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HOW TO LOWER YOUR RISK OF A HEART ATTACK
"What's your cholesterol?"
The next time you ask someone that question, don't be surprised if you get an answer that starts with LDL LDL - ["LDL: A Logic-Based Data-Language", S. Tsur et al, Proc VLDB 1986, Kyoto Japan, Aug 1986, pp.33-41]. and HDL (Hardware Description Language) A language used to describe the functions of an electronic circuit for documentation, simulation or logic synthesis (or all three). Although many proprietary HDLs have been developed, Verilog and VHDL are the major standards. , sweeps rapidly to VLDL VLDL very-low-density lipoprotein.
ß-VLDL , beta VLDL a mixture of lipoproteins with diffuse electrophoretic mobility approximately that of ß-lipoproteins but having lower density; they are remnants derived from and triglycerides Triglycerides
Fatty compounds synthesized from carbohydrates during the process of digestion and stored in the body's adipose (fat) tissues. High levels of triglycerides in the blood are associated with insulin resistance. , touches lightly on blood pressure and blood sugar, and winds up with a short discourse on hs-CRP, lipoprotein lipoprotein (lĭp'əprō`tēn), any organic compound that is composed of both protein and the various fatty substances classed as lipids, including fatty acids and steroids such as cholesterol. (a), and fibrinogen Fibrinogen
The major clot-forming substrate in the blood plasma of vertebrates. Though fibrinogen represents a small fraction of plasma proteins (normal human plasma has a fibrinogen content of 2–4 mg/ml of a total of 70 mg protein/ml), its conversion .
It's a good thing being confused doesn't raise the risk of heart attacks.
In fact, your odds of having heart trouble have always depended on far more than one number. But last May, the government's National Cholesterol Education Program The National Cholesterol Education Program is a program managed by the National Heart, Lung and Blood Institute, a division of the National Institutes of Health. Its goal is to reduce increased cardiovascular disease rates due to hypercholesterolemia (elevated cholesterol (NCEP NCEP National Cholesterol Education Program ) made it easier for people to use those numbers to calculate their risk of a heart attack.
The changes mean that more people will end up on cholesterol-lowering drugs cholesterol-lowering drug Therapeutics Any of a family of agents that ↓ serum cholesterol; the most cost-effective agents for lowering LDL-C are nicotinic acid and lovastatin; the most efficient for ↑ HDL-C are nicotinic acid and gemfibrozil . "Many millions of people are at much greater risk than we had known before," says NCEP coordinator James Cleeman.
But for many of them, drugs won't be enough. "People are so much fatter and physically inactive than they used to be," says Margo Denke of the University of Texas Southwestern Medical Center in Dallas. "They can't just lower cholesterol and assume that they're fine. They have to lose weight, eat a healthier diet, and exercise, too."
Last May's government report on how doctors should protect their patients from heart disease is the third since 1988. It won't be the last.
The latest guidelines don't tell physicians precisely how to deal with the so-called "emerging" risk factors, like lipoprotein(a), homocysteine Homocysteine Definition
Homocysteine is a naturally occurring amino acid found in blood plasma. High levels of homocysteine in the blood are believed to increase the chance of heart disease, stroke, Alzheimer's disease, and osteoporosis. , high-sensitivity C-reactive protein C-Reactive Protein Definition
C-reactive protein (CRP) is a protein produced by the liver and found in the blood.
C-reactive protein is not normally found in the blood of healthy people. (hs-CRP), and fibrinogen.
"These risk factors aren't ready for prime time," says James Cleeman, coordinator of the National Cholesterol Education Program (NCEP), which is part of the National Institutes of Health.
Lowering a high hs-CRP level, for example, may not lower the risk of heart attacks. "We can measure these things "These Things" is an EP by She Wants Revenge, released in 2005 by Perfect Kiss, a subsidiary of Geffen Records. Music Video
The music video stars Shirley Manson, lead singer of the band Garbage. Track Listing
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"Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party. if treating them is going to make a difference," says the University of Texas's Margo Denke.
In some cases, doctors don't even know how to lower them. "If a patient has high fibrinogen levels, a physician might prescribe aspirin or an anti-clotting medicine like warfarin warfarin (wôr`fərĭn), anticoagulant used to treat blood clots. In large doses it causes bleeding. Warfarin, mixed with bait, is used in rodent control.
Anticoagulant drug, marketed as Coumadin. to prevent the clots that high fibrinogen levels can cause," she explains. "But it wouldn't lower fibrinogen."
Instead, doctors can use the emerging risk factors to decide how aggressively to treat the known risk factors. "If a doctor isn't sure whether a patient deserves intensive treatment, the presence of an emerging risk factor like high CRP C-reactive protein (CRP)
A protein present in blood serum in various abnormal states, like inflammation.
Mentioned in: Pelvic Inflammatory Disease
n.pr See C-reactive protein. may put him Over the edge," says Cleeman.
In contrast, there's no question about the benefits of lowering the most powerful risk factor for heart disease: LDL ("bad") cholesterol.
"We have lock, stock, and barrel nailed down the evidence that lowering LDL can prevent heart attacks and enable people to live longer," says Denke. "It's the driving force behind the guidelines because lowering LDL has a proven benefit."
First, the new report helps physicians decide on an "LDL goal" by determining how high the patient's risk is. The higher the risk, the lower the LDL goal.
Then the guidelines go beyond LDL to address a new problem--which they call the "metabolic syndrome metabolic syndrome
See syndrome X.
A group of risk factors for heart disease, diabetes, and stroke. "--that's caused largely by obesity and lack of exercise. Here are some of the key changes in the new report:
DIET AND EXERCISE
The guidelines encourage physicians to start most patients on lifestyle changes. "When the guidelines came out, the headlines seized on the need for more people to take drugs, and those drugs are one of the great success stories of the decade," says Cleeman. "But we shouldn't lose sight of the fact that lifestyle changes are the primary means of preventing heart disease in most people."
And the government's diet advice has gotten tougher. People who are above their LDL goal should immediately cut their saturated fat saturated fat, any solid fat that is an ester of glycerol and a saturated fatty acid. The molecules of a saturated fat have only single bonds between carbon atoms; if double bonds are present in the fatty acid portion of the molecule, the fat is said to be to less than seven percent of calories and their dietary cholesterol to no more than 200 milligrams a day (see "Doing It With Diet," p. 8).
"The diet now has more cholesterol-lowering power," says Cleeman.
Cutting saturated fat and cholesterol makes the biggest dent in LDL. But you can soup up the cholesterol-lowering by adding foods rich in soluble fiber--like beans, peas, corn, and oatmeal--as well as Take Control, Benecol, and other margarines that are made with plant extracts called sterol Sterol
Any of a group of naturally occurring or synthetic organic compounds with a steroid ring structure, having a hydroxyl (—OH) group, usually attached to carbon-3. or stanol esters. Add them all together and the result is impressive.
"If you start by lowering saturated fat and cholesterol, and add soluble fiber, stanol or sterol margarines, physical activity, and weight loss, you can get a 20 to 30 percent lowering of LDL," says Cleeman.
Diet and exercise are critical for slashing LDL. But they're even more vital for people who have the metabolic syndrome.
THE METABOLIC SYNDROME
The new report calls it the metabolic syndrome, but it's also called syndrome X syndrome X
A cluster of metabolic abnormalities, including insulin resistance, high blood levels of triglycerides, low blood levels of HDL-cholesterol, and obesity, that increase the risk of chronic diseases such as hypertension, coronary artery (see March 2000, cover story).
"We estimate that a quarter of the adult population has the metabolic syndrome," says Cleeman. "It's more important than before because so many people are overweight or obese."
Some researchers think that the metabolic syndrome is caused by insulin resistance--that is, the insulin secreted by the pancreas loses its ability to admit blood sugar into cells, where it can be stored or burned for fuel. It's as though the body "resists" the insulin.
If that leads blood sugar levels to soar out of control, the person is diagnosed with diabetes. But even if blood sugar never gets that high, insulin resistance Insulin Resistance Definition
Insulin resistance is not a disease as such but rather a state or condition in which a person's body tissues have a lowered level of response to insulin, a hormone secreted by the pancreas that helps to regulate the level still raises the risk of heart disease.
"For the first time, the guidelines provide five criteria for the metabolic syndrome," says Cleeman. "If you have three of the five, you've got it."
The five criteria are levels of triglycerides, HDL ("good") cholesterol, blood pressure, blood sugar, and abdominal obesity abdominal obesity Androgenous obesity, truncal obesity Public health A clinical form of obesity which is more typical of ♂; those with AO waists > 40 inches had a 3 fold > risk of high cholesterol, were 4 times more likely to be in poor physical (see Step Eight, p. 5). "We measure these things because we can't easily measure insulin resistance," says Denke.
Even if you don't Even If You Don't is a single released by the band Ween in 2000 on Mushroom Records. Formats
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Includes the quicktime video of "Even If You Don't" directed by Matt Stone & Trey Parker of "South Park". have high blood pressure or high blood sugar, you still could have the metabolic syndrome. "All the criteria for the metabolic syndrome are only borderline-high, not high," says Cleeman. "The blood sugar cut-off cut-off Anesthesiology The point at which elongation of the carbon chain of the 1-alkanol family of anesthetics results in a precipitous drop in the anesthetic potential of these agents–eg, at > 12 carbons in length, there is little anesthetic activity, isn't high enough to be diabetes. The blood pressure cut-off isn't high enough to be hypertension."
But if you add up all of the borderline-high risks, the total is worrisome. That's because risks don't start and stop at each cut-off.
"The definition of high blood pressure is 140 over 90," explains Cleeman. "But that doesn't mean you're without risk if your blood pressure is 139 over 89."
The good news is that weight loss and exercise -- alone or, better yet, in combination--can reverse insulin resistance. The bad news is that, if they fail, there is no wonder drug to take their place.
"We have no one drug to fix the problems caused by obesity and inactivity," says Denke.
MILLIONS AT HIGH RISK
People who already have had a heart attack, coronary bypass coronary bypass
Surgical treatment for coronary heart disease to relieve angina pectoris and prevent heart attacks. It became widely used in the 1960s. One or more blood vessels—usually an artery in the chest or a vein from the leg—are transplanted to create operation, angioplasty angioplasty (ăn`jēōplăs'tē), any surgical repair of a blood vessel, especially
balloon angioplasty or percutaneous transluminal coronary angioplasty, a treatment of coronary artery disease. , angina Angina Definition
Angina is pain, "discomfort," or pressure localized in the chest that is caused by an insufficient supply of blood (ischemia) to the heart muscle. , or other signs of heart disease have an LDL goal of 100. That's low. According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. the new guidelines, the 16 million Americans with diabetes fall into the same high-risk category ... and have the same LDL goal.
"A person with diabetes has the same risk of heart disease as a person without diabetes who's already had a heart attack," says Denke.
Diabetes also makes a heart attack more treacherous. "A person with diabetes is more likely to die during or soon after a heart attack, so the name of the game is to prevent the first one," says Cleeman.
Diet is the first step for knocking LDL down below 100. For those who don't succeed, the new report recommends diet plus statins Statins
A class of drugs commonly used to lower LDL cholesterol levels.
Mentioned in: C-Reactive Protein or other drugs.
"Many of these people can get down to an LDL of 130 with lifestyle changes," says Cleeman, "but they can't get down to 100 without drugs."
And there may be nothing magic about 100. "There's reason to suspect that the lower the LDL, the better," says Cleeman. "Some trials have lowered LDL levels down to 70. They show a reduced risk of heart attacks, but we don't know if getting LDL down to 80 or 95 would be just as good."
That would mean even more people on statin drugs. But it's not as though we can just put drugs in the drinking water drinking water
supply of water available to animals for drinking supplied via nipples, in troughs, dams, ponds and larger natural water sources; an insufficient supply leads to dehydration; it can be the source of infection, e.g. leptospirosis, salmonellosis, or of poisoning, e.g. .
"Statins have a very impressive safety and efficacy record," says Cleeman. "But one out of 100 people will get elevated liver enzymes. Although that may not mean any real danger of liver damage, it's reason enough to take them off the drugs.
"And maybe one in 1,000 will have muscle problems that almost always go away when the drug is stopped. It's important to be on the lookout for in search of; looking for.
See also: Lookout those problems."
It's not just people with diabetes who may end up on drugs. For example, an HDL below 35 used to be a risk factor for heart disease. Now an HDL below 40 is considered a risk.
"It's incredibly important to remember that drugs should be combined with lifestyle changes, not substituted for them," says Cleeman. "Diet and exercise keep the dose of drug as low as possible and can accomplish things that drugs don't."
Diet and exercise can raise HDL and lower blood sugar, blood pressure, LDL, triglycerides, and the tendency to form blood clots Blood Clots Definition
A blood clot is a thickened mass in the blood formed by tiny substances called platelets. Clots form to stop bleeding, such as at the site of cut. . Drugs can also do some of those things, but unless you want to take a handful each day, it makes sense to correct the source of the problem.
Says Cleeman: "With diet and drugs, the overall effect on cardiovascular risk is broader."
For more information:
National Heart, Lung, and Blood Institute National Heart, Lung, and Blood Institute,
n.pr established in 1948, this division of the National Institutes of Health is responsible for research and education on cardiovascular, pulmonary, systemic diseases, and sleep disorders. Home Page: www.nhlbi.nih.gov
Web site for the new guidelines: www.nhlbi.nih.gov/guidelines/cholesterol
RELATED ARTICLE: WHAT'S YOUR TEN-YEAR HEART ATTACK RISK?
To estimate your risk of having a heart attack over the next ten years, add up your points for age, total cholesterol, smoking status, HDL, and systolic blood pressure Systolic blood pressure
Blood pressure when the heart contracts (beats).
Mentioned in: Hypertension (the higher number). But be careful how you interpret that risk.
1. Don't forget your long-term risk. Estimating your ten-year risk is useful, but it's not the only thing that matters.
"You can have a low ten-year risk, but a high long-term risk," explains James Cleeman, head of the National Cholesterol Education Program (NCEP). "For example, a 35-year-old with high cholesterol Cholesterol, High Definition
Cholesterol is a fatty substance found in animal tissue and is an important component to the human body. It is manufactured in the liver and carried throughout the body in the bloodstream. and no other risk factors has a low risk of having a heart attack during the next ten years. But there's no question that the high cholesterol can cause tremendous problems in 30 or 40 years," says Cleeman.
2. Don't let points mislead you. As you get older, smoking and high cholesterol saddle you with fewer points. But that doesn't mean that it's safe to smoke or have high cholesterol as you age.
"You can't gauge the importance of a risk factor by the number of points," says Cleeman. "Although the relative risk for smoking and having high cholesterol goes down with age, the absolute risk goes up."
In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"
put differently , smoking and high cholesterol put you at much higher risk relative to other people your age when you're young. But when you're older, your actual, or absolute, risk of having a heart attack is so high that each additional point makes a big difference.
3. Don't expect 100 percent accuracy. "Like all risk assessment tools, this one isn't perfect," says Cleeman. To get the best read on your risk, use an average of at least two fasting blood samples for your total cholesterol and HDL, and an average of several blood pressure readings.
And don't be misled by the use of total (not LDL) cholesterol. The risk assessment uses total cholesterol because it's based on the Framingham Heart Study The Framingham Heart Study is a cardiovascular study based in Framingham, Massachusetts. The study began in 1948 with 5,209 adult subjects from Framingham, and is now on its third generation of participants. , which had better data for total cholesterol than for LDL.
Women Age Points Age Points 20-34 -7 55-59 8 35-39 -3 60-64 10 40-44 0 65-69 12 45-49 3 70-74 14 50-54 6 75-79 16 Total Points Cholesterol Age Age Age Age Age (mg/dL) 20-39 40-49 50-59 60-69 70-79 below 160 0 0 0 0 0 160-199 4 3 2 1 1 200-239 8 5 4 2 1 240-279 11 8 5 3 2 280 or more 13 10 7 4 2 Points Smoking Age Age Age Age Age 20-39 40-49 50-59 60-69 70-79 Non-smoker 0 0 0 0 0 Smoker 9 7 4 2 1 HDL (mg/dL) Points HDL (mg/dL) Points 60 or more -1 40-49 1 50-59 0 below 40 2 Systolic Blood Pressure (mm Hg) If Untreated If Treated below 120 0 0 120-129 1 3 130-139 2 4 140-159 3 5 160 or more 4 6 Risk Point Total 10-Yr Risk (%) less than 0 less than 1 9 1 10 1 11 1 12 1 13 2 14 2 15 3 16 4 17 5 18 6 19 8 20 11 21 14 22 17 23 22 24 27 25 or more 30 or more Men Age Points Age Points 20-34 -9 55-59 8 35-39 -4 60-64 10 40-44 0 65-69 11 45-49 3 70-74 12 50-54 6 75-79 13 Total Points Cholesterol Age Age Age Age Age (mg/dL) 20-29 40-49 50-59 60-69 70-79 below 160 0 0 0 0 0 160-199 4 3 2 1 0 200-239 7 5 3 1 0 240-279 9 6 4 2 1 280 or more 11 8 5 3 1 Points Smoking Age Age Age Age Age 20-39 40-49 50-59 60-69 70-79 Non-smoker 0 0 0 0 0 Smoker 8 5 3 1 1 HDL (mg/dL) Points HDL (mg/dL) Points 60 or more -1 40-49 1 50-59 0 below 40 2 Systolic Blood Pressure (mm Hg) If Untreated If Treated below 120 0 0 120-129 0 1 130-139 1 2 140-159 1 2 160 or more 2 3 Risk Point Total 10-Yr Risk (%) less than 0 less than 1 0 1 1 1 2 1 3 1 4 1 5 2 6 2 7 3 8 4 9 5 10 6 11 8 12 10 13 12 14 16 15 20 16 25 17 or more 30 or more
To calculate your ten-year heart disease risk online, go to hin hin
A unit of liquid measure used by the ancient Hebrews, equal to about five liters.
[Middle English, from Medieval Latin, from Greek, from Hebrew hîn, of Egyptian origin. .nhlbi.nih.gov/atpiii/calculator.asp
RELATED ARTICLE: Doing it with Diet
A single scoop of Haagen-Dazs vanilla ice Robert Matthew Van Winkle (born October 31, 1968), better known as Vanilla Ice, is a Grammy Award nominated, American Music Award winning American rapper and actor known mostly for the 1990 single "Ice Ice Baby. cream has half a day's worth of saturated fat ... if you follow the usual advice to get less than 10 percent of your calories from sat fat.
If you have high LDL cholesterol LDL cholesterol
See low-density lipoprotein.
Low-density lipoprotein cholesterol is the primary cholesterol molecule. High levels of LDL increase the risk of coronary heart disease. , on the other hand, you need to slash saturated fat to less than seven percent of calories. Now your daily limit is only 16 grams of sat fat--and that scoop of Haagen-Dazs just ate up 11 of them. Gulp.
The only way to meet your goal: cut way back on red meat, cheese, ice cream, butter, and other foods that are heavy on sat fat (low-fat versions are fine).
You've also got to limit the trans fat trans fat
1. A trans fatty acid.
2. Trans fatty acids considered as a group.
A fat containing trans fatty acids. that's found in french fries, cakes, pies, and other foods made with hydrogenated oil, shortening, or stick margarine. Like sat fat, trans fat raises LDL.
What don't you have to avoid?
You can indulge in the juiciest fruits and the most delectable vegetables. They're not only low in fat. Some--like beans, peas, corn, and oranges--also have the soluble fiber that can knock your LDL down a few notches.
And you can have some unsaturated fats unsaturated fat: see saturated fat. like salad dressing, cooking oil, nuts, and avocado avocado (ä`vəkä`do, ăv`–), tropical American broad-leaved evergreen tree of the genus Persea of the family Lauraceae (laurel family). . In fact, people with the metabolic syndrome (see Step Eight, p. 5) need to substitute unsaturated fats for some of the sweets, breads, cereals, and other carbohydrates that can raise their triglycerides.
This Daily Food Guide is designed for someone who gets 30 percent of calories from total fat. The National Cholesterol Education Program (NCEP) recommends anywhere from 25 to 35 percent for people with high cholesterol. If you have the metabolic syndrome, you should shoot for the upper end of that range by eating more from the "fats and oils" group and less from the "sweets and snacks" and "breads, cereals, etc." groups. But beware: even unsaturated fats are calorie-dense. And many foods that we may think of as unsaturated--like fried chicken Fried chicken is chicken which is dipped in a breading mixture and then deep fried, pan fried or pressure fried. The breading seals in the juices but also absorbs the fat of the fryer, which is sometimes seen as unhealthy. or doughnuts--harbor saturated (or trans) fat as well.
The NCEP's Daily Food Guide Here's how many servings of which foods you can eat every day. Number of Food Group Servings Serving Size Lean meat, poultry, 5 ounces -- fish, & shellfish or less Skim or low-fat 2-3 1 cup skim or 1% milk dairy foods 1 cup nonfat or low-fat yogurt 1 ounce low-fat cheese Eggs 2 yolks per -- week or less(*) Fats and oils 6-8(*) 1 tsp. tub margarine or vegetable oil 1 Tbs. salad dressing 1 ounce nuts Fruits 2-4 1 piece fruit 1/2 cup diced fruit 3/4 cup fruit juice Vegetables 3-5 1 cup leafy or raw 1/2 cup cooked 3/4 cup juice Breads, 6-11 1 slice bread cereals, rice, 1/2 bun, bagel, or muffin pasta, dry peas & 1 ounce dry cereal beans, grains, and 1/2 cup cooked potatoes cereal, dry peas or beans, potatoes, rice, or other grains 1/2 cup tofu Sweets and snacks Every now -- & then Note: This diet can be adapted for vegetarians by increasing portions of beans, nuts, and tofu and other soy foods to replace meat, poultry, and fish. (*) Includes the egg yolks, fat, and oils in packaged and restaurant foods. Here's a detailed breakdown of the NCEP's diet. For a 2,000- Nutrient Recommendation calorie diet Saturated fat(*) less than 7% of calories less than 16 grams Polyunsaturated fat up to 10% of calories 22 grams or less Monounsaturated fat up to 20% of calories 44 grams or less Total fat 25-35% of calories 55-78 grams Carbohydrate 50%-60% of calories 250-300 grams Fiber 20-30 grams a day 20-30 grams Protein about 15% of calories about 75 grams Cholesterol less than 200 mg a day less than 200 mg (*) Also try to eat as little trans fat as possible.