<![CDATA[Cholesterol - Health.com]]>

<![CDATA[Cholesterol - Health.com]]> en daily 1 Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationYour body needs some cholesterol. But if you have too much—of the wrong kind—it starts to build up in your arteries. Cholesterol is produced naturally by the liver, and also comes from eating certain foods, such as eggs and red meat. Too much of the bad kind, LDL cholesterol, raises your risk of heart disease, stroke, and other conditions. Low levels of the good kind, HDL cholesterol, can have the same effect.Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationYour body needs some cholesterol. But if you have too much—of the wrong kind—it starts to build up in your arteries. Cholesterol is produced naturally by the liver, and also comes from eating certain foods, such as eggs and red meat. Too much of the bad kind, LDL cholesterol, raises your risk of heart disease, stroke, and other conditions. Low levels of the good kind, HDL cholesterol, can have the same effect. <![CDATA[Why the Day After Christmas Is Hazardous to Your Heart]]> http://feeds.health.com/~r/health/cholesterol/~3/rZfkNsvE4UE/0,,20246920,00.html

heart attacks, arrhythmias, and heart failure. And many of these so-called Merry Christmas coronaries will hit people who didn't even realize they were at risk when they unwrapped their gifts the day before.

But the holiday season isn't good for heart health to begin with. A 2004 study by researchers at the University of California, San Diego and Tufts University found that heart-related deaths increase by nearly 5% during the holidays, perhaps because patients delay seeking treatment for heart problems or because hospital staffing patterns change. But anecdotally, doctors say that their ERs stay quiet on Christmas Day itself. Then, come December 26, they see a surge of cardiac traffic. A 2008 study found that daily visits to hospitals for heart failure increased by 33% during the four days after Christmas.

"This time of year is notorious for heart attacks, heart failures, and arrhythmias," says Samin Sharma, MD, director of interventional cardiology at Mount Sinai Medical Center in New York.

In fact, 2009 may pose an even greater risk than years past. Added stress over the recession means you're already putting a lot of pressure on your heart, and that's before the holiday eating and drinking even begin. Here's how to steer clear of the hospital.

Keep your ticker ticking
It's easy to knock back several glasses of wine when you're sitting around the holiday table for long stretches of time, especially if you tell yourself that wine is good for your heart. But more than one alcoholic drink can have consequences: Excessive drinking can trigger atrial fibrillation, a form of irregular heartbeat. If it persists, atrial fibrillation ups your odds of suffering a stroke. "There are huge campaigns not to drink and drive during the holidays, but no one talks about the heart dangers," says Dr. Sharma.

Extra money woes coupled with an already stressful holiday season are like a setup for overindulgence. "It's probably more dangerous than ever this year," says Gerald Fletcher, MD, a cardiologist at the Mayo Clinic in Rochester, Minn. "People don't have as much money, but they still need to spend. They're cutting back, but they're worried about the credit card bill on the way. With all this in mind, people might be drinking more than ever."

Normally, a holiday heart arrhythmia isn't fatal, and in fact it usually fades on its own. Some of the symptoms are the same as a hangover—nausea, weakness, and a pale face—and your heart should be back to normal in 24 hours. But if it isn't, you may need to see a doctor for medication or electrical cardioversion, which will stabilize your heart beat.

Next Page: How to avoid a holiday heart attack

How to avoid a holiday heart attack
Every year, cardiologists see a spike in heart attacks once the weather starts to turn. When temperatures drop, blood vessels start to constrict, raising blood pressure. You may want to think twice before you decide to shovel your stoop or take a postprandial hike in bitter weather, as strenuous physical activity can leave you clutching your chest.

But cold weather isn't the only culprit. Come Christmas Day, many people confuse the signs of a heart attack—like shortness of breath or chest pains—with indigestion from a big dinner. And while you may be apt to play it safe on any other day, hauling yourself down to the hospital may seem like too much of a hassle on a big holiday.

Instead, many people ignore the telltale signs of a heart attack until they wake up on the 26th, still feeling that discomfort. But by then it may be too late. "If you're having a heart attack, studies show that you can't wait longer than 12 hours to be treated," says Dr. Sharma. So if you wait until December 26, you may be playing with your fate.

Listen to your body over the long holiday haul and don't dismiss any discomfort as a by-product of overindulgence. Keep an eye on any friends or family members who have had a heart attack in the past.

Breaking diet rules and heart failure
Patients with heart failure who are following a low-sodium diet need to exercise extra caution this Christmas. Experts say that these people may choose not to live within their everyday rules, opting to partake in holiday overindulgences instead. Heavy meals, too much salt, and excess alcohol can all trigger heart failure.

"Doctors need to make a point of telling their patients not to overindulge," says Dr. Sharma. "Ultimately, though, it's the patients who are going to decide what to do."

But everyone, not just heart patients, can benefit from watching what they eat. "We need to try to stay healthy through the holidays, not wait until January 1," says Dr. Fletcher. "You can't keep your resolution if you don't live through the holidays."

]]> If you aren't careful, your holiday fun could quickly turn fatal. (ISTOCKPHOTO) http://www.health.com/health/condition-article/0,,20246920,00.htmlhttp://feeds.health.com/~r/health/cholesterol/~3/2WdPk1dzKdQ/0,,20246920,00.html <![CDATA[Menopause Causes Cholesterol Jump, Study Shows]]> http://feeds.health.com/~r/health/cholesterol/~3/8zqXiyROYss/0,,20326394,00.html

heart disease rises after menopause, but they weren't exactly sure why. It wasn't clear whether the increased risk is due to the hormonal changes associated with menopause, to aging itself, or to some combination of the two.

Now, we have at least part of the answer: A new study shows beyond a doubt that menopause, not the natural aging process, is responsible for a sharp increase in cholesterol levels.

This seems to be true of all women, regardless of ethnicity, according to the study, which will be published next week in the Journal of the American College of Cardiology.

“As they approach menopause, many, many women show a very striking increase in cholesterol levels, which in turn increases risk for later heart disease,” says the lead author of the study, Karen A. Matthews, PhD, a professor of psychiatry and epidemiology at the University of Pittsburgh.

Over a 10-year period, Matthews and her colleagues followed 1,054 U.S. women as they went through menopause. Each year the researchers tested study participants for cholesterol, blood pressure, and other heart disease risk factors such as blood glucose and insulin.

In nearly every woman, the study found, cholesterol levels jumped around the time of menopause. (Menopause usually occurs around age 50 but can happen naturally as early as 40 and as late as 60.)

In the two-year window surrounding their final menstrual period, the women's average LDL, or bad cholesterol, rose by about 10.5 points, or about 9%. The average total cholesterol level also increased substantially, by about 6.5%.

Other risk factors, such as insulin and systolic blood pressure (the top number in a blood pressure reading), also rose during the study, but they did so at a steady rate, suggesting that the increases—unlike those for cholesterol—were related to aging, not menopause. Of all the risk factors measured in the study, the changes in cholesterol were the most dramatic.

The jumps in cholesterol reported in the study could definitely have an impact on a woman’s health, says Vera Bittner, MD, a professor of medicine at the University of Alabama at Birmingham, who wrote an editorial accompanying Matthews’s study.

“The changes don't look large, but given that the typical woman lives several decades after menopause, any adverse change becomes cumulative over time,” says Dr. Bittner. “If somebody had cholesterol levels at the lower ranges of normal, the small change may not make a difference. But if somebody's risk factors were already borderline in several categories, this increase may tip them over the edge and put them in a risk category where treatment may be beneficial.”

In a first, the study did not find any measurable differences in the impact of menopause on cholesterol across ethnic groups.

Experts have been unsure how ethnicity may affect the link between menopause and cardiovascular risk, because most research to date has been conducted in Caucasian women. Matthews and her colleagues were able to explore the role of ethnicity because their research is part of the larger Study of Women’s Health Across the Nation (SWAN), which includes substantial numbers of African-American, Hispanic, and Asian-American women.

Next Page: More research needed

More research on the connection between menopause and heart disease risk is needed, according to Mathews. The current study doesn't explain how the increases in cholesterol will affect the rate of heart attacks and mortality down the road, for instance.

As the SWAN study continues, Matthews says, she and her colleagues hope to identify warning signs that will show which women are most at risk for heart disease. “The important thing is, ultimately, when we can figure out the characteristics of women who have early signs of cardiovascular risk that, if we don’t do anything about them, could later result in a heart attack.”

Women should be aware of the changes in risk factors that occur around menopause, says Dr. Bittner, and they should talk to their doctors about whether they need to have their cholesterol checked more often or whether they should begin a cholesterol-lowering treatment, such as a statin.

Maintaining a healthy weight, not smoking, and getting plenty of exercise are essential to help keep cholesterol levels in check, Dr. Bittner adds, and she points out that menopause can be an especially difficult time for women to get enough physical activity. “It often falls by the wayside because women in this age range take care of kids, spouse, aging parents, and often work in addition,” she says.

“Midlife is a great time to make these changes,” Matthews says. “If we can essentially reset the course to a more health-promoting direction in midlife, then that will have benefits for many years to come.”

Wolf Ulian, PhD, the founder and executive director of the North American Menopause Society, a nonprofit organization that provides information on menopause to consumers and health-care professionals, says the findings underscore that menopause is a good time for women to adopt healthier lifestyles.

“Menopause is a milestone," he says. "It’s a time to take stock and take control and try to enhance the quality of your second half of life."

]]> Getty Images http://www.health.com/health/condition-article/0,,20326394,00.htmlhttp://feeds.health.com/~r/health/cholesterol/~3/ksyESstdeu4/0,,20326394,00.html <![CDATA[Lower Cholesterol May Lessen Risk of Some Cancers]]> http://feeds.health.com/~r/health/cholesterol/~3/SqAzkngSvLQ/0,,20317842,00.html

In fact, low total cholesterol is associated with about 60% less risk of the most aggressive form of prostate cancer, and higher levels of good cholesterol (HDL) may protect against lung, liver, and other cancers, according to two studies published this week in the journal Cancer Epidemiology, Biomarkers & Prevention.

That’s quite a reversal of fortune for low cholesterol, which has, in the past, been associated with a higher cancer risk. The new studies suggest that low cholesterol may not deserve its bad reputation, earned from a series of studies in the 1980s that said people with low cholesterol might be at risk of cancer.

In fact, cholesterol may drop in people with undiagnosed cancer, meaning that low cholesterol may be a result—not a cause—of cancer.

In the first study, men with HDL cholesterol above roughly 55 mg/dL had an 11% decrease in overall cancer risk, including lung and liver cancer. (HDL levels between 40 and 50 are average for men.) The study, conducted by National Cancer Institute (NCI) researchers who looked at about 29,000 male smokers in Finland over an 18-year period, is the largest to show a relationship between HDL and cancer.

"Very few studies measured [HDL], and any relationship between HDL and overall cancer risk had therefore not been adequately evaluated," the NCI's Demetrius Albanes, MD, the lead author of the study, said at a press briefing.

While the findings are new and intriguing, more research needs to be conducted to confirm a link between HDL and cancer risk reduction.

“[It’s] a very new, exciting question, but we need to do a great deal more research before we have any clear answers," says Eric Jacobs, PhD, an epidemiologist with the American Cancer Society, who co-wrote an editorial accompanying the studies. For his part, Dr. Albanes stressed that the results need to be confirmed, especially in women and nonsmokers.

Next Page: Can cholesterol-lowering drugs help?

At first, Dr. Albanes and his colleagues found their results seemed to back up the studies from the 1980s; they discovered that men with low total cholesterol had a higher cancer risk. The trend all but disappeared when they excluded cases of cancer that were diagnosed during the first nine years of the study. (Such men may have already had cancer, but it hadn’t been diagnosed yet.)

In the second study, researchers looked at about 5,500 men ages 55 and older. Men with total cholesterol under 200 mg/dL—the range the National Heart, Lung and Blood Institute deems "desirable"—had roughly a 60% lower risk of high-grade prostate cancer, an aggressive type.

"It was a notable reduction, which is not that often seen in prostate cancer research," the lead researcher, Elizabeth Platz, ScD, a cancer epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told reporters.

The decrease in risk was found only in high-grade tumors and not in less serious cases of prostate cancer—a pattern that Platz and her colleagues reported in a previous, similar study. According to Jacobs, this pattern is not uncommon in prostate-cancer studies. Obesity, for example, is associated with a higher risk of more dangerous tumors but not with prostate cancer overall, he said.

This study was inspired in part by a growing body of evidence that suggests that statins, which are cholesterol-lowering drugs such as Lipitor, may protect against high-grade prostate cancer. In the current study, however, Platz and her colleagues did not measure statin use and therefore were not able to determine whether the lower risk of high-grade prostate cancer was influenced by statins or other cholesterol-lowering methods, rather than naturally low cholesterol.

"Our next step…is to look not just at total cholesterol, but to also evaluate the relationship for high HDL cholesterol and low LDL cholesterol, and also to evaluate whether cholesterol-lowering—rather than low cholesterol as the usual state for these men—would also explain this relationship," Platz said.

More studies, including randomized controlled trials, are necessary to explain the link between cholesterol and prostate cancer, according to Platz.

Jacobs agreed, noting that the findings of the two studies raise important questions. The effect that HDL cholesterol and total cholesterol have on cancer risk are "likely to be very interesting areas for future research," he said.

]]> Getty Images http://www.health.com/health/condition-article/0,,20317842,00.htmlhttp://feeds.health.com/~r/health/cholesterol/~3/bd8lHvwXhW8/0,,20317842,00.html <![CDATA[Statins May Worsen Heart Failure for Some]]> http://feeds.health.com/~r/health/cholesterol/~3/GKuGKI7uSI4/0,,20317642,00.html

Heart disease can occur when arteries become clogged, but in heart failure, the heart gets progressively weaker and larger.

Still, since the study included a small number of patients and looked at only one point in time, it’s too early to say if the findings have implications for heart failure patients taking statins, according to lead author Lawrence P. Cahalin, PhD, of Northeastern University, in Boston. Cahalin presented his findings on Tuesday at the American College of Chest Physicians annual meeting in San Diego.

Tamara Horwich, MD, an assistant professor of medicine at the University of California, Los Angeles, agrees that the results need to be interpreted with caution. “I just don’t think we can draw any conclusions about statins having benefits versus ill effects in some patients,” says Dr. Horwich, who wasn’t involved with Cahalin’s study.

In heart failure, the enlarged heart struggles to pump a sufficient amount of blood, which can cause fluid to collect in the limbs and lungs, resulting in shortness of breath and fatigue. However, one type of heart failure, systolic, occurs when the lower chambers of the heart can’t contract with enough force to drive blood throughout the body.

In the other type, diastolic heart failure, the heart muscle is so stiff that it can no longer relax enough to fill with blood between beats. About half of people with heart failure have systolic; the other half have diastolic, which becomes more common with age and is more likely to strike women.

About 5 million Americans have heart failure.

Currently, there are no guidelines on whether patients with heart failure should take statins. Some studies have shown that they can be helpful, while others have found no benefit. The decision of whether to prescribe these drugs is typically based on a patient’s cholesterol levels, his age, and whether he also has coronary artery disease, according to Dr. Horwich.

“There’s not a consensus,” she says. “It’s up to the individual physician to make a decision.”

Next Page: Statins can damage muscle

Since statins can cause muscle damage, they could theoretically also harm the heart—which is, essentially, a big muscle—although there is no evidence that this is the case. To investigate whether the drugs might affect the heart and other muscles in heart failure patients, Cahalin and his colleagues analyzed data on lung function and exercise tolerance in 136 patients, 61 of whom were taking statins.

Overall, the patients taking statins had worse lung function and exercise tolerance than those who weren’t taking the drugs. But when Cahalin and his team analyzed patients with the two different types of heart failure—systolic and diastolic—separately, they found the drugs seemed to help those with the systolic version, and hurt those with diastolic heart failure.

Cahalin says he and his colleagues are planning to follow patients with both types of heart failure over time to see how taking statins affects their symptoms. He speculated that the anti-inflammatory effect of the statins could be helping systolic heart failure patients, while their muscle-weakening effects might impair breathing in those with diastolic heart failure.

A major problem with the study, notes Dr. Horwich, is that there were a number of factors that could have contributed to the findings; for example, it’s not clear from the study why doctors chose to put some patients, but not others, on statins. Systolic heart failure patients may have seen more benefits because they were more likely to have coronary artery disease, she adds.

“I think it’s definitely possible that statins may not be helpful in diastolic heart failure,” Dr. Horwich says. She notes that the importance of diastolic heart failure has only become clear relatively recently. Although doctors have a good handle on how to help patients with systolic heart failure, she explains, there really aren’t any treatments that are known to help patients with diastolic heart failure.

According to Cahalin, it could make sense to do a simple lung function test on heart failure patients before prescribing statins. That way, he says, it would be easy to tell if their lung function got worse while they were on the drugs.

And if someone with diastolic heart failure is prescribed the drug and his or her heart failure symptoms—such as weakness, fatigue, and shortness of breath—get worse, he adds, “that should be investigated.”

]]> Istockphoto http://www.health.com/health/condition-article/0,,20317642,00.htmlhttp://feeds.health.com/~r/health/cholesterol/~3/4C2NT9fw7CQ/0,,20317642,00.html <![CDATA[Cholesterol-Lowering Supplements: What Works, What Doesn’t]]> http://feeds.health.com/~r/health/cholesterol/~3/NMmPuTk0xQc/0,,20295990,00.html

But just because your Uncle Jack says a supplement worked miracles on his cholesterol doesn’t mean it will work for you. In fact, his success may be due to a placebo effect or a diet overhaul he neglected to mention.

Though not always perfect, scientific studies are the best way to determine if nonprescription remedies really work. Below, we break down what the research does—and doesn’t—say about the benefits of the most popular alternative remedies for lowering cholesterol.

To see what these supplements look like, view this slideshow.

Artichoke leaf extract

• What it is: The dried extract of the artichoke leaf is also known as Cynara scolymus.

• The evidence: In 2000, German researchers performed a randomized, double-blind, placebo-controlled trial using nearly 150 adults with total cholesterol over 280—well into what the American Heart Association (AHA) considers “high risk” territory. The participants who took an artichoke supplement for six weeks saw their levels of low-density lipoprotein (LDL), or bad cholesterol, fall by 23%, on average, compared to just 6% in the placebo group.

These are promising numbers, but they haven’t been replicated. A more recent, three-month trial of similar design found that total cholesterol fell by an average of 4% among participants taking artichoke leaf extract, but the researchers found no measurable impact on either LDL or high-density lipoprotein (HDL), also known as good cholesterol. They suggested that differences in the health of the participants and the potency of the supplements—the patients in the second study received a dose about 30% smaller—could explain the discrepancy between the results of the two studies.

• The bottom line: There have been very few quality studies conducted on artichoke leaf extract, and the mixed results suggest that more evidence is needed to confirm its effect on cholesterol. Don’t expect your LDL to plummet if you take artichoke supplements.

Fenugreek

• What it is: Fenugreek is a seed (often ground into a powder) that has been used since the days of ancient Egypt and is available in capsule form.

• The evidence: Several studies from the 1990s have reported that, in high doses, various fenugreek seed preparations can lower total cholesterol and LDL, in some cases dramatically. (One study recorded an LDL drop of 38%.) Almost without exception, however, the studies have been small and of poor quality, which casts some doubt on the validity of the results.

Fenugreek contains a significant amount of dietary fiber (anywhere from 20% to 50%, analyses have shown), and some experts speculate that the purported cholesterol-lowering effect of fenugreek may in fact be attributed largely to its fiber content.

• The bottom line: Despite the studies frequently cited as proof of fenugreek’s ability to lower cholesterol, there is not enough evidence to support its use.

Fiber

• What it is: Soluble fiber is a type of dietary fiber found in oats, barley, bran, peas, and citrus fruits, as well as in dietary supplements. (Though it is good for the heart in other ways, insoluble fiber does not affect blood cholesterol.)

• The evidence: In 1999, a team of Harvard Medical School researchers conducted a meta-analysis of nearly 70 clinical trials that examined the effect of soluble fiber on cholesterol levels. High soluble fiber intake was associated with reductions in both LDL and total cholesterol in 60% to 70% of the studies they examined. For each gram of soluble fiber that the participants of the various studies added to their daily diet, their LDL levels fell by about 2 points. (The average time frame was seven weeks.)

The amount of fiber you’d need to eat to significantly lower your LDL is a bit unwieldy. Most people eat far less than the 25 grams of dietary fiber recommended as a minimum by most health organizations—and only about 20% of your total fiber intake is likely to be soluble. (Eating three bowls of oatmeal a day will only yield about 3 grams of soluble fiber, according to the Harvard researchers.) Taking daily fiber supplements can help, but they can cause some gastrointestinal side effects if taken regularly and can interfere with some prescription medications.

• The bottom line: A diet high in soluble fiber can lower your LDL. The effect is likely to be relatively modest, however, and loading up on soluble fiber may be impractical.

Next Page: Fish oil

Fish oil

• What it is: Fish is rich in two heart-healthy omega-3 fatty acids, EPA and DPA. In concentrated form, these fatty acids are the main ingredients in fish oil supplements, which are usually sold as gel capsules.

• The evidence: In clinical trials using relatively high doses (3 grams or more), fish oil has been shown to lower triglyceride levels—the third component of your total cholesterol number—by around 10% to 30%. (The higher your triglyceride levels, the more effective it is.) Fish oil doesn’t lower LDL, however. The supplements actually tend to cause a slight rise in LDL, although the form this additional LDL takes is thought to be less damaging to the arteries.

High triglyceride levels have been associated with an increased risk of coronary heart disease, but lowering them is not as important as lowering LDL. In fact, some experts believe that triglycerides are a sign, rather than a cause, of heart disease risk.

• The bottom line: Fish oil lowers triglycerides, especially in people with high triglycerides. The American Heart Association recommends that people who need to lower their triglycerides should, in consultation with their doctor, take 2 to 4 grams of fish oil a day; people with heart disease should consume about 1 gram a day of EPA and DPA (combined), preferably by eating fatty fish such as salmon.

Garlic

• What it is: Garlic is member of the onion family that is available as an oil, extract, or pill (in addition to its natural state).

• The evidence: In a 2000 report on garlic’s impact on cardiovascular risk factors, the federal Agency for Healthcare Research and Quality found that garlic caused a small but measurable drop in both LDL and total cholesterol, but only in the short term (three months).

Subsequent research hasn’t been encouraging, however. A high-quality 2007 study in the Archives of Internal Medicine compared raw garlic and commercial garlic supplements over a six-month period and found no measurable effects of the various garlic forms on total cholesterol, LDL, HDL, or triglyceride levels versus placebo. The following year, a meta-analysis that included only randomized, placebo-controlled trials also concluded that garlic has no effect on cholesterol.

• The bottom line: Though garlic may help lower LDL temporarily, its ability to meaningfully affect cholesterol levels is questionable at best.

Ginseng

• What it is: Ginseng is an herb native to Asia that has been used in traditional medicine for centuries and is now sold as capsules.

• The evidence: The research on ginseng and cholesterol is mixed but unconvincing. In a comprehensive 2005 review, a team of Harvard Medical School researchers noted that several studies had found a beneficial effect from ginseng on one or more cholesterol components. But most of the studies were small, only a few were randomized, and none were blinded or placebo-controlled. In one study, the researchers found a drop of 45% in LDL levels and a rise in HDL of 44%—but it wasn’t controlled, included only eight participants, and was funded by a Korean manufacturer of ginseng products.

• The bottom line: Though the results of the nonrandomized studies can’t be ignored, there isn’t enough to evidence to support the use of ginseng to lower cholesterol.

Guggul

• What it is: A tree-resin extract, long used in Ayurvedic medicine, guggul contains plant sterols (guggulsterones) and is available in capsule form.

• The evidence: As with ginseng, the research on guggul and cholesterol is sketchy. Early studies reported reductions in total cholesterol, LDL, and triglycerides of 10% or more, but most of the studies were small and flawed. Then, in 2003, researchers at the University of Pennsylvania published a randomized controlled trial of more than 100 people with high cholesterol—the first guggul study conducted in the U.S.—in the Journal of the American Medical Association. They found that guggul had no measurable effect on total cholesterol, HDL, or triglycerides—and that it caused an increase in LDL of about 5%. (LDL levels in the placebo group fell by roughly the same amount.)

• The bottom line: The 2003 JAMA study was a black eye for guggul. More research is needed, but for now there is not enough evidence to justify using guggul to lower cholesterol. Plus, some research has found that 20% of Ayurvedic medicines may be contaminated with lead or other toxins.

Next Page: Niacin

Niacin

• What it is: Niacin is a B vitamin (also known as nicotinic acid) that occurs naturally in meat, fish, and dairy. It’s also available as a capsule.

• The evidence: Experts have known for decades that niacin helps lower cholesterol. Large trials—most notably a six-year study of more than 1,100 people conducted in the 1970s—have found that niacin can cause significant decreases in total cholesterol, LDL, and triglycerides. But its most notable effect is on HDL: Research shows that niacin can raise HDL levels by up to 35%. (In part, for this reason, niacin is commonly used in addition to statins, which lower LDL.)

The catch is that it only has this effect at high doses of 2 grams to 3 grams a day, a dose that is typically taken as an extended-release prescription drug (such as Niaspan). Niacin is available as an over-the-counter supplement in extended-release doses of 500 milligrams or more, but consistently taking large amounts of niacin can result in side effects ranging from skin flushing to liver damage.

• The bottom line: Niacin boosts HDL, but you shouldn’t take it without consulting a doctor. The AHA warns that niacin supplements should not be taken in lieu of a prescription, due to the potentially serious side effects.

Red yeast rice

• What it is: Red yeast rice is a fungus that grows on rice and contains small amounts of a naturally occurring form of lovastatin, a type of statin that is also found in prescription medications.

• The evidence: Compared to that of most dietary supplements, the evidence of red yeast rice’s efficacy is quite strong—which isn’t entirely surprising, given that red yeast rice is, in effect, a low-dose statin. In studies over the years (including in several high-quality trials), various red yeast rice preparations have been shown to lower LDL by around 20% to 30%, comparable to a prescription statin.

More recent studies have backed up these results. In the most recent trial, a 2009 study of patients who had stopped taking statins due to muscle pain, red yeast rice capsules lowered total cholesterol and LDL by 15% and 21%, respectively (compared to 5% and 9% for placebo).

• The bottom line: Red yeast rice is a potentially effective way to lower cholesterol, but its potency makes some experts wary—and suspicious. The amount of lovastatin in red yeast rice pills varies widely across brands—so much so that some brands appear to be spiked with lovastatin, according to an analysis performed by a consumer watchdog group. Inadvertently ingesting too much of a statin can cause side effects (such as muscle pain), and due to the safety concerns, experts discourage using off-the-shelf red yeast rice.

Soy protein

• What it is: Soy protein is found in soy foods such as tofu, edamame, and soy milk. It is also sold as a powder in nutrition stores.

• The evidence: Ten years ago, the U.S. Food and Drug Administration began to allow labels on certain foods that contained soy; the labels said soy protein was low in saturated fat and dietary cholesterol, and it could help reduce the risk of heart disease by lowering LDL.

Soy consumption in the U.S. exploded, but since then, research has found that the effect of soy protein on LDL is relatively modest. A 2006 review by the American Heart Association’s nutrition committee found that an average consumption of 50 grams of soy protein a day—twice as much as the FDA says is necessary to reduce the risk of heart disease—resulted in an average drop in LDL of just 3%. Nor did soy intake cause HDL levels to rise significantly.

• The bottom line: Soy protein does lower LDL, but only slightly. The size of the effect seems to have been overstated.

]]> (GETTYIMAGES) http://www.health.com/health/condition-article/0,,20295990,00.htmlhttp://feeds.health.com/~r/health/cholesterol/~3/lxzb-0YQn5o/0,,20295990,00.html <![CDATA[Atherosclerosis: An Artist's Rendering]]> http://feeds.health.com/~r/health/cholesterol/~3/Xg8kz91IQaw/0,,20260964,00.html

Here is Vicki Behms's artistic rendering of atherosclerosis. View the slideshow.

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