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Scientists Begin to Question Benefit of 'Good' Cholesterol
NY Times ^ | March 15, 2004 | Gina Kolata

Posted on 03/15/2004 11:23:07 AM PST by neverdem

For years, doctors have been saying that to prevent heart disease, patients should pay attention to both the so-called bad cholesterol, or L.D.L., and the good cholesterol, or H.D.L. The good, they said, can counteract the bad.

But now, some scientists say, new and continuing studies have called into question whether high levels of the good cholesterol are always good and, when they are beneficial, how much.

While some heart experts are not ready to change their treatment advice, others have concluded that H.D.L. should play at most a minor role in deciding whether to prescribe cholesterol-lowering drugs. In the meantime, doctors are calling researchers and asking what to do about patients with high H.D.L. levels, or what to do when their own H.D.L. levels are high, and patients are left with conflicting advice.

"There is so much confusion about this that it is unbelievable," said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic.

The good cholesterol hypothesis comes from studies like the Framingham Heart Study, which has followed thousands of people in Framingham, Mass., for decades to see who developed heart disease. The studies showed that if two people had the same levels of the bad cholesterol, L.D.L., but different levels of the good cholesterol, H.D.L., the one with more H.D.L. was less likely to have heart disease.

Researchers examining the biochemistry of the two molecules learned that they have opposite roles. Both transport cholesterol, the fatty substance used to make cell membranes and some hormones, but they carry it in opposite directions.

L.D.L. ferries cholesterol to coronary arteries, where it imbeds and participates in the growth of plaque. H.D.L. takes cholesterol away from arteries to the liver, where it is disposed of.

So with epidemiological studies showing reduced heart disease risk and science showing why, it would seem the picture was clear: the more H.D.L. the better. One H.D.L. molecule might even cancel one of L.D.L.

Too simplistic, says Dr. Daniel Rader, a cholesterol researcher at the University of Pennsylvania School of Medicine. "Yes, high H.D.L. is generally a good thing, but it doesn't mean it is so powerful that it creates a total immunity to heart disease," he said.

Dr. Rader and others say, for example, that there are people who have high levels of H.D.L., but the H.D.L. does not function properly. Instead of being protected from heart disease, these patients may be particularly vulnerable. A simple H.D.L. measurement does not reveal whether a person's high level is good or bad.

Cholesterol researchers say that every clinic has patients with high levels of H.D.L. who ended up with heart disease. The average H.D.L. level for men is 40 to 50 milligrams per deciliter of blood and for women 50 to 60. But, even when H.D.L. levels are much higher, "the L.D.L. can overpower the H.D.L.," said Dr. Christie Ballantyne of Baylor College of Medicine.

Many are like 60-year-old Thomas E. Siko of Chagrin Falls, Ohio, who thought he had nothing to worry about. Heart disease runs in his family on both sides, but no doctor had ever suggested cholesterol-lowering medication. His H.D.L. level was high, at 72, and his L.D.L. only mildly elevated, at 121. (National guidelines say that an L.D.L. level of less than 100 is optimal; 100 to 129 is near or above optimal, depending on other factors; and above 130 is high.)

But last year, after being tested for what he thought was indigestion, Mr. Siko ended up having bypass surgery. Now, with a cholesterol-lowering statin, his L.D.L. level is down to 72 while his H.D.L. is 70. He feels fine. "I run four miles a day," Mr. Siko said.

Part of the confusion arises from an evolving view of the immense importance of reducing L.D.L. levels. Two recent studies, one announced last week, the other published the week before, found that ultra-low levels of L.D.L., down to the 60's or 70's, can protect heart patients from plaque growth in their arteries and from heart attacks and deaths. That raised questions among many doctors and patients of whether their own L.D.L. levels really were optimal and whether their good cholesterol really was canceling out the bad.

Dr. Rader is leading a large study on genetic variations causing high H.D.L. that is trying to sort the question out. But for now he says, "I really don't feel that treatment for high L.D.L. should be withheld just because the H.D.L. level is high."

Instead, Dr. Rader puts high H.D.L. levels to the side and looks at L.D.L. and other risk factors, like a family history of heart disease. If L.D.L. levels and other risk factors tell him to treat, he prescribes L.D.L.-lowering medication. If he is undecided, he brings the high H.D.L. levels back into the picture, allowing them to push him toward or away from treatment.

Dr. Bryan Brewer, chief of the molecular disease branch of the National Heart, Lung and Blood Institute, said no one should ignore high levels of L.D.L. "If you have a high L.D.L. level you should be concerned about it, independently of your H.D.L. You are still at risk," he said.

Dr. Nissen says he focuses on L.D.L. so much that he mostly discounts H.D.L. in deciding whether to give cholesterol-lowering drugs to patients with heart disease or to those with high L.D.L. levels and other risk factors like high blood pressure or a family history of heart disease. He notes that statins are safe drugs that reduce L.D.L. levels and that study after study has shown that lowering L.D.L. prevents heart attacks and deaths.

He says that recent research bears him out. His study, published this month in the Journal of the American Medical Association, looked directly at the accumulation of plaque in coronary arteries when heart patients took cholesterol-lowering drugs. Their H.D.L. levels, he said, played no role in plaque growth; the only thing that mattered was what happened to L.D.L. When L.D.L. levels dropped, plaque growth slowed. That means, Dr. Nissen concludes, that the benefit of lowering L.D.L. is the same whether H.D.L. levels are high or low.

Others have different views on how to weigh H.D.L. in treatment decisions. Many, like Dr. Alan Garber, a professor of internal medicine at Stanford, look at overall risk. The starting place, he says, is assessing how likely it is that people will have heart attacks, given everything known about their L.D.L. and H.D.L. levels, their blood pressure, their family history and whether they smoke or have diabetes.

Dr. Garber said that with data from recent studies, it looked increasingly safe to treat high L.D.L. levels and ignore other factors. But, he said, "that's not the way I would do it." One concern is that people who are otherwise at low risk for heart disease would gain little by taking drugs to reduce their L.D.L. levels but would spend years paying for the drugs, which can cost $100 a month.

Dr. David Waters, of the University of California at San Francisco, also looks at overall risk, but lets a high H.D.L. level counteract one of the other predisposing factors to heart disease in deciding who needs to take drugs to lower L.D.L. levels.

With different doctors using such different reasoning, doctors and patients say they can be frustrated and confused about what to do.

Dr. Christopher Cannon of Brigham and Women's Hospital in Boston needed advice for his mother. Her H.D.L. was above 100, which is very high, but her L.D.L. was 160, also high. Last year, he called Dr. Rader, who said that because Dr. Cannon's mother's only risk factor for heart disease was her L.D.L., he did not advise treatment.

But now, new studies, including one reported last week by Dr. Cannon and his colleagues, are indicating that people might do much better with much lower levels of L.D.L. He looked over his own data and said it showed people with high H.D.L. levels got the same benefit from driving their L.D.L. very low as people whose H.D.L. was low or normal. So, he says, he will be calling Dr. Rader again. "It's time for a reassessment," he said.


TOPICS: Culture/Society; Front Page News; Government; News/Current Events; US: California; US: District of Columbia; US: Massachusetts; US: Ohio; US: Pennsylvania; US: Texas
KEYWORDS: cad; chd; cholesterol; hdl; health; heartdisease; ldl; nhlbi; weareallgonnadie
The saga continues.
1 posted on 03/15/2004 11:23:08 AM PST by neverdem
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To: fourdeuce82d; Travis McGee; El Gato; JudyB1938; Ernest_at_the_Beach; Robert A. Cook, PE; lepton; ...
PING
2 posted on 03/15/2004 11:24:26 AM PST by neverdem (Xin loi min oi)
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To: Canticle_of_Deborah
ping
3 posted on 03/15/2004 11:25:46 AM PST by nickcarraway
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To: neverdem
And they don't even get into homocystene.
4 posted on 03/15/2004 11:26:57 AM PST by nickcarraway
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To: neverdem
They never want to look at the big picture.
5 posted on 03/15/2004 11:27:35 AM PST by nickcarraway
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To: neverdem
Junk science to the rescue ! HAH!

If you study water long enough, you will find that IT CAN KILL!!

BAN WATER!! BAN SALT!! BAN FOOD!! AIR!! etc etc etc...

Stupidity knows no bouds.
6 posted on 03/15/2004 11:30:05 AM PST by steplock (http://www.gohotsprings.com)
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To: steplock
What they consider fact changes enough that I will just enjoy my T-bones and Hershey's with the understanding that they dont really that know much.
7 posted on 03/15/2004 11:32:14 AM PST by No Blue States
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To: No Blue States
spellchecker have should that caught.
8 posted on 03/15/2004 11:32:54 AM PST by No Blue States
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To: steplock
Aaack! We're all gonna die! (eventually, of something)
9 posted on 03/15/2004 11:35:01 AM PST by .38sw
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To: neverdem
I'm confused. I'm 40 and have tried to follow all of the rules for a healthy heart. Four weeks ago I had a heart attack. I guess I start eating cardboard.
10 posted on 03/15/2004 11:35:06 AM PST by TankerKC (Clogged Arteries and Still Smilin'!)
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To: nickcarraway
And they don't even get into homocystene.

I am not opposed to assistance for homosexuals, I just dont want them getting married.

11 posted on 03/15/2004 11:37:56 AM PST by Paradox (I have NO idea..)
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To: neverdem
There is a "big picture" that consists of many variables. Scientific American magazine had a nice big article on it. You can't just look at these variables in isolation. We still dont know what is going on exactly.
12 posted on 03/15/2004 11:39:25 AM PST by Paradox (I have NO idea..)
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To: No Blue States
nice comment. here is one for the junk people to ponder. research at UT Southwestern into protein has found that it can eat FAT. An injection into mice caused them to lose weight. Aktins will be smiling from someplace. The beef guys will be selling more too.
13 posted on 03/15/2004 11:44:32 AM PST by q_an_a
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To: nickcarraway
And they don't even get into homocysteine.

I'm sure it's being studied. But there's not much money to be made treating homocysteine levels as the treatment is folic acid, a vitamin. Coronary artery disease is a work in progress.

14 posted on 03/15/2004 11:50:54 AM PST by neverdem (Xin loi min oi)
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To: No Blue States
and Hershey's

Chocolate is good for you! I've always said it is medicine but no one believed me :-) In addition to antioxidants it also has marijuana-like compounds, ha!

My great aunt is 97 years old. She spent her entire life eating whole eggs every day, whole milk, cream, butter and the FAT off meat. Never had a heart attack. Just recently she experienced a minor stroke and some TIAs. However, she did not grow up eating fast food or boxed food. Everything was always homemade and natural. There may be something to that in addition to outstanding genetics.

15 posted on 03/15/2004 11:56:47 AM PST by Canticle_of_Deborah
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To: q_an_a
One of the best things ive found to burn my fat is to climb a mountain, or even a hill...walk a few miles. Its good for the soul too.

My unscientific opinion is that if one drinks enough water, avoid gobs of pure animal fat, then is active doing something, anything to get the heart working..then one can eat just about whatever the like, just avoid tequila.

But im only 40 so the wisdom of my plan is dependant on my longevity. Now, if i could just stay off cigs..hehe

16 posted on 03/15/2004 11:57:44 AM PST by No Blue States
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To: neverdem
Other things to worry about:

Asteroid Impact, Same Sex Marriage, Massive gamma ray burst from an outside the solar system event, BSE nvCJD, SARS, Smallpox, Ebola ,Flu- (human, bird, swine, duck, chicken), Salmonella, Carbs, Fat, Protein, Terrorists, Anthrax, Earthquakes, Volcanoes, Too little ozone, Too much ozone, Global warming, Global cooling, Global Warming Chaos, Pesticides, Deer ticks, Nerve gas, Dirty bombs, Haliburton, SUVs, Guns, Acid rain, Too much Rain, Too little Rain, Nuclear power, Non-nuclearpower, Nuclear war, Conventional war, Wind Turbines shredding endangered birds, Obesity, Starvation, BCS, The Yankees with A’Rod, NCAA Basketball Tournament Selections, Pit bulls, Rottweilers, German Shepherds, Huskies, Alaskan Malamutes ,Doberman Pinschers, Chow Chows, Great Danes, St. Bernards, Akitas, green ketchup, MRSA (Methicillin-resistant Staphylococcus aureus), Pet spiders, Yard Sale Congestion, Red King Crabs, Shadow people, Cattle mutilations, Junk Science, Supersize fries, ”Our worst fears were confirmed”, steroids in baseball, microwave popcorn, HIV, Peak Oil, Cholesterol both LDL and HDL,...

So much to worry about...

17 posted on 03/15/2004 11:57:46 AM PST by Calamari (Pass enough laws and everyone is guilty of something.)
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To: Canticle_of_Deborah
Thats good, because I bought a whole case at Sams and hid them in my top drawer. ;o

I think the main thing missing in our diet today is exercise, machines do the work for us.

Its hard to pump weight or ride a thread mill to me, But taking a bike ride or long walk is actually pretty uplifting, especially now that spring is here.

I bet your great Aunt stayed busy most of all.

18 posted on 03/15/2004 12:01:19 PM PST by No Blue States
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To: neverdem
I wonder if this is being questioned because Atkins dieters have high levels of good cholesterol?
19 posted on 03/15/2004 12:01:20 PM PST by DannyTN
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To: neverdem
Bump
To read later
20 posted on 03/15/2004 12:02:24 PM PST by Fiddlstix (This Space Available for Rent or Lease by the Day, Week, or Month. Reasonable Rates. Inquire within.)
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To: codyjacksmom
BUMP to read later
21 posted on 03/15/2004 12:03:38 PM PST by codyjacksmom
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To: neverdem
If you wait long enough what is good for you will eventually be bad for you and vice versa.
22 posted on 03/15/2004 12:03:58 PM PST by Uncle Hal
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To: neverdem
Want to kill yourself trying to AVOID HEART DISEASE?

Then just obey the Food Police and eat a VERY LOW-FAT DIET.

I've been cautioning my readers about this for years and now I'm even hearing agreement from the Chairman of the Nutrition Committee of the American Heart Association. Even he now admits that a very low-fat diet can be harmful to many people! So unless you've actually been tested and found to have a very specific condition called "pattern B LDL," be careful to get enough animal fat in your diet.

At this point patients often ask me,"But how can I keep my cholesterol down?" Well, maybe you should be more concerned about getting it higher. Because...

LOW CHOLESTEROL can be much deadlier than high cholesterol

Here too, even the American Heart Association is now admitting... LOW CHOLESTEROL CAN TRIGGER THE DEADLIEST KIND OF STROKE. It's called a "massive stroke," and it happens when blood vessels in your brain are so weak, they burst open. EVEN MODERATELY LOW CHOLESTEROL LEVELS can raise your risk of these strokes. By this, I mean under 200. Yet many doctors routinely prescribe cholesterol-lowering drugs if it's over 200!

No wonder the British Medical Journal recently announced:

"CHOLESTEROL SCREENING IS NOT WORTHWHILE!"

When they actually looked at the figures, guess what? Folks with lower cholesterol were just about as likely to develop heart disease as those with higher levels. It simply doesn't matter. So what's the real cause of heart disease? Well, for one thing:

Too little RED MEAT in your diet

See how pleasant real health can be? Your friends might say "YOU'RE NUTS," but the actual biochemistry behind my EAT LIKE A HUMAN diet is now endorsed by just about every serious heart researcher.

You see, of all the different substances they can measure in your blood, the deadliest risk factor for heart disease is not cholesterol, but a chemical called HOMOCYSTEINE. Because...

Cholesterol doesn't do diddly unless it "catches" on a ridge or a pit in your artery walls. And the secret cause of these "cholesterol traps" is homocysteine. Too much homocysteine and your arteries corrode like a rusty pipe.

But it's so easy to cut down your homocysteine levels! Three vitamins do the trick quickly, including vitamins B6 and B12. And by far the richest source of these vitamins is... You got it. Red meat. Per Dr. Douglass

23 posted on 03/15/2004 12:05:17 PM PST by shield
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To: neverdem
So, good is bad and bad is bad? Say it ain' so...


24 posted on 03/15/2004 12:10:06 PM PST by GalaxieFiveHundred
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To: Paradox
"And they don't even get into homocystene."

Or into Sugar. The issue is not being properly addressed. One of the biggest culprits to heart disease and obesity is sugar. It appears the medical community has remove sugar from their vocabulary. Just read the label. The food processing industry jams packaged foods with tons of sugar. The average person consumes 180 pounds of sugar a year. The low carb craze is about the cause and effect of carbohydrates turning into sugar. An obese America can look forward to millions and millions of new cases of diabetes, along with high health care costs.
25 posted on 03/15/2004 12:11:35 PM PST by Smartass
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To: No Blue States
I'll have you know that "pure gobs of animal fat" have made me the oustanding person I am today. Thank you very much! ;9)
26 posted on 03/15/2004 12:12:41 PM PST by Ditter
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To: Howlin; Ed_NYC; MonroeDNA; widgysoft; Springman; Timesink; dubyaismypresident; Grani; coug97; ...

Just damn.

If you want on the list, FReepmail me. This IS a high-volume PING list...

27 posted on 03/15/2004 12:16:45 PM PST by mhking
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To: neverdem
For years, doctors have been saying that to prevent heart disease, patients should pay attention to both the so-called bad cholesterol, or L.D.L., and the good cholesterol, or H.D.L. The good, they said, can counteract the bad.

First of all, there is no good or bad cholesterol. There is just cholesterol. There are, though, a variety of different lipoproteins which provide the name for and the description of various particles that contain cholesterol. These different particles represent different phases or parts of the system for maintaining cholesterol homeostasis. Relative differences in proportions between these lipoproteins (and in conjunction with various types of fat) have been associated with different disease states. The association is strong enough and the mechanisms are well-understood enough that generally one should aim to lower one's LDL (through diet and exercise first) and seek to elevate one's HDL (through diet and exercise). There could, though, be pathogenic reasons for low LDL or a high HDL levels: you could have a home incapable of being blown down by a tornado because it's already been burned down by lightning. In this case, its degree of imperviousness to wind damage is nothing to be happy about.
28 posted on 03/15/2004 12:17:07 PM PST by aruanan
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To: nickcarraway
Oh! I am just SO suprised! :O

Wonder what this is leading up to?

What food or activity will they "ban" now?
29 posted on 03/15/2004 12:18:11 PM PST by Iron Matron (Civil Disobedience? No. Gay liberals are breaking the law.)
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To: GalaxieFiveHundred
Krispy Grease!!
30 posted on 03/15/2004 12:44:03 PM PST by international american (DU trolls outsourced for free!!)
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To: q_an_a
It looks like you're referring to leptin, which is something else entirely from the macronutrient protein, and doesn't work in humans the way it does in rats.

A good primer on leptin is:

http://www.avantlabs.com/magmain.php?issueID=3&pageID=51

http://www.avantlabs.com/magmain.php?issueID=4&pageID=58

31 posted on 03/15/2004 12:53:59 PM PST by gura
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To: neverdem
Remember, if you want to look young and healthy like this guy:

then i have the perfect diet for you!
32 posted on 03/15/2004 1:29:09 PM PST by arielb
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To: gura
yes my comment was about leptin. it is possible that the research done here is producing a result which is different from the study you point to in your post.

i'm not a doctor and don't play one on TV either,so I'll just say that more tomatoes and more chicken, turkey and beef may give me something to lower many of the artificial killers of old people. time will tell. Thanks for your comment.

33 posted on 03/15/2004 2:00:06 PM PST by q_an_a
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To: neverdem
Bump for later, got to heat up some turkey burger.
34 posted on 03/15/2004 4:06:59 PM PST by Springman
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To: q_an_a
I'm not a doctor, just an advocate of the "mom" diet, the diet my mom used to feed me. Every meal had a protein source, 1-3 types of veggies, and maybe some bread. Want a snack? Step away from the cookies and eat some fruit. Eat things that come in boxes or cartons rarely and in moderation.
35 posted on 03/15/2004 4:12:36 PM PST by gura
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To: shield
Thank you. Saving this. My sister and I have this discussion all the time. She eats a lot of super refined carbs, no meat and almost no fat (her doctor ordered her to eat more). And while my eating habits were bad a decade or so ago, I'm doing much better, but I add the some 'healthy' fats and nuts and meat. My b-i-l has the high cholestrol and their kids are more anemic than I am (dr also told her "feed them meat!", she does now) and I think this is definitely contributing to the dilemma. We jokingly refer to her as 'the food police' or the 'food nazi'.
36 posted on 03/15/2004 4:22:32 PM PST by fortunecookie
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To: Calamari; Landru
So much to worry about...

Who told us that we could live forever? I love the line that goes "Eat healthy, stay fit--die anyway!

37 posted on 03/19/2004 5:48:27 PM PST by scholar
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To: scholar
Yes! The trick is deciding what to ignore and what really needs to be "worried" about. Better to resolve real issues important to you that you have control over and not spend time worrying about that which is unlikely to affect you and over which you have no real control.

The "Other Things to Worry About List" was started on Feb. 23, 2004 and is from articles posted on FR. It is growing like a well watered weed. Most of it is junk science or agendized enviromental propaganda such as "global warming may cause the next ice age".

With a little effort, a fax machine and a catchy name; I might be able get some one to write an article declaring that beer is a new food group and counter acts the free radicals in you body more effectively than colloidal silver.

38 posted on 03/19/2004 9:28:28 PM PST by Calamari (Pass enough laws and everyone is guilty of something.)
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