Misleading claims and the proven facts on Cholesterols and Statins (from the ESC)

Some of the misleading claims, and the proven facts:

CLAIM: Cholesterol is not bad for us. It is a fundamental fat needed to make our cells. We can’t live without it.

FACT: Cholesterol per se is indeed essential for life. But LDL cholesterol in the blood produces fatty deposits called atherosclerotic plaques. These plaques restrict blood flow which can damage organs or lead to a heart attack or stroke. Nearly 3 million deaths worldwide are linked each year to high levels of LDL cholesterol.

CLAIM: Eating foods high in cholesterol (e.g. eggs or butter) does not kill you. Therefore, cholesterol is not a problem but a myth of the pharmaceutical industry designed to sell us drugs.
FACT: Eating eggs or butter in reasonable amounts does not increase cholesterol in the blood. An estimated 85 percent of cholesterol circulating in the body is produced by the liver, independent of what we eat, and that is where the focus should be. As for claims that the pharmaceutical industry is getting rich from selling statins, the vast majority of these drugs are no longer covered by patents. They are generics sold for cents.

CLAIM: There is no link between a population’s LDL-cholesterol levels and the frequency of heart attacks.

FACT: Globally, about 33% of coronary heart disease cases can be attributed to high cholesterol. More than half of Europeans (54%) have high LDL cholesterol. For adults between the ages of 35 and 55, even if they are otherwise healthy, every decade that they live with high cholesterol increases their chances of developing heart disease by 39%. Germany has one of the highest cholesterol levels in the world and is ranked second amongst high income countries in the rate of deaths caused by ischemic heart disease.

CLAIM: High LDL cholesterol is less dangerous than many other factors, including inactivity, smoking and obesity. Changing those things in our lives is where we need to act first. FACT: “All those factors are contributors to the risk of heart disease,” said Professor Stephan Gielen, past president of the European Association of Preventive Cardiology. “It is indeed critical to stop smoking, be physically active and watch one’s diet. But lifestyle changes typically reduce cholesterol levels by only 5 to 10 percent. For people with high levels of LDL cholesterol, more is needed,” he said. “Combining exercise and statin therapy substantially reduces the mortality risk and is potentially the ideal combination.”

CLAIM: The side effects of statins are not worth the risk.

FACT: The most common side effect reported by statin users is muscle aches (myalgia), which occurs in less than 1 percent of patients and are often alleviated by switching to another brand of statin. Claims of more severe side effects, including Type 2 diabetes, Alzheimer’s, and cancer have been occasionally reported, but the evidence is weak or misinterpreted. Statins can indeed raise blood sugars slightly. But one would have to have significant pre-diabetes to develop Type 2 diabetes because of a statin. This occurs in only about 1 percent of patients with pre-diabetes taking the medication.

On Alzheimer’s disease, a study recently published in the Journal of the American College of Cardiology found no association between statin use and a decline in memory or thinking ability. Indeed, patients who take statins for heart disease and have a genetic predisposition to Alzheimer’s disease actually scored better on some memory tests. The lead author of the study, Doctor Katherine Samaras, a professor of medicine at the University of New South Wales, Australia said, “If you are experiencing memory problems while taking statins, don’t stop. Talk to your doctor. You may have other factors for that memory loss.”

CLAIM: Those taking statins should simply stop taking them.

FACT: Published studies have shown that patients who are taking statins and at risk for cardiovascular disease, increase that risk if they stop taking the medicine. One alarming study of 28,000 patients found that 3 in 10 stopped taking their statins because they presumed the aches and pains they were experiencing were due to the drug. The result: 8.5% suffered a heart attack or stroke within just four years, compared to 7.6% who continued taking the drugs. And there is good evidence that the benefits of statin use continue well into old age.

CONCLUSION:

There is absolutely no question that the benefits of statins far outweigh any risk,”  “You owe it to yourself to see for yourself – to review the many published, peer-reviewed studies, from reputable institutions. The stakes are simply too high to do otherwise.”

 

https://www.escardio.org/Education/Practice-Tools/Talking-to-patients/arming-your-patients-with-the-facts-on-statins?twitter&fbclid=IwAR1CYhMPZKs2uGlf20N7MzycSZr88G_cUrQap4l8zh6STeaC1gEtsD3ln5U

 

 

2019 Guideline on Heart Disease Prevention!

https://www.cardiosmart.org/Heart-Conditions/Guidelines/Primary-Prevention-Heart-Disease

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PreventHeartDisease

 

 

Dietary Guidelines 2015-2020 summary

 

Guidelines (Abbreviated)

  • Follow a healthy eating pattern across the life span.
  • Focus on variety, nutrient density, and amount.
  • Limit calories from added sugars and saturated fats and reduce sodium intake.
  • Shift to healthier food and beverage choices.
  • Support healthy eating patterns for all.

 

Key Recommendations
Follow a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level.       A healthy eating pattern includes

A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other

Fruits, especially whole fruits

Grains, at least half of which are whole grains

Fat-free or low-fat dairy, including milk, yogurt, cheese, and fortified soy beverages

A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products

Oils

A healthy eating pattern limits saturated fats and trans fats, added sugars, and sodium.

 

Key recommendations that are quantitative are provided for several components of the diet of particular public health concern that should be limited.

Consume less than 10% of calories per day from added sugars.

Consume less than 10% of calories per day from saturated fats.

Consume less than 2300 mg/d of sodium.

If alcohol is consumed, it should be consumed in moderation—up to 1 drink per day for women and up to 2 drinks per day for men—and only by adults of legal drinking age.

 

The Dietary Guidelines also include a key recommendation to meet the Physical Activity Guidelines for Americans.

 

 

 

 

This Viewpoint summarizes the updated recommendations of the US Department of Health and Human Services’ recently released 2015-2020 Dietary Guidelines for Americans.

Source: JAMA Network | JAMA | Dietary Guidelines for Americans

Cooking oils? Which ones are good for heart?

Cooking oil is plant, animal, or synthetic fat used in frying, baking, and other types of cooking. It is also used in food preparation and flavouring that doesn’t involve heat, such as salad dressings and bread dips, and in this sense might be more accurately termed edible oil.

Cooking oil is typically a liquid at room temperature, although some oils that contain saturated fat, such as coconut oil, palm oil and palm kernel oil are solid.

The FDA recommends that 30% or fewer of calories consumed daily should be from fat.

Oils containing higher percentage of saturated fats are associated with higher cholesterol and triglyceride levels. This can be bad for the heart.

Oils containing higher percentage of Unsaturated fats (monounsaturated or polyunsaturated fats) are generally healthier.

Mayo Clinic has highlighted oils that are high in saturated fats, including coconut, palm oil and palm kernel oil. Those of lower amounts of saturated fats, and higher levels of unsaturated (preferably monounsaturated) fats like olive oil, peanut oil, canola oil, avocado, safflower, corn, sunflower, soy, mustard and cottonseed oils are generally healthier.

The National Heart, Lung and Blood Institute and World Heart Federation have urged saturated fats be replaced with polyunsaturated and monounsaturated fats. The health body lists olive and canola oils as sources of monounsaturated oils while soybean and sunflower oils are rich with polyunsaturated fat.

Here is the List of Cooking oils arranged in increasing amount of saturated fats!

Type of oil or fat Saturated (%) Monounsaturated (%) Polyunsaturated (%)
Canola oil 6 62 32
Almond oil 8 66 26
Pumpkin seed oil 8 36 57
Sunflower oil (high oleic) 9 82 9
Walnut oil 9 23 63
Hemp oil 9 12 79
Safflower oil 10 13 77
Flaxseed oil 11 21 68
Sunflower oil (linoleic) 11 20 69
Avocado oil 12 74 14
Grapeseed oil 12 17 71
Macadamia oil 12.5 84 3.5
Mustard oil 13 60 21
Corn oil 13 25 62
Olive oil 14 73 11
Seame oil 14 43 43
Soybean oil 15 24 61
Groundnut/peanut oil 18 49 33
Rice bran oil 20 47 33
Margarine (soft) 20 47 33
Tea seed oil 22 60 18
Cottonseed oil 24 26 50
Lard 41 47 2
Palm oil 52 38 10
Ghee 65 32 3
Butter 66 30 4
Margarine (hard) 80 14 6
Coconut oil 92 6 2

oils

Its better to choose oil which are low in Saturated fats and high in monounsaturated fats as they are found to be healthier. However, the total amount of oil consumed still needs to be less than 30% of your calorie intake!

We are much more than our cholesterol level.

 

The new guidelines on cholesterol treatment advocate aggressive control of Cholesterol levels by drugs called statins for primary prevention of heart disease. They advocate high-intensity and moderate intensity statins in patients with intermediate risks of developing heart disease.

Majority of the Physicians would be following these recommendations. But, there is a great need to discuss the risks and benefits of statin therapy with individual patients.

These become more relevant when we know that statins do increase marginally the incidence of developing diabetes.

Two recent studies also throw up interesting findings:

Study 1. A study presented in April 2014 at the Society of General Internal Medicine meeting in San Diego showed that individuals prescribed statin therapy for high cholesterol consumed more calories and more fat than nonstatin users. And, not surprisingly, this increase in calories paralleled an increase in BMI in statin users.

Study 2. An analysis of a prospective cohort study of men (published in JAMA Internal Medicine) revealed that physical-activity levels were “modestly” lower among statin users compared with nonusers independent of other cardiac medications and of medical history.

Though there may be a biologic or chemical explanation for the above findings, the above studies point to Lifestyle-Statin interaction whereby there seems to be a sense of protection felt by the patients on statins. Individuals on statins (due to a sense of security due to their drug compliance) may be abandoning on Diet moderation and Physical activity. This abandoning of important lifestyle measures would reduce gains of statin therapy.

The above findings suggest that Physicians need to continuously emphasise the importance of Lifestyle measures to individual patients irrespective of their cholesterol levels or statin therapy!

 

http://www.medscape.com/viewarticle/827675?nlid=60603_1985&src=wnl_edit_medn_card&spon=2#1

 

NYC’s Public-Health Policies Linked to Lower Cardiovascular Disease!

A decade of health policies and health-promotion messages in New York City aimed at preventing cardiovascular disease have pushed heart-disease rates downward faster than they have elsewhere in the US, according to the city’s health commissioner. “Making healthy choices easy ought to be our goal at the population level,” Dr Thomas Farley said during the opening ceremonies of the Canadian Cardiovascular Congress 2013.

Since 2002, when Mayor Michael Bloomberg took office and began implementing policies to battle smoking and obesity, the life expectancy of New Yorkers has risen by 36 months vs an average increase of 21.6 months in the rest of the country, Farley noted. Half of this increase was from decreased heart disease—probably the result of the ban on smoking in public places.

 

Encouraging Smoking Cessation

The city used a multipronged strategy to get its citizens to stop smoking. In 2002, it banned smoking in public places. Currently, it has the highest taxes on cigarettes in the country. When focus groups revealed that smokers were afraid of suffering but not of dying, they implemented a hard-hitting ad campaign that shows a patient with lung cancer “suffering every minute.”

The prevalence of smoking dropped from 21% in 2002 to 15.5% in 2012, “which represents about 300 000 fewer smokers . . . and saves an estimated 1500 lives a year,” Farley said.

Focusing on Diet, Calories, and Physical Fitness

Close to 60% of adults in New York City are overweight or obese—”a problem of normal people in an abnormal environment,” according to Farley.

To turn this around, the public-health department focused on increasing consumption of fruits and vegetables and making people aware of calories, sugary drinks, trans fat, and sodium.

The city established standards for food and beverage vending machines that deliver millions of meals and snacks to New York City government employees. It is also working with retailers to increase the prominence of healthy foods and set up a system of street vendors who sell only fruits and vegetables, in targeted neighborhoods.

In 2006, the New York Board of Health voted to restrict artificial transfat in 24000 restaurants, one of the first major cities to take this step. That initiative appears to have paid off. Then, in 2008, the city implemented a policy requiring that fast-food restaurants post the calorie content of foods. This resulted in a small but meaningful effect: 15% of consumers read the calorie content, and these individuals then eat 100 fewer calories.

The city has also led a successful campaign to lower the sodium content in food. Last year, 21 companies met voluntary sodium-reduction targets for such products as Heinz ketchup (15% lower) and Kraft singles American cheese (18% lower).

Public Policies to Prevent CVD

Speaking with heartwire after Farley’s presentation, CCC scientific program committee chair Dr Andrew Krahn (University of British Columbia, Vancouver) noted that the public-policy approaches undertaken in New York will be key to combating CVD.

 

via http://www.medscape.com/viewarticle/812802

Mediterranean diet supplemented with mixed nuts, olive oil and 7 glasses of wine a week! prevents heart disease and stroke!

This is the largest randomized trial to date. The Mediterranean diet has been studied previously in randomized trials but not in a trial as large as this!

It is fascinating that this was a study of more than 7400 individuals who were randomly assigned to 3 different diets. Two were Mediterranean diets enriched with either extra-virgin olive oil or nuts and other Mediterranean foods, both including more than 7 glasses of wine per week. The control diet was a low-fat diet, which some people have argued is not an ideal control. There was very good compliance with the diets in this large number of people for many years. The primary endpoint was death, heart attack, or stroke. There was a very important significant reduction of this cluster endpoint in the Mediterranean diet groups. Particularly noteworthy, even by itself, was the reduction in stroke.

So what does the Mediterranean diet consists of?

The Mediterranean diet is a modern nutritional recommendation inspired by the traditional dietary patterns of southern Italy, Greece and Spain. The principal aspects of this diet include proportionally high consumption of olive oil, legumes, unrefined cereals, fruits and vegetables, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheese and yogurt), moderate wine consumption, and low consumption of meat and meat products. (Source: from Wikipedia).

So go on!

Fruits, veggies, legumes,

7 glasses of wine a week,

nuts,

salads with olive oil dressing

should do the trick!

via Topol: ‘Evidence Is Compelling’ on Mediterranean Diet.