Posts tagged with "LDL cholesterol"

Study debunks ‘standard operating procedures’ for blocked arteries

November 19, 2019

The findings of a large federal study on the efficacy of cardiac bypass surgeries and stents—led by NYU Langone Health with collaboration from 15 other leading U.S. and Canadian hospitals—call into question the medical care provided to tens of thousands of heart disease patients with blocked coronary arteries, scientists reported at a meeting of the American Heart Association on November 16.

The purpose of the ISCHEMIA trial was to determine the best management strategy for higher-risk patients with stable ischemic heart disease (also known as hardening of the arteries). The study involved over 5,000 participants.

Among the researchers’ key findings: Drug therapy, alone, may save lives just as effectively as bypass or stenting procedures. Stenting and bypass procedures, however, did help some patients with intractable chest pain, called angina.

“You would think that if you fix the blockage the patient will feel better or do better,” Dr. Alice Jacobs, director of Cath Lab and Interventional Cardiology at Boston University, told The New York Times after the results were released.. The study, she added, “certainly will challenge our clinical thinking.”

This is far from the first study to suggest that stents and bypass are overused. But, the Times reports, previous results have not deterred doctors, who have called earlier research on the subject inconclusive and the design of the trials flawed.

Previous studies did not adequately control for risk factors, like LDL cholesterol, that might have affected outcomes, Dr. Elliott Antman, a senior physician at Brigham and Women’s Hospital in Boston told the news outlet in an interview. Nor did those trials include today’s improved stents, which secrete drugs intended to prevent opened arteries from closing again.

With its size and rigorous design, the new study, called Ischemia, was intended to settle questions about the benefits of stents and bypass.

“This is an extraordinarily important trial,” Dr. Glenn Levine, director of Cardiac Care at Baylor College of Medicine in Houston, told The New York Times.

The results will be incorporated into treatment guidelines, added Dr. Levine, who sits on the guidelines committee of the American Heart Association.\

However, there may be a catch: The conventional wisdom among cardiologists is that the sort of medical therapy that patients got in Ischemia is just not feasible in the real world, said Dr. William E. Boden, scientific director of the Clinical Trials Network at VA Boston Healthcare System, who was a member of the study’s leadership committee.

Doctors often say that making sure patients adhere to the therapy is “too demanding, and we don’t have time for it,” he said.

But getting a stent does not obviate the need for medical therapy, Dr. Boden told the Times. Since patients with stents need an additional anti-clotting drug, they actually wind up taking more medication than patients who are treated with drugs alone.

About one-third of stent patients develop chest pain again within 30 days to six months and end up with receiving another stent, Dr. Boden added.

“We have to finally get past the whining about how hard optimal medical therapy is and begin in earnest to educate our patients as to what works and is effective and what isn’t,” Dr. Boden said.

Research source: @nytimes

Who knew? Steak and chicken affect blood cholesterol equally

June 6, 2019

Many people who are health-conscious limit the amount of red meat they consume, preferring to have white meat, because they believe it is lower in cholesterol.

Wrong. Contrary to popular belief, beef and turkey have the same effect on cholesterol levels, when saturated fat levels are equivalent, base on findings of a study published on June 4 in the American Journal of Clinical Nutrition, News-Medical.net reports.

The study, led by scientists at Children’s Hospital Oakland Research Institute (CHORI)– the research arm of UCSF Benioff Children’s Hospital Oakland—surprised the researchers with the discovery that consuming high levels of red meat or white poultry resulted in higher blood cholesterol levels than consuming a comparable amount of plant proteins. Moreover, this effect was observed whether or not the diet contained high levels of saturated fat, which increased blood cholesterol to the same extent with all three protein sources.

Indeed, the lead author of the study, Ronald Krauss, M.D., senior scientist and director of Atherosclerosis Research at CHORI, commented, “When we planned this study, we expected red meat to have a more adverse effect on blood cholesterol levels than white meat, but we were surprised that this was not the case: Their effects on cholesterol are identical when saturated fat levels are equivalent.”

Krauss, who also is a UCSF professor of Medicine, noted that the meats studied did not include grass-fed beef or processed products such as bacon or sausage; nor did it include fish.

But the results were notable, as they indicated that restricting meat altogether, whether red or white, is more advisable for lowering blood cholesterol levels than previously thought.

No surprise: The study found that plant proteins, such as beans, are the healthiest for blood cholesterol.

This study, dubbed the APPROACH (Animal and Plant Protein and Cardiovascular Health) trial, also found that consuming high amounts of saturated fat increased concentrations of large cholesterol-enriched LDL particles, which have a weaker connection to cardiovascular disease than smaller LDL particles.

Similarly, red and white meat increased amounts of large LDL in comparison to nonmeat diets. Therefore, using standard LDL cholesterol levels as the measure of cardiovascular risk may lead to overestimating that risk for both higher meat and saturated fat intakes, as standard LDL cholesterol tests may primarily reflect levels of larger LDL particles.

“Our results indicate that current advice to restrict red meat and not white meat should not be based only on their effects on blood cholesterol,” Krauss said. “Indeed, other effects of red meat consumption could contribute to heart disease, and these effects should be explored in more detail in an effort to improve health.”

Research contact: rkrauss@chori.org