Study: Nearly half of heart attack and stroke survivors don't know their LDL cholesterol levels

I have no idea what mine is and really don't care, my doctor doesn't seem concerned since the statins seem to be taking care of it. 

Study: Nearly half of heart attack and stroke survivors don't know their LDL cholesterol levels

A 2023 survey from the American Heart Association conducted by The Harris Poll, found that a majority (70%) of heart attack and stroke survivors are unaware that LDL cholesterol is commonly referred to as 'bad cholesterol.' This matters because LDL cholesterol (low-density lipoprotein cholesterol) significantly contributes to the development of cardiovascular disease, increasing the risk of heart attacks and strokes. According to the Centers for Disease Control and Prevention, heart attack occurs every 40 seconds in the U.S.

Survey highlights:

• 75% of heart attack and stroke survivors reported having high cholesterol.
• Survey shows 47% of heart attack and stroke survivors are unaware of their LDL cholesterol number.

The survey, conducted on behalf of the Association, the world's leading voluntary organization dedicated to building healthier lives for all, found that 75% of heart attack and stroke survivors reported having high cholesterol. However, only 49% recognized the need to prioritize lowering their cholesterol.

There's a pervasive lack of public awareness and understanding around bad cholesterol and its impact on your cardiovascular health. As bad cholesterol usually has no symptoms, we often find that many patients are walking around without knowing they're at risk or how to mitigate it."

Joseph C. Wu, MD, PHD, FAHA, American Heart Association volunteer president and director, Stanford Cardiovascular Institute and Simon H. Stertzer, MD, Professor of Medicine & Radiology at Stanford School of Medicine

Through its Lower Your LDL Cholesterol Now™ initiative, sponsored nationally by Amgen Inc., the American Heart Association is encouraging people to ask their doctor to check their cholesterol levels. In the Harris Poll study, 98% of heart attack and stroke survivors surveyed say they are willing to take a simple blood test if recommended by their health care professional.

"What's eye-opening about these survey results is that nearly half of those who have suffered a heart attack or stroke don't know their LDL cholesterol levels, which is a vital step in helping to prevent a second heart attack or stroke," said Paul Burton, M.D., Ph.D., senior vice president and chief medical officer, Amgen. "Amgen is committed to working with other health care leaders, like the American Heart Association, to empower people to know more and do more about their cardiovascular disease. For patients, this starts with talking to your doctor about your LDL cholesterol number and appropriate steps for testing and treatment."

Among those who have experienced a heart attack and/or stroke, 69% say they have heard of LDL cholesterol. However, a substantial proportion (47%) remain unaware of their LDL number. LDL cholesterol plays a crucial role in the buildup of fatty deposits within arteries, leading to a condition known as atherosclerosis. This narrowing of arteries significantly escalates the risk of heart attacks, strokes, and peripheral artery disease (PAD).

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"At the American Heart Association, we recommend that all adults 20 or older should have their cholesterol checked every 4 to 6 years as long as their risk remains low. After age 40, your health care professional will also want to use an equation to calculate your 10-year risk of having a heart attack or stroke. People who have had a prior heart attack or stroke may need their cholesterol checked more often," said Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, past volunteer president of the American Heart Association and chair of the department of preventive medicine, the Eileen M. Foell Professor of Heart Research and professor of preventive medicine, medicine and pediatrics at Northwestern University's Feinberg School of Medicine in Chicago. "This is very much a case where knowledge is power. The more you know, the more you can do to decrease your risk of heart attack and stroke in the future."

An encouraging finding from the survey is that 65% of heart attack and stroke survivors polled correctly believe high cholesterol poses a moderate to high increased risk for heart attack and stroke. "However, there's still progress to be made," emphasizes Lloyd-Jones, "as this statistic underlines that a considerable portion of survivors require further understanding, particularly regarding the specific risk associated with LDL cholesterol. It's essential for heart attack and stroke survivors to grasp the profound impact of high LDL cholesterol, often referred to as the 'bad' cholesterol, on their cardiovascular health."

According to American Heart Association guidelines, lifestyle habits like eating a healthy and balanced diet, regular exercise and eliminating tobacco use can all help you control your cholesterol and should be the first line of defense. However, some individuals, especially heart attack and stroke survivors, should have a conversation with their doctor about cholesterol-lowering medications. There are also several medications available including statins, PCSK9 targeting agents, Ezetimibe, Bile Acid Sequestrants, and ATP citrate lyase (ACLY) Inhibitors.

Visit heart.org/LDL to learn more about LDL cholesterol, access a treatment plan discussion guide and find the answers to many commonly asked questions about LDL cholesterol.

Source:

American Heart Association

Dual therapy for lower target LDL after stroke reduces risk for events at 5 years

 For discussion with your doctor. If your doctor is competent s/he will bring this up before you mention it.

Dual therapy for lower target LDL after stroke reduces risk for events at 5 years 

An LDL target of less than 70 mg/dL with ezetimibe plus statin therapy was associated with lower risk for subsequent events after stroke/transient ischemic attack at 5 years vs. a target between 90 mg/dL and 110 mg/dL, researchers reported.

In addition, ezetimibe plus statin therapy — dual therapy — for a lower target LDL was not associated with increased risk for intracranial bleeding, according to findings of a post hoc analysis of the Treat Stroke to Target trial published in Stroke.

Source: Adobe Stock

“In the lower target group, dual therapy with statin and ezetimibe significantly reduced major vascular events, and the reduction was not significant on the statin monotherapy, as compared with all patients in the higher target group,” Pierre Amarenco, MD, chairman of the department of neurology and the Stroke Center at Bichat Hospital and professor of neurology at Xavier Bichat Medical School and Denis Diderot University in Paris, and colleagues wrote. “This difference was observed although the mean LDL cholesterol achieved was very similar in both groups.”

The Treat Stroke to Target trial

Treat Stroke to Target was a parallel-group trial conducted in France and South Korea and included 2,860 patients with stroke or TIA and evidence of cerebrovascular or coronary artery atherosclerosis (mean age, 67 years; 68% men; mean LDL at baseline, 135 mg/dL). Participants received dual therapy or statin monotherapy and were assigned to an LDL target of less than 70 mg/dL or 90 to 110 mg/dL. The primary endpoint was subsequent stroke, MI, urgent revascularization or CV death at a median follow-up of 3.5 years.

As Healio previously reported, patients with signs of atherosclerosis after stroke or TIA who achieved a LDL level of less than 70 mg/dL had lower risk for subsequent CV events compared with patients achieving LDL between 90 mg/dL and 110 mg/dL (adjusted HR = 0.78; 95% CI, 0.61-0.98).

Dual vs. monotherapy and lower target LDL

For the post hoc analysis, researchers evaluated whether dual therapy or statin monotherapy reduced risk for the primary outcome in patients who achieved a lower target LDL compared with a higher target LDL.

In the group assigned to the lower LDL target, those on dual therapy had higher mean LDL at baseline compared with patients on statin monotherapy (141 vs. 131 mg/dL; P < .001).

Mean achieved LDL was 66.2 mg/dL in the dual therapy group and 64.1 mg/dL in the statin monotherapy group.

Amarenco and colleagues reported that dual therapy for a lower target LDL was associated with lower risk for the primary outcome compared with a higher target LDL (HR = 0.6; 95% CI, 0.39-0.91; P = .016).

However, there was no association between statin monotherapy and lower risk for the primary outcome in the lower LDL target group compared with the higher target (HR = 0.92; 95% CI, 0.7-1.2; P = .52).

Risk for intracranial bleeding was also lower in patients on dual therapy with an LDL target of less than 70 mg/dL compared with all patients with higher target LDL (HR = 0.62; 95% CI, 0.41-0.94; P = .023).

“Explanation for such a different effect between dual therapy and statin monotherapy groups may be a higher baseline mean LDL cholesterol level in the dual therapy group, with consequently greater reduction in LDL cholesterol from baseline,” the researchers wrote. “Indeed, the effect of LDL-lowering therapy has always been associated with the magnitude of the reduction in LDL cholesterol from baseline.”

 

Carotid Atherosclerosis Evolution When Targeting a Low-Density Lipoprotein Cholesterol Concentration <70 mg/dL After an Ischemic Stroke of Atherosclerotic Origin

 Just maybe you want your hospital to be competent enough to know about and implement this. Your responsibility to get this done, your hospital will do nothing.  This probably would have solved my 80% carotid blockage which my hospital doctors never found.

Carotid Atherosclerosis Evolution When Targeting a Low-Density Lipoprotein Cholesterol Concentration <70 mg/dL After an Ischemic Stroke of Atherosclerotic Origin

Pierre Amarenco

,

Cristina Hobeanu

,

Julien Labreuche

,

Hugo Charles

,

Maurice Giroud

,

Elena Meseguer

,

Philippa C. Lavallée

,

Philippe Gabriel Steg

,

Éric Vicaut

,

Eric Bruckert

,

Pierre-Jean Touboul

Originally published29 Jun 2020https://doi.org/10.1161/CIRCULATIONAHA.120.046774Circulation. 2020;142:748–757

Abstract

Background:

The TST trial (Treat Stroke to Target) showed the benefit of targeting a low-density lipoprotein cholesterol (LDL-C) concentration of <70 mg/dL in terms of reducing the risk of major cardiovascular events in 2860 patients with ischemic stroke with atherosclerotic stenosis of cerebral vasculature. The impact on carotid atherosclerosis evolution is not known.

Methods:

TST-PLUS (Treat Stroke to Target–Plaque Ultrasound Study) included 201 patients assigned to an LDL-C concentration of <70 mg/dL and 212 patients assigned to a target of 100±10 mg/dL. To achieve these goals, investigators used the statin and dosage of their choice and added ezetimibe as needed. Ultrasonographers were certified and carotid ultrasound examinations were performed using M′Ath software at baseline and at 2, 3, and 5 years. All images were uploaded to the Intelligence in Medical Technologies database directly from the carotid ultrasound device. The central core laboratory performed all offline measurements of the intima–media thickness of both common carotid arteries blinded from the randomization arm. The main outcomes were newly diagnosed atherosclerotic plaque on carotid bifurcation or internal carotid artery using the Mannheim consensus definition and between-group comparison of common carotid arteries intima–media thickness change.

Results:

After a median follow-up of 3.1 years, the achieved LDL-C concentrations were 64 mg/dL (1.64 mmol/L) in the lower-target group and 106 mg/dL (2.72 mmol/L) in the higher-target group. Compared with the higher-target group, patients in the lower-target group had a similar incidence of newly diagnosed carotid plaque: 46/201 (5-year rate, 26.1%) versus 45/212 (5-year rate, 29.7%). The change in common carotid arteries intima–media thickness was −2.69 µm (95% CI, −6.55 to 1.18) in the higher-target group and −10.53 µm (95% CI, −14.21 to −6.85) in the lower-target group, resulting in an absolute between-group difference of −7.84 µm (95% CI, −13.18 to −2.51; P=0.004).

Conclusions:

In patients with ischemic stroke and atherosclerosis, an LDL-C target of <70 mg/dL (1.8 mmol/L) did not reduce the incidence of new carotid plaques but produced significantly greater regression of carotid atherosclerosis than an LDL-C target of 90 to 110 mg/dL.

Registration:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01252875.

 

Lower target LDL after stroke prevents 25% of events at 5 years

I have no clue what mine is or was, the doctor rattles off some numbers assuming I know what is being talked about. Do you really think your hospital will pick up on this and create a protocol for it?

Lower target LDL after stroke prevents 25% of events at 5 years

During the 5 years after a stroke, targeting LDL of less than 70 mg/dL prevented more than one-quarter of major CV events, recurrent cerebral infarction or urgent carotid revascularization and recurrent cerebral infarction or hemorrhage vs. an LDL target of less than approximately 100 mg/dL.
According to new data from the Treat Stroke to Target trial presented at the International Stroke Conference, the target LDL of less than 70 mg/dL in the 5-year period after stroke was associated with lower risk for the primary endpoint of stroke, MI, new symptoms requiring urgent coronary or carotid revascularization and CV death compared with target LDL of less than 100 ± 10 mg/dL (9.6% vs. 12.9%; HR = 0.74; 95% CI, 0.75-0.94).

The lower target LDL was also associated with reductions in cerebral infarction or urgent carotid revascularization (27%; P = .046), cerebral infarction or intracranial hemorrhage (28%; P = .023), and the primary outcome plus intracranial hemorrhage (25%; P = .022) vs. the higher target LDL.
The findings were simultaneously published in Stroke.
“In patients with ischemic stroke associated with atherosclerotic disease, as compared to a target LDL of 100 mg/dL, targeting LDL of less than 70 mg/dL during 5.3 years avoided one subsequent major vascular event in four and one ischemic stroke or intracranial hemorrhage in four without increasing the risk of intracranial hemorrhage, with a number needed to treat of 30, meaning that if you treat 30 patients you will avoid one stroke,” Pierre Amarenco, MD, of the department of neurology and stroke center at Bichat Hospital, University of Paris, said during the presentation. “This is a very important achievement for future guidelines.”
In other findings, intracranial hemorrhages occurred in 1.2% of patients assigned to LDL less than 70 mg/dL and in 1% of patients assigned to LDL less than 100 ± 10 mg/dL (HR = 1.17; 95% CI, 0.53-2.62).
Patients with proven ischemic stroke
“In a subanalysis, we found a strange result in patients with proven ischemic stroke, having a 37% relative risk reduction and no apparent benefit in patients with transient ischemic attack, that is, no ischemia proven on a brain imaging, with a significant interaction. It’s difficult to explain that,” Amarenco said during his presentation. “Perhaps there is too much noise in the diagnosis of transient ischemic attacks. This is possible and, in future trials, we should concentrate on patients with proven ischemic stroke.”

• 1
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Perspective

Larry B. Goldstein

The primary report was published in the New England Journal of Medicine earlier this year and showed the benefit of treatment with a statin targeting an LDL of approximately 70 mg/dL compared with 100 mg/dL on reducing major vascular events in participants who had an ischemic stroke or TIA related to atherosclerosis within the prior 3 months (22% reduction). The trial was conducted in France and Korea, which started enrollment later and where follow up was shorter (5.3 vs. 2 years).  Although there was no statistical heterogeneity based on country, there was no significant benefit in Korea. An exploratory analysis focused on France found a 26% reduction in major vascular events. The participants from Korea will continue to be followed to determine whether they also benefit. Overall, the results are consistent with exploratory analyses of the SPARCL trial that found a greater benefit with achieving an LDL of approximately 70 mg/dL and support this therapeutic target.

• Larry B. Goldstein, MD, FAAN, FANA, FAHA
• Cardiology Today Editorial Board Member
  University of Kentucky

FDA OK's New Cholesterol Drug

You'll want to talk to your doctor and read the comments associated with the article.

FDA OK's New Cholesterol Drug

First-in-class agent wins long-awaited approval

• by Nicole Lou, Staff Writer, MedPage Today February 21, 2020

WASHINGTON -- It's a green light for bempedoic acid (Nexletol): FDA approved the once-daily oral pill for low-density lipoprotein (LDL) cholesterol lowering as an adjunct to maximally tolerated statin therapy, the agency announced.
With this approval, bempedoic acid is now indicated for people with heterozygous familial hypercholesterolemia (FH) or established atherosclerotic cardiovascular disease who require additional lowering with hypercholesterolemia. Bempedoic acid is an oral adenosine triphosphate (ATP) citrate lyase inhibitor from Esperion Therapeutics that reduces cholesterol and fatty acid synthesis in the liver.
The pill is to be taken at 180 mg orally once daily with or without food. The drug label warns against concomitant use with simvastatin greater than 20 mg or pravastatin greater than 40 mg.
Bempedoic acid marks the first oral non-statin drug for LDL reduction to be approved in nearly two decades. Reuters reported the drug would be sold at roughly $10 a pill.
FDA approval for the drug was based on LDL-lowering and safety data from several phase III pivotal trials. The last of these to be reported was 2018's CLEAR Wisdom, which showed a 17% reduction in LDL with 12 weeks of bempedoic acid compared with placebo among 779 patients with atherosclerotic cardiovascular disease (ASCVD) or heterozygous FH already on maximally tolerated statin treatment.
Separately, the CLEAR Harmony safety study of 2,230 people showed that the drug reduced mean LDL cholesterol level by 16.5% but was associated with more adverse events leading to discontinuation and a higher incidence of gout.
Given bempedoic acid's modest magnitude of efficacy, its main clinical application is likely to be in combination with ezetimibe in patients unwilling to take a statin, according to Jennifer Robinson, MD, MPH, of the University of Iowa in Iowa City.
Esperion had waited years for the FDA to give the go-ahead to market bempedoic acid in the U.S.
In 2016, FDA first accepted the New Drug Application (NDA) for the fixed dose combination of bempedoic acid 180 mg and ezetimibe 10 mg. There was concern back then that the agency would cease to favor LDL as a surrogate endpoint when there were no data on hard outcomes like death and myocardial infarction to support the drug's actual clinical benefits.
In March 2017, the FDA said it would continue to consider LDL data in considering approval for an LDL-lowering indication for bempedoic acid. The agency stipulated, however, that it would still require a cardiovascular outcomes trial before approving the drug for a cardiovascular risk reduction indication.
In 2019, upon completion of the phase III studies, Esperion had a new round of NDAs accepted for bempedoic acid alone and in combination with ezetimibe.
The CLEAR outcomes trial won't have data reported until 2022 at the earliest. It is expected to enroll 12,600 statin-intolerant patients with or at high risk for cardiovascular disease.
"As we have seen for many drugs in the past, such as torcetrapib, estrogen, and others, a drug could lower LDL and still be bad for patients. Without data of clinical benefits, I will not be using bempedoic acid," said Rita Redberg, MD, of the University of California San Francisco Health.
In the meantime, patients with high cholesterol continue to have options such as statins and PCSK9 inhibitors.
"Statins are still first line and that shouldn't change given the extensive data for CVD lowering," commented Amit Khera, MD, of UT Southwestern Medical Center in Dallas. "However, there is a niche here for the patients that truly can't tolerate a statin or an adequate dose of statin. PCSK9 inhibitors are a good option but can be a challenge to obtain and are not cost effective in those without ASCVD, FH, or very high-risk conditions."
Bempedoic acid is not yet approved in Europe, though the European Medicines Agency's Committee for Medicinal Products for Human Use recently recommended approval.
The bempedoic acid/ezetimibe combination tablet has yet to be approved by the FDA; its PDUFA date is Feb. 27.
The fixed-dose combination pill cut LDL by 32% in a phase III study reported in 2018 involving 382 patients with ASCVD, or at high risk for ASCVD, on maximally tolerated statins.

Lower LDL target beneficial after stroke

I suppose I should look into my medical records and see what my LDL is. 

Lower LDL target beneficial after stroke

Pierre Amarenco

PHILADELPHIA — Among patients with signs of atherosclerosis following stroke or transient ischemic attack, those who achieved a target LDL level of less than 70 mg/dL had lower risk for subsequent CV events than patients achieving LDL levels between 90 and 110 mg/dL, according to findings presented at the American Heart Association Scientific Sessions.
In the Treat Stroke to Target trial of 2,860 patients with stroke or TIA (mean LDL at baseline, 135 mg/dL), those assigned to a regimen to treat LDL level to a target of < 70 mg/dL had a lower incidence of the primary endpoint of subsequent stroke, MI, urgent revascularization, or CV death at a median follow-up of 3.5 years compared with patients assigned a regimen to achieve LDL 90 mg/dL to 110 mg/dL (adjusted HR = 0.78; 95% CI, 0.61-0.98).

The primary endpoint occurred in 8.5% of the lower-target group, which achieved a mean LDL of 65 mg/dL, and in 10.9% of the higher-target group, which achieved a mean LDL of 98 mg/dL, according to the researchers.
The findings were simultaneously published in The New England Journal of Medicine.
The trial was stopped for administrative reasons after 277 of an anticipated 385 endpoint events had occurred, according to the presentation.
“With the limitation that we had to stop the trial ... it showed that after an ischemic stroke with evidence of atherosclerosis, the target LDL cholesterol of less than 70 mg/dL compared to 100 mg/dL reduces the risk of subsequent cardiovascular events,” Pierre Amarenco, MD, chairman of the department of neurology and the Stroke Center at Bichat Hospital and professor of neurology at Xavier Bichat Medical School and Denis Diderot University in Paris, said during the presentation. “We also saw no significant increase in intracranial hemorrhage or in newly diagnosed diabetes.”
Methods and limitations
In this parallel-group trial conducted in France and South Korea, all patients (mean age, 67 years; 68% men) had evidence of cerebrovascular or coronary artery atherosclerosis and received a statin and/or ezetimibe.
“The extension of the trial by the sponsor allowed follow-up for every patient until the end of the trial rather than for 3 years, as initially planned,” the researchers wrote in NEJM. “This allowed for the observed 277 events to provide a sufficient power to detect a 25% lower relative risk in the lower-target group, as hypothesized in the original trial design.”

Rethinking good cholesterol A high HDL cholesterol level may not be as beneficial as once believed.

What does your doctor think?
http://www.health.harvard.edu/heart-health/rethinking-good-cholesterol?utm_source=delivra&utm_medium=email&utm_campaign=WR20170707-Cholesterol&utm_id=557639&dlv-ga-memberid=10994398&mid=10994398&ml=557639
If you're hoping to avoid heart disease, you probably keep tabs on your blood cholesterol values — especially your low-density lipoprotein (LDL), or "bad" cholesterol. Too much LDL in the bloodstream helps to create the plaque that accumulates inside arteries, raising the risk of a heart attack. The lower your LDL, the lower your risk of having a heart attack.
In contrast, high-density lipoprotein (HDL) has long been known as the "good" cholesterol. These particles are known to patrol blood vessels, grabbing cholesterol from both the bloodstream and artery walls and ferrying it to the liver for recycling and disposal. In population-based studies, people with high HDL levels tend to have fewer heart attacks, while those with lower HDL values have more.

HDL: Just a bystander?

But the HDL story is more complex than doctors initially thought. It turns out that not all HDL is created equal (see "The many faces of HDL"). Instead of acting as the good guy that helps lower heart disease risk, HDL may be more of a bystander.
"We're now realizing that HDL appears to be a marker for other factors that raise or lower the risk of a heart attack," says Dr. Christopher Cannon, professor of medicine at Harvard Medical School and a cardiologist at Brigham and Women's Hospital.
People with low HDL levels (see "Lipid lowdown: The numbers to know") tend to have other problems closely linked to higher cardiovascular risk, such as being overweight and having diabetes. "When you see a low HDL value, it's often a middle-aged man with a big belly who has high blood sugar and high blood pressure," says Dr. Cannon. It may be that those factors, rather than the low HDL, are behind the higher risk, he explains.

The many faces of HDL Cholesterol, a waxy, pale yellow lipid, travels through the bloodstream in tiny, protein-covered particles called lipoproteins that mix easily with blood. While low-density lipoproteins (LDL) are rich in cholesterol, high-density lipoproteins (HDL) contain more protein. But that's just the beginning: there are also very-low-density and intermediate-density particles, as well as subcategories within these different lipoprotein classes. HDL, for example, comes in different shapes and sizes. Some types are spherical, while others are doughnut-shaped. Some types of HDL are great at plucking cholesterol from LDL and artery walls, while other types are indifferent to cholesterol, and some even transfer cholesterol the wrong way — into LDL and cells. Researchers are investigating this phenomenon using a test known as cholesterol efflux capacity testing. Currently available only in research settings, the test reveals how effective HDL particles are at moving cholesterol out of plaques and back to the liver. Preliminary findings suggest that high scores are linked to a lower heart disease risk, meaning the test might one day prove useful for predicting heart attack risk.

Genetic research and drug trials

But two major lines of evidence have also put HDL in a less-than-positive light. The first comes from studies of people with genetic mutations that cause high HDL. If high HDL truly protects against heart disease, those people should have fewer heart attacks. But they don't — they're just as likely to have heart disease as people without HDL-raising mutations. The second body of evidence is perhaps even more incriminating: To date, five major clinical trials that sought to raise HDL levels with drugs have failed to lower heart disease risk. These trials included several investigational new drugs as well as an old standby, niacin. Many people continue to take niacin, despite the fact that last year, the FDA withdrew its approval for using niacin-containing drugs as add-on drugs for treating cholesterol problems, Dr. Cannon notes.
What does all this mean for people with low HDL? Think of it as a warning to pay attention to your other numbers, especially your LDL, which should still be your primary focus. Aim for an LDL of 100 or lower, ideally through lifestyle changes such as weight loss, a healthy diet, and exercise, plus cholesterol-lowering statins, if indicated. These measures — especially exercise — may also nudge up your HDL. Vigorous workouts that make you sweat seem to be the most effective.
On the flip side, people with high HDL shouldn't assume that it cancels out a high LDL, as some physicians still believe. Again, your main goal should be to keep your LDL in a healthy range, Dr. Cannon says.

Lipid lowdown: The numbers to know
Test	General desirable level
Total cholesterol	Under 200mg/dL
LDL cholesterol	Under 100 mg/dL
HDL cholesterol	Over 40 mg/dL for a man, over 50 mg/dL for a woman
Tryglycerides	Under 150 mg/dL

Discovery Could Help Doctors Spot Cardiovascular Disease at Earlier Stage

See what your doctor thinks of this, would it have predicted your event?
http://www.rdmag.com/news/2017/02/discovery-could-help-doctors-spot-cardiovascular-disease-earlier-stage?
Screening methods for cardiovascular diseases such as heart attacks and strokes could be improved by measuring different biological signposts to those currently being tested, a new study led by researchers from King's College London suggests.
Published in the Journal of the American College of Cardiology, the study could allow doctors to better predict the development of cardiovascular disease at an earlier stage.
The research, which was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, explored the role of a family of proteins called apolipoproteins.
Currently, the main focus is on apolipoprotein A1 (apoA1), the main component of high-density lipoproteins (HDL) or 'good' cholesterol, and apolipoprotein B (apoB), which is present on low-density lipoproteins (LDL) or 'bad' cholesterol.
However, for the first time, researchers have used a technology called mass spectrometry to measure an unprecedented number of apolipoproteins in a population-based study and discovered that another group of apolipoproteins might complement the signposts of good and bad cholesterol: apoE, apoC2 and apoC3.
These apolipoproteins are associated with very low-density lipoproteins (VLDL) and predominantly linked to another type of fat called triglycerides. ApoE, apoC2 and apoC3 have shown a stronger association with cardiovascular disease than apoA1 and apoB, suggesting that currently some of the most predictive apolipoproteins are not measured in patients who may be at risk of cardiovascular disease.
The findings could lead to a change in the way patients all over the world are screened for cardiovascular disease, a condition which affects seven million people and causes more than 160,000 deaths in each year in the UK. It could also pave the way for more personalised treatments.
Lead author of the study Professor Manuel Mayr from King's College London said:
"We directly compared the association of a broad panel of apolipoproteins to new onset of cardiovascular disease over a 10-year observation period, and found that while apoB was predictive, other apolipoproteins, namely apoE, apoC2 and apoC3, were even better.
"These unexpected strong associations of VLDL-associated apolipoproteins with cardiovascular disease provide support to expanding the current measurements of apolipoproteins and to the concept of targeting additional apolipoproteins to reduce risk."
The study identified apoC3 as a prime therapeutic target for lowering VLDL, which might reduce excess cardiovascular risk related to high VLDL.

Review of clinical trials suggests eating oats can lower cholesterol levels as measured by a variety of markers

I bet your doctor will not use this to update your diet stroke protocol and allow you not to take statins. Do not do this on your own, that would be dangerous and stupid.
http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2016/1011

Toronto, October 11, 2016
By Leslie Shepherd

Researchers have known for more than 50 years that eating oats can potentially lower cholesterol levels and thus reduce a person’s risk of developing cardiovascular disease.
Studies during that time have focused on the impact of oats on levels of LDL (or “lousy”) cholesterol, which collects in the walls of blood vessels where it can cause blockages or blood clots.
But there is growing evidence that two other markers provide an even more accurate assessment of cardiovascular risk -- non-HDL cholesterol (total cholesterol minus the “H” or “healthy cholesterol”) and apolipoprotein B, or apoB, a lipoprotein that carries bad cholesterol through the blood. This is especially true for people with metabolic syndrome and Type 2 diabetes, since they typically do not have elevated LDL cholesterol levels.
A new systematic review and meta-analysis of randomized controlled trials has concluded that eating oat fibre can reduce all three markers. The study, led by Dr. Vladimir Vuksan, a research scientist and associate director of the Risk Factor Modification Centre of St. Michael’s Hospital, was published online in the British Journal of Nutrition.
Dr. Vuksan said oats are a rich source of beta-glucan, a viscous soluble fibre, which seems to be responsible for the beneficial effects. The first study of its kind, published in 1963, found that substituting white bread with oat bread containing 140g of rolled oats lowered LDL cholesterol.
Dr. Vuksan’s group looked at 58 clinical trials involving almost 4,000 people from around the world that assessed the effect of diets enriched with oat beta-glucan compared with controlled diets on LDL cholesterol, and, for the first time, on non-HDL cholesterol and apoB as well.
“Diets enriched with about 3.5 grams a day of beta-glucan fiber from oats were found to modestly improve LDL cholesterol, but also non-HDC and apoB compared to control diets,” Dr. Vuksan said.
The review found that overall, LDL cholesterol was reduced by 4.2 per cent, non-HDL cholesterol by 4.8 per cent and apoB by 2.3 per cent.
Dr. Vuksan said it could be difficult for people to consume the recommended amount of oat fiber by eating oat meal alone so he recommends people increase their consumption of oat bran. For example, one cup of cooked oat bran (88 calories) contains the same quantity of beta-glucan as double the amount of cooked oat meal (166 calories). Oat bran can also be eaten as a cereal, used in some baked goods (although since it is low in gluten, the texture may be tough) or sprinkled on other foods.
Canada is the third largest producer of oats in the world, so increasing consumption is good for health and the economy as well, Dr. Vuksan said. Consumption of oats has been declining considerably for many years.


This paper is an example of how St. Michael's Hospital is making Ontario Healthier, Wealthier, Smarter.

No association between 'bad cholesterol' and elderly deaths, new study says

Ok, studies were wrong about fat, which only took 40+ years to find. How many decades before new protocols are written for cholesterol, especially since statin treatment for cholesterol was just updated Nov. 2014.
Do not stop on your own, you don't want to get ahead of your doctor. Over 60, interesting I just hit 60. Well 25% of the cholesterol in your body is in your brain, so disturbing that balance could cause problems. Ask your doctor these simple questions.
http://medicalxpress.com/news/2016-06-association-bad-cholesterol-elderly-deaths.html

A University of South Florida professor and an international team of experts have found that older people with high levels of a certain type of cholesterol, known as low-density lipoprotein (LDL-C), live as long, and often longer, than their peers with low levels of this same cholesterol.
The findings, which came after analyzing past studies involving more than 68,000 participants over 60 years of age, call into question the "cholesterol hypothesis," which previously suggested people with high cholesterol are more at risk of dying and would need statin drugs to lower their cholesterol.
Appearing online this month in the open access version of the British Medical Journal, the research team's analysis represents the first review of a large group of prior studies on this issue.
"We have known for decades that high total cholesterol becomes a much weaker risk for cardiovascular disease with advancing age," said Diamond. "In this analysis, we focused on the so-called "bad cholesterol" which has been blamed for contributing to heart disease."
According to the authors, either a lack of association or an inverse relationship between LDL-C and cardiovascular deaths was present in each of the studies they evaluated. Subsequently, the research team called for a reevaluation of the need for drugs, such as statins, which are aimed at reducing LDL-C as a step to prevent cardiovascular diseases.
"We found that several studies reported not only a lack of association between low LDL-C, but most people in these studies exhibited an inverse relationship, which means that higher LDL-C among the elderly is often associated with longer life," said Diamond.
Diamond also points out the research that suggests that high cholesterol may be protective against diseases which are common in the elderly. For example, high levels of cholesterol are associated with a lower rate of neurological disorders, such as Parkinson's disease and Alzheimer's disease. Other studies have suggested that high LDL-C may protect against some often fatal diseases, such as cancer and infectious diseases, and that having low LDL-C may increase one's susceptibility to these diseases.
"Our results pose several relevant questions for future," said study leader and co-author health researcher Dr. Uffe Ravnskov. "For example, why is total cholesterol a factor for cardiovascular disease for young and middle-age people, but not for the elderly? Why do a substantial number of elderly people with high LDL-C live longer than elderly people with low LDL-C?"
Diamond and colleagues have published a number of studies relating to the use and possible misuse of statins for treating cholesterol. Those studies, including their recent paper published in the medical journal Expert Review of Clinical Pharmacology, which demonstrated that the benefits of taking statins have been exaggerated and are misleading.
"Our findings provide a contradiction to the cholesterol hypothesis," concluded Diamond. "That hypothesis predicts that cardiovascular disease starts in middle age as a result of high LDL-C cholesterol, worsens with aging, and eventually leads to death from cardiovascular disease. We did not find that trend. If LDL-C is accumulating in arteries over a lifetime to cause heart disease, then why is it that elderly people with the highest LDL-C live the longest? Since people over the age of 60 with high LDL-C live the longest, why should we lower it?"

Explore further: US regulators give limited approval to cholesterol drug

Journal reference: British Medical Journal (BMJ)

VIDEO: Understanding mechanisms of LDL, arteries removes ‘black magic’

Sorry Dr. Ira Tabas you still have it wrong. You should be stopping the inflammation that grabs the LDL out of the bloodstream. Please learn about cause and effect. This was written way back in 2002 in the AHA journal Circulation. Solve the correct problem. As a programmer my managers always insisted I fix the root cause of any problem, not incidental ones or side effects.
http://www.healio.com/cardiology/chd-prevention/news/online/%7B6eda57a2-e8dd-412f-b00c-6f9d00692e1e%7D/video-understanding-mechanisms-of-ldl-arteries-removes-black-magic?utm_source=maestro&utm_medium=email&utm_campaign=cardiology%20news
Ira Tabas, MD, PhD, of Columbia University Medical Center, highlights the clinical relevance of gaining clarity on the interplay between LDL and CVD in improving patient care.

“When you have firm understanding of mechanism, it makes treatment choices a lot easier,” he said. “It helps to understand why lowering LDL helps us. … It takes away a lot of the black magic.”

Tabas details the damage done to the arterial wall caused by floating LDL particles, the effects on blood flow and the resulting CV events.

“It’s really very simple in terms of the LDL getting in or not getting in,” he said. “If we prevent it from getting in … there’s less probability that the LDL will do its damage in the arterial wall.”

Tabas touches on therapeutic approaches known to lower LDL, underscores questions that remain as to their role in reducing CVD and expresses hope that “having a mechanistic underpinning for interpreting the clinical data” will reap benefits.

 

Milk proteins may protect against cardiovascular disease

Even if true I bet your doctor has never talked to the hospital nutritionist to get a proper stroke diet protocol created for survivors. You'll have to call the hospital president with your findings of how incompetent your stroke department is.
http://loonylabs.org/2015/06/11/milk-proteins-protect-against-cardiovascular-disease/
The Maillard reaction is a chemical reaction between amino acids and reducing sugars that results in browned foods like seared steaks and toasted bread. When proteins and sugars are mixed together and heated, new chemical compounds are formed. Some are responsible for new flavors and some, according to a new study, may protect us against cardiovascular disease. Researchers at the R&D Center, Seoul Dairy Cooperative, the College of Life Science & Biotechnology, Korea University, and the BK21 Plus Graduate Program, Department of Animal Science and Institute Agricultural Science & Technology, Chonbuk National University in South Korea, have determined that dietary compounds formed in milk-based products lowered serum total and low-density lipoprotein (LDL) cholesterol levels and triglycerides in mice. These compounds also protected against acute pulmonary thromboembolism as well as aspirin, but without the possible bleeding consequences often observed in aspirin therapy. Whey protein concentrate and sodium caseinate were heated with lactose to form whey-protein Maillard reaction products (wMRP). Lactic acid bacteria were then used to produce fermented MRPs (f-MRP). Sodium caseinate alone was also reacted to form Maillard-reacted sodium caseinate (cMRP) and further fermented to f-cMRP. To determine antithrombotic effects, 60 mice were divided into four treatment groups of 15. Group one received phosphate buffered saline (PBS) (negative control), group two received aspirin (positive control), group three received wMRP, and group four received f-MRP in addition to a normal diet. Assessment of antioxidant activity and cholesterol reduction effect of fermented cMRP was done with another group of 60 mice fed various diets with and without f-cMRP.

Consuming whole eggs may improve blood lipids, new research suggests

Your doctor should know all about this, so ask him/her.  Or maybe you'd rather consume brains to get your cholesterol.
http://www.news-medical.net/news/20121215/Consuming-whole-eggs-may-improve-blood-lipids-new-research-suggests.aspx

New research suggests that consuming whole eggs may improve blood lipids

It is estimated that 34% of Americans are affected by an increasingly prevalent condition known as metabolic syndrome which is a combination of at least three of the following risk factors: large waistline, high triglycerides, low HDL cholesterol, high blood pressure and elevated blood sugar. These individuals have a variety of risk factors that increase the likelihood of developing diabetes and cardiovascular disease. Decades of mixed messaging regarding dietary cholesterol have led to avoidance of certain foods, such as eggs, particularly among individuals who are faced with health conditions. However, a recent study published in Metabolism suggests that including whole eggs as part of a weight loss diet may have positive effects on lipoprotein profiles for individuals with metabolic syndrome.
In this study, middle-aged men and women with metabolic syndrome consumed either three whole eggs or an equivalent amount of egg substitute daily as part of a carbohydrate-restricted, weight loss diet. Although participants eating the whole eggs were consuming twice as much cholesterol as they had at the beginning of the study, the researchers observed no effects on total blood cholesterol or LDL cholesterol levels after 12 weeks on the diet. All participants, including those consuming whole eggs, had improved lipid profiles with decreases in plasma triglycerides and increases in HDL cholesterol.
"Eating egg yolks was actually associated with enhanced health benefits in these high-risk individuals," explains Dr. Maria Luz Fernandez, lead study author and Professor at the University of Connecticut, "Subjects consuming whole eggs had greater increases in HDL cholesterol and more significant reductions in the LDL/HDL cholesterol ratio than those who ate the cholesterol-free egg substitute."

Discovery: Resistin Protein Causes High Levels Of LDL Cholesterol

A serious question for your doctor, and don't allow them to throw up their hands and say 'I don't know'. Send them back to study the issue and report back to you.  You are paying them for their expertise, so have them display it.
http://www.science20.com/news_articles/discovery_resistin_protein_causes_high_levels_ldl_cholesterol-95725
Researchers have discovered that the protein resistin, which is secreted by fat tissue, causes high levels of "bad" cholesterol (low-density lipoprotein or LDL), increasing the risk of heart disease.

High blood cholesterol is a major risk factor for heart disease and stroke. It can lead to a buildup of plaque in the artery walls and narrowing of the arteries, causing atherosclerosis, which can make it more difficult for blood to flow through the heart and body.

Rest at the link.

Vitamin D supplement fails to lower cholesterol in short term

So ask your doctor what you should do.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=123605&CultureCode=en
Taking vitamin D supplements to compensate for vitamin D deficiency didn’t improve cholesterol — at least in the short term, according to new research in Arteriosclerosis, Thrombosis and Vascular Biology, an American Heart Association journal.
Researchers studied 151 people with vitamin D deficiency who received either a mega-dose (50,000 internationals units) of vitamin D3 or placebo weekly for eight weeks. Participants’ cholesterol levels were measured before and after treatment.
Correcting vitamin D deficiencies with high doses of oral vitamin D supplements did not change cholesterol levels, researchers found. This was despite effectively increasing vitamin D to recommended levels. Vitamin D levels nearly tripled in the group that received actual supplements, but were unchanged in the placebo group.
“Our study challenges the notion that vitamin D repletion improves cholesterol levels” said Manish Ponda, M.D., M.S., study lead author and assistant professor of clinical investigation in Dr. Jan Breslow’s laboratory of biochemical genetics and metabolism at The Rockefeller University in New York, N.Y. “These clinical trial results confirm those from a recent data mining study.”
The researchers also tested the effect of vitamin D supplementation on more sophisticated biomarker measures of cholesterol, such as particle size and number. “These measures of cholesterol, which are not used in routine clinical practice, also did not change in response to vitamin D therapy,” Ponda said.
As expected, replenishing subjects with high-dose supplements of oral vitamin D decreased parathyroid hormone levels and increased calcium levels — physical functional changes that were linked to participants’ increase in low-density lipoprotein (LDL, bad cholesterol).
“For example, participants receiving vitamin D who had an increase in calcium levels experienced a 7 percent increase in LDL cholesterol, while those whose calcium levels fell or did not change had a 5 percent decrease in LDL cholesterol,” Ponda said.
The study questions the use of vitamin D supplements to improve cholesterol, Ponda said. While the dose of vitamin D in this study was high, it was appropriate for correcting a vitamin D deficiency over an eight week period.
However, longer-term studies on the impact of the changes in LDL cholesterol as a result of high dose vitamin D supplementation are needed to make stronger recommendations. And questions remain about whether increasing vitamin D levels with exposure to sunlight, the predominant natural source, would have a different effect than with high-dose oral supplements.
To address these issues, Ponda and Breslow will begin another clinical trial this fall, comparing the effect of oral vitamin D to ultraviolet light exposure with a longer follow-up period.

I am however taking this because it might help fatigue. 
Or maybe to prevent muscle atrophy.
Or fall prevention.

Boosting good cholesterol could reduce cancer risk

I bolded the interesting part about bad cholesterol. Talk to your doctor about what statins really do for you. Wonder why this is from 2009 and just shows up now.
http://www.tuftsmedicalcenter.org/AboutUs/NewsReleases/2009NewsReleases/AHA_Scientific_Sessions_HDL_C

Data released today at the American Heart Association (AHA) Scientific Sessions 2009 demonstrate reduced cancer risk with increased levels of HDL-C (high density lipoprotein cholesterol, which is known as “good cholesterol” because of its ability to reduce heart disease risk). The data show a 21% (95% CI: 8%-33%) relative reduction in the rate of cancer incidence with every 10 point increase (10 mg/dl) in HDL-C (p = 0.05). The decrease in cancer risk with increasing HDL-C levels was even stronger when adjusted for baseline LDL-C (low density lipoprotein cholesterol), age, BMI and smoking status (p = 0.004).

“It may be that the anti-inflammatory and anti-oxidant properties of HDL-C help to counteract the inflammatory processes that cause cancer cells to multiply, and I believe future studies on this mechanism are necessary” said Richard Karas, MD, PhD, Professor of Medicine, Tufts University School of Medicine and Associate Director, Molecular Cardiology Research Institute, Tufts Medical Center, who led this research. “These data further support how important it is for researchers and clinicians to move away from looking only at the total cholesterol and instead to focus more on the various components of total cholesterol.”

Results demonstrate cancer risk is reduced with increased levels of HDL-C, independent of LDL-C, age, BMI and smoking status, based on a meta-analysis of 21 related randomized-controlled trials involving 586,528 person-years of follow-up, and 7,928 incident cancers, over a median follow-up of five years (interquartile range 2.9 - 5.1).

Findings also confirm previous data by the same research group at Tufts Medical Center demonstrating that increasing LDL-C (“bad cholesterol”) levels are associated with a decreased risk of cancer incidence, and reaffirmed a well-known association between increased age and increased cancer risk. Interestingly, the study found a connection between BMI (Body Mass Index, a statistical measurement of body fat and, therefore, obesity) and cancer risk, which was no longer significant when researchers adjusted for HDL-C.

About Tufts Medical Center and Floating Hospital for Children

Tufts Medical Center is an exceptional, not-for-profit, 451-bed academic medical center that is home to both a full-service hospital for adults and Floating Hospital for Children. Conveniently located in downtown Boston, the Medical Center is the principal teaching hospital for Tufts University School of Medicine. Founded in 1796 as the Boston Dispensary, Tufts Medical Center is the oldest permanent medical facility in New England and one of the first hospitals in the nation. For more than 200 years, Tufts Medical Center has pioneered innovative programs in clinical care and research and is a recognized leader in cancer care, cardiology, neurosciences, organ transplantation and pediatrics. More information is available at www.tuftsmedicalcenter.org.