theanine, found in tea; and EGCG reportedly has a sedative effect and reduces responses to separation stress.

"Although it does not appear to reduce the actual levels of stress we experience, tea does seem to have a greater effect in bringing stress hormone levels back to normal," the researchers said of the of the study, which was funded by the U.K.'s BBSRC, Unilever Research and the British Heart Foundation.

"This just goes to show what I've been saying for years," says health advocate and "The Seven Laws of Nutrition" author Mike Adams. "You don't need prescription drugs to deal with everyday stress. Natural beverages such as black tea can help you deal with tension without any dangerous side effects, and when you combine these natural foods and beverages with regular exercise, stress barely affects you at all."

FDA approves heart health claim for canola oil

The FDA has approved a qualified health claim on canola oil labels that states it supports heart health and reduces the risk of coronary heart disease due to its unsaturated fat content.

The heart healthy claim -- also found on oils such as phytosterols, omega-3s and olive oil -- is popular among nutraceutical companies because consumers are spending more on healthier foods. The U.S. Canola Oil Association petitioned to be able to make the claim in January in order to promote the benefits of canola oil.

"The claim may ... encourage food manufacturers and food service providers to substitute canola oil for other oils with less favorable nutritional profiles," said USCA president John Haas, who added that he expects the availability of the claim to promote consumer health by informing them of a simple, affordable and convenient strategy to reduce heart disease risk.

Studies suggest canola oil is high in healthy unsaturated fats, free of cholesterol and trans fats, and has the lowest saturated fat content of any common edible oil. Because canola oil is low in LDL (bad) cholesterol, the labels will be allowed to say:

"Limited and not conclusive scientific evidence suggests that eating about 1 1/2 tablespoons (19 grams) of canola oil daily may reduce the risk of coronary heart disease due to the unsaturated fat content in canola oil. To achieve this possible benefit, canola oil is to replace a similar amount of saturated fat and not increase the total number of calories you eat in a day. One serving of this product contains (x) grams of canola oil."

"There is ample scientific evidence to demonstrate these benefits from the unsaturated fats in canola oil," Haas said. "By using it in place of other common edible oils, consumers can increase their compliance with the latest dietary recommendations."

However, insiders are worried about what the move may mean for the industry as a whole. Since the health claims promote all canola oils, some companies have wondered why they would invest in claims that increase the sales of their competitors. Also, canola oil, along with olive oil, was granted it's heart health claim by the FDA because of it's low level of unsaturated fats, and experts say this may spur industry representatives for other oils to petition for the claim because of their oils' similar properties.

Although a proponent of healthy food ingredients, consumer health advocate and "Seven Laws of Nutrition" author Mike Adams advised skepticism.

"Do not celebrate these health claims too quickly," he said. "They are the FDA's way of easing off just slightly on the broad censorship now impacting all food and supplement companies.

"The FDA does not allow food companies to tell the truth about the health benefits of natural products like healthy oils, except in rare circumstances when powerful food groups lobby the agency to approve some watered-down claim," Adams said.

Prostate Cancer Treatment Increases Risk of Diabetes and Heart Disease

A treatment mainstay for prostate cancer puts men at increased risk for diabetes and cardiovascular disease, according to a large observational study published in the Sept. 20 Journal of Clinical Oncology.

“Men with prostate cancer have high five-year survival rates, but they also have higher rates of non-cancer mortality than healthy men,” says study author Nancy Keating, MD, MPH, assistant professor of health care policy and of medicine at Harvard Medical School. “This study shows that a common hormonal treatment for prostate cancer may put men at significant risk for other serious diseases. Patients and physicians need to be aware of the elevated risk as they make treatment decisions.”

The principal systemic therapy for prostate cancer involves blocking testosterone production. This is done either by removal of the testes (bilateral orchiectomy), or more commonly, by regular injections of a gonadotropin-releasing hormone (GnRH) agonist drug. GnRH agonists are the main therapy for metastatic prostate cancer and may also improve survival for some men with locally-advanced cancers.

However, little is known about the efficacy of GnRH agonists in treating men with less-advanced local or regional prostate cancer, many of whom receive this therapy. Earlier studies have found GnRH agonists to be associated with obesity and insulin resistance, a precursor to diabetes.

“Our study found that men with local or regional prostate cancer receiving a GnRH agonist had a 44 percent higher risk of developing diabetes and a 16 percent higher risk of developing coronary heart disease than men who were not receiving hormone therapy,” says Keating, who is also a physician at Brigham and Women’s Hospital.

“Doctors should think twice about prescribing GnRH agonists in situations for which studies have not demonstrated improved survival until we better understand the risks of treatment,” says co-author Matthew Smith, MD, PhD, associate professor of medicine at HMS and a medical oncologist at Massachusetts General Hospital. “For men who do require this treatment, physicians may want to talk with their patients about strategies, such as exercise and weight loss, which may help to lower risk of diabetes and heart disease.”

Given the number of men receiving GnRH agonists, often for many months or years, these increased risks can have important implications for the health of prostate cancer survivors, says Keating. Additional studies are needed to fully understand the biological mechanisms responsible for these increased risks.

Prostate cancer is the most frequently diagnosed cancer among men, affecting more than 200,000 men in the United States every year. With prostate cancer’s favorable prognosis, however, decisions about treatments are particularly important because adverse effects and complications of treatments may impact overall health and quality of life more than prostate cancer itself.

The study assessed whether androgen deprivation therapy was associated with an increased incidence of diabetes, coronary heart disease, myocardial infarction, or sudden cardiac death by examining data from approximately 73,000 men age 66 or older who were diagnosed with local or regional prostate cancer.

This work was supported by the Prostate Cancer Specialized Program of Research Excellence (SPORE) of the National Cancer Institute, one of the National Institutes of Health.

HARVARD MEDICAL SCHOOL http://hms.harvard.edu/Harvard Medical School has more than 7,000 full-time faculty working in eight academic departments based at the School's Boston quadrangle or in one of 47 academic departments at 18 Harvard teaching hospitals and research institutes. Those Harvard hospitals and research institutions include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, The CBR Institute for Biomedical Research, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, VA Boston Healthcare System.

Avoiding high-carb processed foods cuts heart disease risk in women by 30 percent

A new Harvard study has found that women who eat diets low in carbohydrates but high in vegetable-based fats and proteins can reduce their risk of heart disease by as much as 30 percent.

The researchers examined a study of more than 80,000 nurses, and found that healthy fats from foods such as avocados, nuts, seafood and liquid vegetable oils can help women reduce their heart disease by as much as a third.

Women also benefit from increasing their consumption of less-processed carbohydrates such as fruits, vegetables and whole-grain bread and cereal products, the study found.

The researchers' findings, published in yesterday's New England Journal of Medicine, indicate that replacing processed carbohydrates -- such as white bread, bagels, candy, cookies and cake -- and animal fats with healthy plant-based oils "can help reduce the risk of heart disease," according to Tufts University professor Alice H. Lichtenstein.

However, the scientists note that their research was not intended to help women lose weight. Though reducing carbohydrate intake was once a popular weight-loss method, the researchers say their findings advocate a more moderate approach to carb intake than the Atkins diet.

"We didn't really design the study to look at weight loss," said lead researcher Frank Hu, an associate professor of nutrition and epidemiology at the Harvard School of Public Health.

According to Lichtenstein, "there's no magic formula for weight loss," and dieters must still focus on reducing their total calorie intake -- as well as increasing exercise levels -- to successfully lose weight.

Hu and his colleagues found that participants in the study who reported eating a moderately reduced carbohydrate diet, such as that suggested for heart benefits, experienced "no significant long-term effect on body weight."

Folic acid proven to prevent heart disease and stroke in study

Experts have long recommended folic acid for pregnant women or women who may become pregnant, but a new study by researchers at the Wolfson Institute for Preventive Medicine in London and the Barts & The London Queen Mary's School of Medicine and Dentistry has confirmed the B vitamin also reduces people's risk of cardiovascular disease and stroke.

In previous studies, folic acid -- abundant in liver and leafy greens -- was found to contribute to the healthy formation of brain and spinal cord tissue while fetuses are in the womb, and evidence suggested that severe folic acid deficiency lead to the neural tube disorder known as spina bifida. However, the Wolfson Institute researchers took a different route and analyzed previous research on the relationship between cardiovascular complications and homosysteine, a blood compound that can harm arteries and increase heart disease risk at high levels.

The study covered a large number of people with high homosysteine levels, as well as a group of people who have a genetic mutation that raises homosysteine levels. The mutation affects about 10 percent of the world's population.

The evidence from the study lead the team to conclude that both groups showed positive effects after their homosysteine levels were lowered by consuming folic acid by between 10 and 20 percent, according to lead researcher Dr. David Wald. The homosysteine levels of the group afflicted by the mutation were brought down to normal by folic acid consumption.

"Folic acid is a much undervalued vitamin," Wald said. "Not only does it prevent the serious birth defect spina bifida, but the evidence that it can reduce the risk of heart attack and stroke is becoming increasingly persuasive".

Additionally, small, randomized trials showing the effects of lowered homosysteine levels were studied as part of the research, although the researchers eventually concluded the trials were too small and non-representative to provide a definitive conclusion.

Other sources rich in folic acid include nuts, seeds, oranges, grapefruits, sprouts, poultry, whole wheat bread, and beans and peas, which must be lightly cooked as too much heat will destroy the folate.

Red meat consumption heightens heart disease risk in diabetics

(NewsTarget) Diabetic women who eat large quantities of red meat and other foods high in iron run a significantly higher risk of developing heart disease, according to new Harvard research published in the journal Diabetes Care.

A team of researchers -- led by Dr. Lu Qi of the Harvard School of Public Health -- examined more than 6,100 women who had participated in the Nurses' Health Study, and who had reported being diagnosed with Type 2 (adult onset) diabetes.

Lu's research team conducted follow-up interviews with the women from 1980 through 2000. During those 20 years, the diabetic women reported 550 new cases of heart disease.

Lu's team found that the women's risk of developing heart disease was associated with their intake of "heme" iron, which is far more easily absorbed by the body than other types of dietary iron. Heme iron is typically found in red meat, chicken liver, clams and oysters.

The researchers found that -- after accounting for body weight and age -- the diabetic women who consumed the highest amounts of heme iron ran a 50 percent higher risk of developing heart disease, compared to those with the lowest intake. Postmenopausal, type 2 diabetic women ran the highest risk, Lu's team found.

According to Lu, it would be prudent for type 2 diabetics -- especially postmenopausal women with the disease -- to "limit consumption of heme iron and red meat."

Consumer advocate Mike Adams, author of "Grocery Warning," said increasing amounts of scientific evidence show that eating red meat can be a danger to consumers' health.

"In addition to greatly increasing the risk of colon cancer and pancreatic cancer, red meat now appears to be especially dangerous to diabetics," Adams said. "This is yet more evidence that diabetics would be well served to shift to plant-based diets that avoid processed foods and animal products."

Grape juice as good for the heart as red wine, new research suggests

(NewsTarget) A new study suggests that red grape juice may offer the same protection against heart disease as red wine.

"Grape juice can have a similar effect as red wine but without the alcohol," said lead researcher Dr. Valeri Schini-Kerth.

According to the FDA, drinking one to two glasses of red wine each day may lower cholesterol levels and decrease the risk of heart disease and cancer. However, the alcohol in wine can cause bodily damage if taken in excess.

One of the hypothesized reasons for the benefits of both red wine and grape juice is the high content of chemicals called polyphenols, which have antioxidant properties. Research suggests that antioxidants remove molecules called free radicals, which can cause cell damage linked to heart disease and cancer. In addition, researchers believe that polyphenols block the production of a protein linked to cardiovascular disease.

"Many people don't realize that the positive effects on heart health from red wine actually come from the natural medicines found in red grapes," explained Mike Adams, author of "The Seven Laws of Nutrition."

"You can get the same benefits be eating both red grape skins, which contain resveratrol, and red grape seeds, which contain proanthocyanidins, another powerful heart medicine with miraculous cardiovascular benefits. Grape seed extract supplements are also another way to experience the benefits of this natural medicine derived from food."

The grape juice study was funded by Welch Foods Inc., a major grape juice producer. Welch Foods is also the marketing and food production branch of the National Grape Cooperative Association.

Researchers from the Universite Louis Pasteur de Strasbourg in France examined the effect of concord grape juice on the endothelial cells of pigs. The data suggest that the polyphenols found in certain types of grapes cause these cells to produce nitric oxide, which helps maintain healthy blood pressure and blood vessel function.

Blood vessels are made up of endothelial cells, and heart problems often occur due to their malfunctioning.

Schini-Kerth cautioned that not all grape juices offer the same benefit. "It has to have a high level of polyphenols," she said.

Air pollution increases risk of heart disease and stroke, study says

(NewsTarget) A new study published in the New England Journal of Medicine has discovered a significant correlation between the air pollution around a woman's home and her risk of heart disease.

While only women were studied, researchers believe that air pollution has the same effects on men. However, women are at greater risk for heart disease in general, because their arteries are narrower and thus more easily blocked.

Researchers in the Women's Health Initiative Observational Study studied more than 65,000 women between the ages of 50 and 79 in 36 different U.S. cities for nine years. At the beginning of the study, none of the women had heart disease. At the end of the study, researchers compared the frequency of heart disease among participants in the different cities with information on local air quality. They found a substantial correlation between the density of particulate matter in the air and the occurrence of cardiovascular disease.

"These soot particles ... are typically created by fossil-fuel combustion in vehicles and power plants, " said lead researcher Joel Kaufman of the University of Washington. "The tiny particles — and the air pollutant gases that travel along with them — cause harmful effects once they are breathed in."

The average particulate levels varied by city, from four to nearly 20 micrograms per cubic meter of air. A 10 microgram increase in particulate concentration corresponded to a 76 percent greater chance of a woman dying from cardiovascular causes, including heart attacks and strokes.

"This adds to the mounting evidence that air pollution should be taken seriously as a risk factor for cardiovascular disease," said Jeremy Pearson, associate medical director for the British Heart Foundation.

The study's authors also urged stricter standards on particulate emissions.

According to Pearson, the British Heart Foundation is funding research on how to minimize the harm from air pollution. "In the meantime," he said, "when localized air pollution is particularly high, people with ... coronary heart disease should avoid staying outside for long periods."

Thai government sets aside patent law to produce generic AIDS, heart disease drugs

(NewsTarget) Thailand has authorized compulsory licenses to produce generic versions of two patented drugs, one being a HIV/AIDS antiretroviral drug, breaking the patents held by drug companies.

The decision comes at the protest of the World Health Organization, which wanted the country to come to a compromise solution with the drug companies to negotiate lower prices.

The WHO also has concerns that government-produced generics will not be of the same quality or effectiveness compared to the patented drugs.

The drugs involved are Kaletra, an HIV/AIDS antiretroviral drug produced by Abbott Laboratories from Illinois, and the blood-thinning medication Plavix, a popular drug produced by Bristol-Meyers Squibb. Thailand's distribution of licenses to make the drugs is permitted by World Trade Organization rules, which say the country can declare a "national emergency" to produce the drugs and override held patents.

Thailand's breaking of the local patent on Kaletra comes four months after the country broke the patent on another HIV/AIDS drug, Efavirenz by Merck.

Among its population of 64 million people, Thailand has more than 580,000 people living with HIV/AIDS, and its national health care system attempts to treat more than 82,000 HIV-positive people.

The move to make generics is expected to save the government $24 million in costs: Treating a person using Kaletra costs the government more than $4,000 a year, whereas using a generic would cost an estimated $1,400 a year, meaning the comparative cost of using a generic is up to two-thirds less.

Kaletra is used in Thailand for patients whose HIV has overpowered a weaker government-produced drug given to them as a first line of defense. Plavix, the other drug that Thailand broke the patent for, is one of the top five drugs sold worldwide, with sales of nearly $6 billion in 2005 alone.

Breaking patents and licensing these generic drugs could improve the Thai government's ability to negotiate lower drug prices with pharmaceutical companies, the director of the Thailand-based Aids Access Foundation, Nimit Tien-udom, was reported as saying by the Thai News Agency.

Thailand is not the only country to break patents: India and Brazil are examples of other countries that produce generic versions of patented drugs under the "national emergency" regulations of the WTO.

A Canadian company also produced a generic version of Kaletra briefly in 2006 for the worldwide market until it was forced to stop.

Heart disease rates in U.S. vary by region, education level

(NewsTarget) The Centers for Disease Control (CDC) has released the results of a national survey to determine US prevalence of heart disease. The 2005 Behavioral Risk Factor Surveillance System (BRFSS) study (published in 2007) is the first to collect data by state, allowing a regional analysis of heart disease prevalence and risk factors. They show that some states display much higher rates of heart disease than others (higher rates in Alabama, Arizona, Florida, Kentucky, Louisiana, Missouri, Oklahoma, Tennessee, Texas, West Virginia, and Puerto Rico) and that education level plays a significant role in heart disease (the lower a person's education, the higher their chance of being diagnosed with heart disease).

Jump directly to: conventional view | alternative view | resources | bottom line

What you need to know - Conventional View
• The term "heart disease" can refer to either myocardial infarction (MI, or "heart attack") or anginal/coronary heart disease (CHD). Between the two, heart disease has been the US's leading cause of death for 80 years.

• The direct and indirect costs associated with coronary heart disease in the US are projected to be more than $150 billion in 2007.

• The BRFSS was conducted by telephone. Respondents over the age of 18 were asked if a doctor had ever told them that they had experienced MI or CHD, and information was collected on their age, ethnicity/race, sex, education and residence location.

• 6.5 percent of respondents reported having experienced MI or CHD. Men had a significantly higher rate of occurrence than women for both conditions. The risk of heart disease increased with age and decreased with education level, and was highest among respondents of native or multiracial descent.

• The study's results may have been skewed by its reliance on land-line telephones and voluntary participation, and its exclusion of those in prisons, mental hospitals, nursing homes or other institutions.

What you need to know - Alternative View
Statements and opinions by Mike Adams

• Heart disease remains one of the largest preventable causes of disease and death in the United States. Hundreds of thousands of patients are needlessly dying each year from a health condition that is easily prevented using natural methods.

• Conventional medicine continues to attack and criticize nearly all natural prevention or treatment protocols for heart disease, denying patients access to information about natural cures that really work.

• Heart disease is an enormous profit center for doctors, surgeons and drug companies. It is not in the financial interests of anyone in conventional medicine to actually teach prevention. Our modern "sick care" system actually depends on continued heart disease for recurring revenues and profits.

• Heart disease is caused by consuming things like fried foods, processed foods, animal fats, dairy products and avoiding exercise or smoking cigarettes. It is prevented by consuming raw foods, fresh produce, superfoods, antioxidants and engaging in regular physical exercise while avoiding environmental toxins. Heart disease is primarily a nutritional disease that can be reversed by altering dietary choices.

Resources you need to know
• Naturopathic physician Dr. Decker Weiss has helped thousands of patients reverse heart disease using safe, natural protocols requiring no drugs or surgery. He documents his clinical success and treatment strategies in The Weiss Method, a book that teaches consumers how to prevent or reverse heart disease.

Bottom line
• Unless conventional medicine starts teaching prevention, heart disease is likely to remain the top killer in the United States.

Benefits of Garlic in Heart Disease

Numerous clinical trials have looked at the role and benefits of garlic supplements in heart disease. Many of these randomized studies showed positive benefits of garlic in heart disease: in particular, lowering total cholesterol, LDL cholesterol (the Bad cholesterol) and triglycerides (Also Read: How to lower Triglycerides?). A few small randomized trials also suggested the benefits of garlic in the prevention of platelet aggregation and thrombosis (the formation of plaques in the blood). Another study also showed that aged garlic extracts lowered high blood pressure. Most of these studies are relatively short-term, therefore we do not know if the positive benefits of garlic will last more than 3 months. Please also note that there were a number of studies showing conflicting results.
How much Garlic?

The American Dietetic Association suggested that in order to obtain the potential health benefits of garlic, one must take 600 - 900mg (about 1 fresh clove) per day.
Other Benefits of Garlic

Some studies looked at the potential benefits of garlic in cancer prevention. Some suggested that garlic inhibited the development and progression of breast, colon, stomach, esophagus, prostate and skin cancers in test tubes and in animals. Read Benefits of Garlic in Cancer

Other studies also showed that garlic exhibits antibiotic and antifungal effects.

benefits of Garlic HeartGarlic and Heart Key Message: Despite of the conflicting results of some studies, results of the majority of the clinical studies seemed to show promising benefits of garlic in heart disease for its ability of lowering blood cholesterol and anti-clogging blood vessels. Please be cautious if you are taking garlic supplements and blood thinners such as aspirin and warfarin at the same time. Garlic supplements will further thin your blood. In addition, it is suggested to discontinue garlic supplementation at least 7 days prior to surgery.

Pomegranate Juice May Clear Clogged Arteries

Antioxidants in Pomegranate Juice May Fight Hardening of the Arteries


March 21, 2005 -- A new study shows that pomegranate juice may help fight hardening of the arteries.

Researchers found that pomegranate juice not only appears to prevent hardening of the arteries by reducing blood vessel damage, but the antioxidant-rich juice may also reverse the progression of this disease.

Hardening of the arteries, known medically as atherosclerosis, refers to the build up of plaque in the walls of arteries. This causes decreased blood flow that can lead to heart attacks and strokes.
Pomegranate Juice Soothes Stressed Arteries

In the study, researchers tested the effects of pomegranate juice on samples of human cells that line blood vessels. The cells were exposed to excessive physical stressstress, such as might occur with high blood pressurehigh blood pressure.

Cells that were treated with pomegranate juice had less evidence of damage from the stress.

In addition, tests on mice showed that pomegranate juice significantly slowed hardening of the arteries that developed from high cholesterolhigh cholesterol.

If further studies show those results in humans, researchers say pomegranate juice may be useful in both prevention and treatment of heart diseaseheart disease.
Pomegranate Tops Other Juices

The tests showed that pomegranate juice reduced the effects of stress on human blood vessel cells by stimulating the production of nitric oxide. This chemical is thought to help keep arteries open and keep blood flowing.

Researchers say the beneficial effects of pomegranate juice on hardening of the arteries are likely largely due to its high antioxidant content. The study showed that the antioxidant level in pomegranate juice was higher than that found in other fruit juices, including blueberry, cranberry, orange, and even red wine.

Previous studies on red wine, black tea, and purple grape juice have already indicated these antioxidant-rich beverages can protect arteries from damage by improving blood flow. However, large clinical trials using different antioxidants have yet to show that antioxidants can prevent heart attacks and other major heart-related events.

The results of this study appear in the current issue of the Proceedings of the National Academy of Sciences.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding coronary artery disease:

1.
I'm worried about my cardiac health because of a family history, but I don't have other risk factors. How often should I get blood work done?

2.
What do you think of unconventional "risk factors" such as CRP and homocysteine measurements?

3.
Will I need to take medication for life if I start on medication to control my disease?

4.
Is there anything I could have done differently, or could be doing differently, to interfere with my disease?

5.
Is it possible to reverse coronary artery disease?

6.
What symptoms should trigger a visit to your office? What symptoms should trigger an emergency 911 call?

7.
What kind of exercise do you recommend?

8.
What kind of dietary choices should I make to reduce my risk of heart attack?

9.
What's a good source for dietary information?

10.
How will you decide if/when I need to undergo a procedure such as stenting or bypass surgery?

11.
Are my children at increased risk because of my disease?

Inflammation and CAD

Increasingly, inflammation has been singled out as an underlying factor that both causes and accelerates atherosclerosis. Atherosclerosis itself is an inflammatory process, characterized by activation of the body's inflammatory cascade at the level of the endothelium. This inflammatory cascade is part of a normal immune response. It is thought that atherosclerosis is characterized by a local immune response caused by damage to the arterial wall. As a result, white blood cells gather at the site of the injury and release inflammatory chemicals (such as interleukin-6 [IL-6]) that further damage the arterial wall and attract more white blood cells. Eventually, the arterial wall becomes permeable, allowing toxic LDL molecules to migrate into the inner lining of the artery. The white blood cells combine with LDL cholesterol molecules to form a lipid foam. This lipid foam is the main component of arterial plaque streaks, which appear early in the atherosclerotic process.

During this process, the body releases a number of inflammatory markers that can be measured in the blood. These include C-reactive protein, IL-6, lipoprotein-associated phospholipase A2 and others. Currently, only C-reactive protein is regularly used as a marker of heart disease risk, while researchers are examining the role of other inflammatory markers. So far, the data on C-reactive protein has been somewhat mixed. Some studies have found that C-reactive protein is a useful independent measure of heart attack risk, while others have found conflicting results. The source of this conflict might lie in the fact that C-reactive protein is not specific: levels are raised in response to inflammation and injury anywhere in the body. Nevertheless, some physicians recommend monitoring C-reactive protein to measure inflammation in the body.

In the future, lipoprotein-associated phospholipase A2 might emerge as another important tool to measure risk of heart attack. Studies have found that elevated levels of this enzyme are a strong risk factor for heart attack, even in the presence of other normal LDL cholesterol levels.

Researchers have also been investigating the link between infection/inflammation and CAD. Based on the connection between inflammation and immune system activation, researchers have hypothesized that chronic, inflammatory conditions, such as rheumatoid arthritis and persistent bacterial infection, may contribute to atherosclerosis.

Role of genes in CAD

While there are many risk factors for coronary artery disease that patients can control, they can’t change their genes – at least not yet. Scientists have identified more than 250 genes that may play a role in the development of CAD. Research has shown that atherosclerosis often begins in childhood with subtle damage to the interior lining of arterial walls (e.g., the endothelium). Studies have also shown that atherosclerosis is more widespread than was once thought. A person with atherosclerosis in their coronary arteries is more likely to have the condition in other arteries also. These findings suggest a genetic component to atherosclerosis, although researchers have yet to uncover the complex interaction between a person’s genetic make-up and their likelihood of developing coronary artery disease and atherosclerosis.

Some progress has been made, however, concerning the relationship between genes and cholesterol. Cholesterol is carried through the bloodstream by proteins called apolipoproteins. When these proteins wrap around cholesterol and other types of fats (lipids) to transport them through the bloodstream, the resulting “packages” are called lipoproteins. There are five different types of lipoproteins:

* High-density lipoproteins (HDL), which are associated with “good” cholesterol.

* Low-density lipoproteins (LDL), associated with “bad” cholesterol.

* Very-low-density lipoproteins (VLDL), which are associated with “very bad” cholesterol.

* Intermediate–density lipoproteins. Like VLDLs, these also carry both cholesterol and another type of fat (lipid) called triglycerides.

* Chylomicrons, which only carry a small percentage of cholesterol. Chylomicrons are mostly rich in triglycerides.

For more detailed information, see Cholesterol & Your Health.

The primary cholesterol-related genes that scientists are exploring as a means of better understanding and combating CAD include:

* Apolipoprotein A1 (APOA1). APOA1 is the major component of HDL, or protective cholesterol. Scientists have discovered that variations in the gene that codes for APOA1 can affect HDL levels, thus affecting overall risk for heart attack and stroke.

* CETP, or cholesterol ester transfer protein. This protein is involved in transforming cholesterol from the protective HDL form to the damaging LDL form. Research has shown that certain variations in the genes that code for CETP may result in higher HDL levels. Additionally, CETP is the target of newer drugs, which have not yet been approved, that seek to inhibit transformation of HDL into LDL cholesterol.

* LDL Receptor (LDLR). LDL receptors are present mostly in the liver cells, where they are responsible for recognizing LDL in the bloodstream and removing it. About one in every 500 people, however, has a mutation in the gene that controls the LDL receptors and inhibits their function, allowing LDL to build up in the blood. This condition is known as familiar hypercholesterolemia (FH). FH is the most widespread inherited cholesterol disorder, with affected individuals having cholesterol levels as high as 550 milligrams per deciliter. This is almost four times the desired level, thereby significantly increasing the risk for early heart attack, regardless of the presence of other risk factors. Researchers have also discovered that high-fat diets can also create subtle alterations in the LDLR gene even among people with normal LDLR genes. If too much dietary fat is present, too much LDL cholesterol is absorbed into the liver. In response, the liver cells repress the LDLR gene, which results in fewer LDL receptors and less LDL removed from the bloodstream. As a result, LDL levels rise in the bloodstream and can contribute to heart disease.

* Apolipoprotein E (APOE). Apolipoprotein E is a major component of VLDL. Variations in the gene that controls APOE can cause high levels of LDL to occur, especially in people who eat a high-fat, high-cholesterol diet.

* Apo(a). A gene that creates the Apo(a) protein, which combines with LDL cholesterol to form Lp(a), a new protein that affects the ability of the blood to clot (coagulation). High Lp(a) levels in the blood have been linked to the development of CAD and to increased heart attack risk.

* Apo(b). This gene controls the production of apo(b), another component of apolipoproteins and chylomicrons. Blood test that measure apo(b), or one of its products, apoB100, are considered a very accurate risk assessment for heart attack risk.

Other genes that are being investigated as to their impact on CAD include:

* Integrin (ITGB3). Another gene that affects coagulation, variations of ITGB3 have been found in a significant number of CAD patients.

* Elastin (ELN). The blueprint for a protein component of the elastic fibers found throughout the body. These fibers affect the elasticity of body tissue such as blood vessels. For instance, arteries deficient in elastin will often take a shape that inhibits the flow of blood and contributes to CAD. Elastin is lost as a part of the aging process.

* PTGIS. The blueprint for a protein (prostacyclin) that coats the inner layers of blood vessels, keeping blood from sticking and forming clots.

* ACE. While this gene is one of the most studied in regard to CAD, very little is known about its effect on heart disease. ACE is the blueprint for a protein that affects the heart, kidneys and arterial walls.

Prevention methods for CAD

Because coronary artery disease tends to develop gradually, effective strategies exist to help prevent or control it. Individuals should become well informed about how changes in lifestyle and behaviors can reduce the speed at which atherosclerosis or other heart-related problems develop. Some of the most common strategies for preventing CAD, or slowing its progression, include:

* Learning your family medical history. A patient’s family medical history can greatly increase (or decrease) the risk of the patient developing certain medical conditions, including coronary artery disease. Some patients prefer to develop their own medical family tree and bring it with them to their doctor appointment. A complete family tree traces the medical history of an individual (and his or her spouse, if applicable), through at least several generations.

* Eating a heart-healthy diet. Research has consistently supported the idea that the health of people’s bodies is largely determined by what they choose to eat. Certain vitamins and minerals have been shown to be helpful to heart health, in addition to whole grains, fruits and vegetables, and soluble fiber (the American Heart Association recently recommended that dietary fiber intake should be between 25 and 30 grams daily). In contrast, certain fats and oils such as saturated fat, trans fat and hydrogenated oils are particularly harmful because they can accelerate coronary artery disease, atherosclerosis and contribute to obesity. As of Jan. 1, 2006, the U.S. Food and Drug Administration (FDA) has mandated that all food companies publish the amount of trans fat in their nutritional information, in addition to the levels of saturated fat and overall fat. This will hopefully help consumers make more informed dietary choices. Conversely, monounsaturated fats, such as olive oil and the oils found in cold-water fish such as salmon, are good for the heart when eaten in moderation.

* Improving your cholesterol ratio. A person’s total cholesterol level (which includes LDL cholesterol, HDL cholesterol and triglycerides) should be no more than 200 milligrams per deciliter and no more than five times the HDL level. Key strategies for reducing levels of total cholesterol, LDL cholesterol and triglycerides are to eat a heart-healthy diet and exercise regularly. If these strategies do not reduce total cholesterol levels, a physician may prescribe cholesterol-reducing drugs. Strategies for increasing levels of HDL cholesterol include eating monounsaturated fats in moderation, decreasing the amount of saturated fat, limiting alcohol use and starting an exercise program.

* Controlling homocysteine levels. There is considerable debate over the role of homocysteine in heart disease. Homocysteine is an amino acid that is produced as a byproduct of other chemical reactions in the body. Numerous studies have shown that people with elevated homocysteine are at greater risk for heart attack, stroke and other cardiovascular problems. However, researchers have been unable to determine if elevated homocysteine levels are caused by heart disease, or if they cause heart disease. Also, two large, well-designed studies have recently shown that moderately lowering homocysteine among people with diabetes and existing heart disease had no effect on lowering risk for cardiovascular events. At this point, the American Heart Association has not identified elevated homocysteine as a major risk factor for heart disease and does not recommend widespread use of folic acid and vitamin B supplements to lower homocysteine. However, because of the association between homocysteine and heart disease, people are advised to obtain these important nutrients through a healthy diet that includes fruits, vegetables, whole grain and fortified grain products. Additionally, people who have a family history or personal history of heart disease but lack other well-defined risk factors, such as smoking or obesity, should consider monitoring their homocysteine levels. In the event of elevated homocysteine (above 15 mmol/L), supplementation to lower homocysteine should only be done under the supervision of a physician to ensure the patient's safety. Folate supplements that are used to lower homocysteine, for example, may mask a true vitamin B-12 deficiency. In addition, studies find that these supplements may increase the risk of artery re-narrowing (restenosis) following revascularization procedures such as balloon angioplasty and stenting.

* Exercising regularly. Exercise is an excellent tool for both preventing heart disease and improving quality of life for heart patients. Physically, it can slow or even reverse the process of atherosclerosis, as well as lower blood pressure, reduce cholesterol levels and help prevent obesity. Emotionally, it can reduce levels of stress and depression. Individuals should consult with their physician before starting any exercise program.

* Controlling diabetes. People with diabetes are more likely to develop heart-related diseases, and elevated blood glucose levels are known to accelerate the atherosclerotic process. It is essential that diabetics maintain strict glucose control, through diet, exercise and medications, in conjunction with careful blood glucose monitoring.

* Controlling high blood pressure (hypertension). Individuals with high blood Hypertension is the medical term for high blood pressure (the force of blood against artery walls).pressure are at greater risk of cardiovascular problems resulting from CAD, including heart attack. Hypertension can be controlled through taking medications, self-monitoring, eating a heart-healthy diet that is low in sodium, and engaging in regular exercise. People are also encouraged to have regular check-ups with their physician.

* Controlling weight. Obesity and being overweight are major risk factors for a host of serious health conditions, including coronary artery disease, high blood pressure, diabetes, heart attack and stroke. Some weight control methods include limiting fat in the diet, increasing activity levels, counseling, medication and surgical interventions.

* Managing stress. Some people react to stress in unhealthy ways, such as overeating and smoking. Chronic stress (and hostility) by itself may be a direct contributor to poor heart health because it produces increases in blood pressure that could become permanent, as well as other physiological changes that affect the health of arteries.

* Quitting smoking (or not starting to smoke). Tobacco smoking is a major cause of coronary artery disease and cardiac arrest. The latest statement by the U.S. Centers for Disease Control and Prevention (CDC) shows heart disease as the leading smoking-related cause of death in the United States among men and women, with tobacco use the leading preventable cause of death. The CDC also states that both middle-aged males and female smokers triple their risk of death to heart disease.

* Controlling chronic depression. Depression has been linked with a higher risk of developing high blood pressure, heart disease and having a heart attack.

These strategies may help to preserve health and prolong life, and are particularly important for those of advanced age and those with a family history of heart disease. Even someone who has suffered a cardiac event (e.g., heart attack) can reduce the risk of having another one by changing unhealthy behaviors and stopping all high-risk activities.

Treatment options for CAD

Treatments for CAD vary according to the severity of the disease, the location of any blockages in the blood vessels, the presence of any risk factors (e.g., abnormal cholesterol profile or high blood pressure) and the overall health of the patient. Options include lifestyle changes, medication, and interventional and surgical techniques.

Medications used to treat CAD fall into the following categories:

* Beta blockers. Medications that reduce the workload of the heart by blocking certain chemicals from binding to beta receptors in the heart.

* Nitrates. Medications that cause blood vessels to relax and dilate, allowing more oxygen-rich blood to reach the heart.

* Calcium channel blockers (calcium antagonists). Medications that increase blood flow through the heart and may reduce the workload of the heart by blocking calcium ions from signaling the blood vessels to constrict or tighten.

* Antiplatelets (e.g., aspirin, clopidogrel). Medications that inhibit the formation of blood clots by decreasing the ability of platelets (a clotting component of the blood) to bind together and form a blood clot.

* Statins. A type of cholesterol-reducing drug that lowers the levels of fats (lipids) in the blood, including cholesterol and triglycerides. Statins work by blocking the production of specific enzymes used by the body to make cholesterol. They are effective in lowering blood fat levels in patients with high cholesterol (hypercholesterolemia) and are therefore helpful in the prevention of coronary, cerebrovascular and peripheral vascular disease.

* Other drugs that interfere with the absorption of cholesterol from the intestinal tract (e.g., ezetimibe, fibrates, bile acid resins).

There are several main procedures used in the treatment of CAD:

* Balloon angioplasty. A procedure in which the physician guides a balloon-tipped catheter into the blocked coronary artery, then rapidly inflates the balloon. This crushes the plaque against the artery wall, thus allowing more blood to flow through the widened vessel. A major problem with this approach is the gradual reclosure of the vessel (restenosis). The recent introduction of stents has somewhat helped this problem. These tiny wire mesh tubes are implanted in the artery after angioplasty. They hold the plaque against the wall and help prevent the vessel from closing again. Newer stents, known as drug-eluting stents, are available. These drug-eluting stents have been coated with special drugs that further help reduce restenosis. Drug-eluting stents were initially rapidly accepted by physicians and used in the majority of situations. However, new research has revealed that drug-eluting stents may increase the risk of blood clots in certain situations and physicians are currently studying the best applications for both drug-eluting stents and the older bare-metal stents.

Balloon angioplasty and stenting are procedures to increase blood flow through a narrowed artery. Atherectomy involves using a bladed device to cut or grind away hardened plaque in arteries.

* Atherectomy. Another catheter-based procedure in which the physician guides a special catheter into the blocked coronary artery. This catheter is equipped with a blade that cuts away the soft plaque deposits, or a grinding burr that pulverizes harder, calcified plaque

* Coronary artery bypass graft (CABG). A surgery that increases blood flow to the heart by creating a detour and re-routing the blood flow around the blocked portion of the artery. A section of a blood vessel from another part of the body (e.g., the leg or chest) is relocated and grafted above and below the damaged portion of the coronary artery to form an open channel around the blockage. Traditionally, this surgery is performed with use of the heart-lung machine, which supports the patient’s circulation while the surgeon operates on the heart. Today, however, about 25 percent of CABG surgeries are performedBypass surgery creates a detour around a blocked artery using a blood vessel from another body area. as off-pump bypass procedures. In this case, portions of the beating heart are held still with special stabilizers while the surgeon performs the operation through a traditional incision. This reduces side effects associated with the use of the heart-lung machine.

* MIDCAB (minimally invasive bypass surgery). This is a less traumatic form of the traditional bypass graft surgery that relies on smaller incisions to gain access to the chest cavity. While MIDCAB is effective in some situations, such as patients who have limited disease in one or two main coronary arteries, the procedure is not commonly used. MIDCAB is sometimes used in conjunction with coronary angioplasty to treat multi-vessel disease.