Regulation of cholesterol synthesis
Biosynthesis of cholesterol is directly regulated by the cholesterol levels present, though the homeostatic mechanisms involved are only partly understood. A higher intake from food leads to a net decrease in endogenous production, whereas lower intake from food has the opposite effect. The main regulatory mechanism is the sensing of intracellular cholesterol in the endoplasmic reticulum by the protein SREBP (sterol regulatory element-binding protein 1 and 2).[22] In the presence of cholesterol, SREBP is bound to two other proteins: SCAP (SREBP-cleavage-activating protein) and Insig1. When cholesterol levels fall, Insig-1 dissociates from the SREBP-SCAP complex, allowing the complex to migrate to the Golgi apparatus, where SREBP is cleaved by S1P and S2P (site-1 and -2 protease), two enzymes that are activated by SCAP when cholesterol levels are low. The cleaved SREBP then migrates to the nucleus and acts as a transcription factor to bind to the SRE (sterol regulatory element), which stimulates the transcription of many genes. Among these are the low-density lipoprotein (LDL) receptor and HMG-CoA reductase. The former scavenges circulating LDL from the bloodstream, whereas HMG-CoA reductase leads to an increase of endogenous production of cholesterol.[23] A large part of this signaling pathway was clarified by Dr. Michael S. Brown and Dr. Joseph L. Goldstein in the 1970s. In 1985, they received the Nobel Prize in Physiology or Medicine for their work. Their subsequent work shows how the SREBP pathway regulates expression of many genes that control lipid formation and metabolism and body fuel allocation.
Cholesterol synthesis can be turned off when cholesterol levels are high, as well. HMG CoA reductase contains both a cytosolic domain (responsible for its catalytic function) and a membrane domain. The membrane domain functions to sense signals for its degradation. Increasing concentrations of cholesterol (and other sterols) cause a change in this domain's oligomerization state, which makes it more susceptible to destruction by the proteosome. This enzyme's activity can also be reduced by phosphorylation by an AMP-activated protein kinase. Because this kinase is activated by AMP, which is produced when ATP is hydrolyzed, it follows that cholesterol synthesis is halted when ATP levels are low.[24]
Monday, July 18, 2011
Cholesterol
Here we present you the newest information of the Cholesterol. We provide you the meaning of the Cholesterol and how to prevent this Cholesterol that come to our body.
Cholesterol is a waxy steroid of fat that is manufactured in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals.[2] It is an essential structural component of mammalian cell membranes. It is required to establish proper membrane permeability and fluidity. In addition cholesterol is an important component for the manufacture of bile acids, steroid hormones, and Vitamin D. Cholesterol is the principal sterol synthesized by animals; however, small quantities can be synthesized in eukaryotes such as plants and fungi. It is almost completely absent among prokaryotes including bacteria.[3] Although cholesterol is important and necessary for mammals, high levels of cholesterol in the blood can damage arteries and are potentially linked to diseases such as those associated with the cardiovascular system (heart disease).[4]
The name cholesterol originates from the Greek chole- (bile) and stereos (solid), and the chemical suffix -ol for an alcohol. François Poulletier de la Salle first identified cholesterol in solid form in gallstones, in 1769. However, it was only in 1815 that chemist Eugène Chevreul named the compound "cholesterine".[5]
Contents
[hide]
* 1 Physiology
o 1.1 Function
o 1.2 Dietary sources
o 1.3 Biosynthesis
o 1.4 Regulation of cholesterol synthesis
o 1.5 Plasma transport and regulation of absorption
o 1.6 Metabolism, recycling and excretion
* 2 Significance
o 2.1 Hypercholesterolemia
o 2.2 Hypocholesterolemia
o 2.3 Cholesterol testing
* 3 Interactive pathway map
* 4 Cholesteric liquid crystals
* 5 See also
* 6 Additional images
* 7 References
* 8 External links
[edit] Physiology
Since cholesterol is essential for all animal life, it is primarily synthesized from simpler substances within the body. However, high levels in blood circulation, depending on how it is transported within lipoproteins, are strongly associated with progression of atherosclerosis. For a person of about 68 kg (150 pounds), typical total body cholesterol synthesis is about 1 g (1,000 mg) per day, and total body content is about 35 g. Typical daily additional dietary intake in the United States is 200–300 mg.[citation needed] The body compensates for cholesterol intake by reducing the amount synthesized.
Cholesterol is recycled. It is excreted by the liver via the bile into the digestive tract. Typically about 50% of the excreted cholesterol is reabsorbed by the small bowel back into the bloodstream. Phytosterols can compete with cholesterol reabsorption in the intestinal tract, thus reducing cholesterol reabsorption.[6]
Cholesterol is a waxy steroid of fat that is manufactured in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals.[2] It is an essential structural component of mammalian cell membranes. It is required to establish proper membrane permeability and fluidity. In addition cholesterol is an important component for the manufacture of bile acids, steroid hormones, and Vitamin D. Cholesterol is the principal sterol synthesized by animals; however, small quantities can be synthesized in eukaryotes such as plants and fungi. It is almost completely absent among prokaryotes including bacteria.[3] Although cholesterol is important and necessary for mammals, high levels of cholesterol in the blood can damage arteries and are potentially linked to diseases such as those associated with the cardiovascular system (heart disease).[4]
The name cholesterol originates from the Greek chole- (bile) and stereos (solid), and the chemical suffix -ol for an alcohol. François Poulletier de la Salle first identified cholesterol in solid form in gallstones, in 1769. However, it was only in 1815 that chemist Eugène Chevreul named the compound "cholesterine".[5]
Contents
[hide]
* 1 Physiology
o 1.1 Function
o 1.2 Dietary sources
o 1.3 Biosynthesis
o 1.4 Regulation of cholesterol synthesis
o 1.5 Plasma transport and regulation of absorption
o 1.6 Metabolism, recycling and excretion
* 2 Significance
o 2.1 Hypercholesterolemia
o 2.2 Hypocholesterolemia
o 2.3 Cholesterol testing
* 3 Interactive pathway map
* 4 Cholesteric liquid crystals
* 5 See also
* 6 Additional images
* 7 References
* 8 External links
[edit] Physiology
Since cholesterol is essential for all animal life, it is primarily synthesized from simpler substances within the body. However, high levels in blood circulation, depending on how it is transported within lipoproteins, are strongly associated with progression of atherosclerosis. For a person of about 68 kg (150 pounds), typical total body cholesterol synthesis is about 1 g (1,000 mg) per day, and total body content is about 35 g. Typical daily additional dietary intake in the United States is 200–300 mg.[citation needed] The body compensates for cholesterol intake by reducing the amount synthesized.
Cholesterol is recycled. It is excreted by the liver via the bile into the digestive tract. Typically about 50% of the excreted cholesterol is reabsorbed by the small bowel back into the bloodstream. Phytosterols can compete with cholesterol reabsorption in the intestinal tract, thus reducing cholesterol reabsorption.[6]
Monday, March 16, 2009
Healthy, Low-Fat Soup: Recipes and Tips
Healthy, Low-Fat Soup: Recipes and Tips
One of the best "light" dinner options when the weather is cold is soup! Just pair a big bowl of soup with a wheat roll or some wheat crackers, and call it a meal. I always have some favorite canned soups in my pantry so anyone in the family can serve themselves some soup in l5 minutes. But there's something to be said for slowly simmering a homemade pot of soup over the stove until the flavors meld together perfectly. From chicken matzo ball soup to hearty lentil soup, it can really hit the spot on a cold day or night. Read on for some healthy and low-fat soup recipes, as well as tips on how to make any soup recipe lighter.
Soup for Supper
Can soup suffice as supper? If you are accustomed to eating light at night -- or if this is something you're moving toward -- a bowl of soup can definitely work as a satisfying evening meal.
Here are three reasons why:
It's almost impossible to slam down a bowl of soup. You have to eat slowly and enjoy each spoonful.
The high liquid content of most soups does a great job of filling your stomach.
If the soup or stew is high in fiber (from beans, vegetables, and/or whole grains), it will also help add bulk to your meal and thus help you feel full longer.
Light and Low-Fat Soups
As long as the soup you're slurping is broth- or tomato-based, you usually can't get into too much trouble, calorie-wise. A cup of broth, by itself, is about 25 calories with 1 to 2 grams of fat. A cup of tomato juice is about 40 calories and 1 gram of fat.
But with a cream-based soup, all bets are off. One cup of light whipping cream (in liquid form) is about 700 calories and 74 grams of fat, while 1 cup of half-and-half is 315 calories and 28 grams of fat. Wowza! Switching to whole milk in your creamy soup recipes is sounding a "whole" lot better now, isn't it?
One cup of whole milk is about 150 calories and 8 grams of fat. Using whole milk will usually give your soup the creamy taste and texture you desire, but without all the excess calories and fat. The lower-fat options for "cream" like whole milk, low-fat milk, and fat-free half-and-half are more sensitive to high heat, so avoid boiling and add them to the soup toward the end just to warm.
Here's a chart of the calories, fat, saturated fat, cholesterol, and fiber found in soup base ingredients so you can compare them for yourself:
Ingredient 1 (cup) Calories Fat (g) Sat. Fat (g) Cholesterol (mg) Fiber (g)
Light whipping Cream, liquid 698 74 46 265 0
Half-and-half 315 28 17 89 0
Whole milk 150 8 5 33 0
Stewed tomatoes, Canned 66 0.4 0 0 4
Tomato juice 41 0.1 0 0 2
Chicken/beef broth 25 1 0.5 ~2 0.5
4 More Tips for Low-Fat and Healthy Soups
Here are four more tips to help you keep your soup recipes low fat and healthy:
If your soup recipe calls for meat, choose leaner cuts whenever possible, like skinless chicken or turkey breast, pork tenderloin, or sirloin steak trimmed of visible fat. If the recipe calls for sausage, substitute a less-fat turkey sausage (such as turkey polska kielbasa links). Remember that you can usually get by with half as much as the recipe calls for.
When using fresh herbs, add them toward the end of cooking or stir them in right before serving. Some fresh herbs even work well sprinkled on as a garnish. Add dried herbs in the beginning or middle of cooking so they have plenty of time to rehydrate and give off their flavor.
If the soup recipe calls for stirring in butter at the end of the cooking process, just don't go there. If it calls for sauteing vegetables in butter in the beginning, just use a tablespoon of olive oil or canola oil instead. If you need more moisture as the vegetables are browning, add in a couple of tablespoons of water, wine, or broth.
Pump up the fiber in your soups by adding beans when possible and use whole grains like barley, brown rice, wild rice, or whole wheat blend pastas instead of refined grains.
3 Healthy, Low-Fat Soup Recipes
Here are three new light and nutritious soup recipes to try this winter!
Moroccan Lentil Soup/Stew
1 large onion, chopped (about 1 1/2 cups)
1 tablespoon minced garlic
1 teaspoon minced fresh ginger (or 1/2 teaspoon ground dried ginger)
1 tablespoon olive or canola oil
6 cups low-sodium chicken or beef broth (water can also be used)
1 1/2 cups red lentils, dried
15-ounce can garbanzo beans, rinsed and drained
14.5-ounce can diced tomatoes (tomatoes and any juice), low sodium if available
3/4 cup diced carrots
3/4 cup chopped celery (about 3 medium stalks)
1 teaspoon garam masala (a spice blend)
1 1/2 teaspoons ground cardamom
1/2 teaspoon ground cayenne pepper
1/2 teaspoon ground cumin
6 tablespoons fat-free sour cream (optional garnish)
Add onions, garlic, ginger and olive to a large nonstick saucepan and cook over medium-high heat, stirring often (about 7 minutes). Add the broth, lentils, garbanzo beans, diced tomatoes, carrots, celery, garam masala, cardamom, cayenne pepper, and cumin.
Bring stew to a boil, then lower heat to simmer, cover saucepan, and continue to cook until lentils are soft (about 1 to 1 1/2 hours.)
Ladle about a third to a half of the soup into a large food processor or blender and pulse to briefly puree. Pour soup puree back into the pot and stir. Serve each bowl with a dollop of fat-free sour cream, if desired.
One of the best "light" dinner options when the weather is cold is soup! Just pair a big bowl of soup with a wheat roll or some wheat crackers, and call it a meal. I always have some favorite canned soups in my pantry so anyone in the family can serve themselves some soup in l5 minutes. But there's something to be said for slowly simmering a homemade pot of soup over the stove until the flavors meld together perfectly. From chicken matzo ball soup to hearty lentil soup, it can really hit the spot on a cold day or night. Read on for some healthy and low-fat soup recipes, as well as tips on how to make any soup recipe lighter.
Soup for Supper
Can soup suffice as supper? If you are accustomed to eating light at night -- or if this is something you're moving toward -- a bowl of soup can definitely work as a satisfying evening meal.
Here are three reasons why:
It's almost impossible to slam down a bowl of soup. You have to eat slowly and enjoy each spoonful.
The high liquid content of most soups does a great job of filling your stomach.
If the soup or stew is high in fiber (from beans, vegetables, and/or whole grains), it will also help add bulk to your meal and thus help you feel full longer.
Light and Low-Fat Soups
As long as the soup you're slurping is broth- or tomato-based, you usually can't get into too much trouble, calorie-wise. A cup of broth, by itself, is about 25 calories with 1 to 2 grams of fat. A cup of tomato juice is about 40 calories and 1 gram of fat.
But with a cream-based soup, all bets are off. One cup of light whipping cream (in liquid form) is about 700 calories and 74 grams of fat, while 1 cup of half-and-half is 315 calories and 28 grams of fat. Wowza! Switching to whole milk in your creamy soup recipes is sounding a "whole" lot better now, isn't it?
One cup of whole milk is about 150 calories and 8 grams of fat. Using whole milk will usually give your soup the creamy taste and texture you desire, but without all the excess calories and fat. The lower-fat options for "cream" like whole milk, low-fat milk, and fat-free half-and-half are more sensitive to high heat, so avoid boiling and add them to the soup toward the end just to warm.
Here's a chart of the calories, fat, saturated fat, cholesterol, and fiber found in soup base ingredients so you can compare them for yourself:
Ingredient 1 (cup) Calories Fat (g) Sat. Fat (g) Cholesterol (mg) Fiber (g)
Light whipping Cream, liquid 698 74 46 265 0
Half-and-half 315 28 17 89 0
Whole milk 150 8 5 33 0
Stewed tomatoes, Canned 66 0.4 0 0 4
Tomato juice 41 0.1 0 0 2
Chicken/beef broth 25 1 0.5 ~2 0.5
4 More Tips for Low-Fat and Healthy Soups
Here are four more tips to help you keep your soup recipes low fat and healthy:
If your soup recipe calls for meat, choose leaner cuts whenever possible, like skinless chicken or turkey breast, pork tenderloin, or sirloin steak trimmed of visible fat. If the recipe calls for sausage, substitute a less-fat turkey sausage (such as turkey polska kielbasa links). Remember that you can usually get by with half as much as the recipe calls for.
When using fresh herbs, add them toward the end of cooking or stir them in right before serving. Some fresh herbs even work well sprinkled on as a garnish. Add dried herbs in the beginning or middle of cooking so they have plenty of time to rehydrate and give off their flavor.
If the soup recipe calls for stirring in butter at the end of the cooking process, just don't go there. If it calls for sauteing vegetables in butter in the beginning, just use a tablespoon of olive oil or canola oil instead. If you need more moisture as the vegetables are browning, add in a couple of tablespoons of water, wine, or broth.
Pump up the fiber in your soups by adding beans when possible and use whole grains like barley, brown rice, wild rice, or whole wheat blend pastas instead of refined grains.
3 Healthy, Low-Fat Soup Recipes
Here are three new light and nutritious soup recipes to try this winter!
Moroccan Lentil Soup/Stew
1 large onion, chopped (about 1 1/2 cups)
1 tablespoon minced garlic
1 teaspoon minced fresh ginger (or 1/2 teaspoon ground dried ginger)
1 tablespoon olive or canola oil
6 cups low-sodium chicken or beef broth (water can also be used)
1 1/2 cups red lentils, dried
15-ounce can garbanzo beans, rinsed and drained
14.5-ounce can diced tomatoes (tomatoes and any juice), low sodium if available
3/4 cup diced carrots
3/4 cup chopped celery (about 3 medium stalks)
1 teaspoon garam masala (a spice blend)
1 1/2 teaspoons ground cardamom
1/2 teaspoon ground cayenne pepper
1/2 teaspoon ground cumin
6 tablespoons fat-free sour cream (optional garnish)
Add onions, garlic, ginger and olive to a large nonstick saucepan and cook over medium-high heat, stirring often (about 7 minutes). Add the broth, lentils, garbanzo beans, diced tomatoes, carrots, celery, garam masala, cardamom, cayenne pepper, and cumin.
Bring stew to a boil, then lower heat to simmer, cover saucepan, and continue to cook until lentils are soft (about 1 to 1 1/2 hours.)
Ladle about a third to a half of the soup into a large food processor or blender and pulse to briefly puree. Pour soup puree back into the pot and stir. Serve each bowl with a dollop of fat-free sour cream, if desired.
High Cholesterol Risks: Top 2 Dangers
This is the way to decrease cholesterol. for busy people.
High Cholesterol Risks: Top 2 Dangers
There are usually no symptoms of high risk cholesterol.
A lot of people don't take the risks of high cholesterol very seriously. After all, one out of five people have high cholesterol. A staggering 50% of Americans have levels above the suggested limit. Could something so common really be a serious health risk?
Unfortunately, yes. Cholesterol is a direct contributor to cardiovascular disease, which can lead to strokes and heart attacks.
"Despite all of the amazing medicines and treatments we have, cardiovascular disease is still the number one cause of death and illness in our society," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga.
The World Health Organization estimates that almost 20% of all strokes and over 50% of all heart attacks can be linked to high cholesterol.
But if you've been diagnosed with high cholesterol, don't despair. The good news is that high cholesterol is one risk factor for strokes and heart attacks that you can change. You just need to take action now, before your high cholesterol results in more serious disease.
All About High-Risk Cholesterol Numbers
When it comes to high cholesterol risks, it's tough to keep the details straight. We might have a vague idea of whether our cholesterol is "good" or "bad," but we forget the actual numbers by the time we get to the parking lot outside our doctor's office. So it may be worth reviewing the basics.
Cholesterol is a fat-like substance circulating in your blood. Some of your cholesterol comes from the foods you eat. But the bulk of it is actually made in your own body, specifically in the liver. Cholesterol does have some good uses. It helps produce new cells and some hormones. But an excess of it in the bloodstream can lead to trouble.
There are two types of cholesterol: LDL cholesterol and HDL cholesterol.
LDL is also called "bad cholesterol" -- Sperling suggests that you think of the "L" as standing for lousy. LDL cholesterol can clog your arteries, increasing the risk of heart attack and stroke. Most people should aim for a level of less than 100 mg/dL. However, people who already have heart disease may need to aim for under 70 mg/dL.
HDL is "good cholesterol." Imagine the "H" stands for healthy, Sperling suggests. This type of cholesterol attaches to bad cholesterol and brings it to the liver, where it's filtered out of the body. So HDL cholesterol reduces the amount of bad cholesterol in your system. You should aim for 60 mg/dL or higher.
Triglycerides are not cholesterol but another type of fat floating in your blood. Just as with bad cholesterol, having a high level of triglycerides increases your risk of cardiovascular problems. Aim for a level of less than 150 mg/dL.
So although we all talk about high cholesterol risks, the term is a little misleading. What we really mean is high levels of bad LDL cholesterol and triglycerides and a low level of good HDL cholesterol.
What about total cholesterol, which is the sum of your LDL and HDL? While anything under 200 mg/dL is still considered the target, most experts don't focus on the number. It doesn't mean all that much. "Someone can have a total cholesterol of under 200 -- which is lower than average for Americans -- but still have unhealthy levels of HDL or LDL," says Sperling.
High Cholesterol Risks: Top 2 Dangers
There are usually no symptoms of high risk cholesterol.
A lot of people don't take the risks of high cholesterol very seriously. After all, one out of five people have high cholesterol. A staggering 50% of Americans have levels above the suggested limit. Could something so common really be a serious health risk?
Unfortunately, yes. Cholesterol is a direct contributor to cardiovascular disease, which can lead to strokes and heart attacks.
"Despite all of the amazing medicines and treatments we have, cardiovascular disease is still the number one cause of death and illness in our society," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga.
The World Health Organization estimates that almost 20% of all strokes and over 50% of all heart attacks can be linked to high cholesterol.
But if you've been diagnosed with high cholesterol, don't despair. The good news is that high cholesterol is one risk factor for strokes and heart attacks that you can change. You just need to take action now, before your high cholesterol results in more serious disease.
All About High-Risk Cholesterol Numbers
When it comes to high cholesterol risks, it's tough to keep the details straight. We might have a vague idea of whether our cholesterol is "good" or "bad," but we forget the actual numbers by the time we get to the parking lot outside our doctor's office. So it may be worth reviewing the basics.
Cholesterol is a fat-like substance circulating in your blood. Some of your cholesterol comes from the foods you eat. But the bulk of it is actually made in your own body, specifically in the liver. Cholesterol does have some good uses. It helps produce new cells and some hormones. But an excess of it in the bloodstream can lead to trouble.
There are two types of cholesterol: LDL cholesterol and HDL cholesterol.
LDL is also called "bad cholesterol" -- Sperling suggests that you think of the "L" as standing for lousy. LDL cholesterol can clog your arteries, increasing the risk of heart attack and stroke. Most people should aim for a level of less than 100 mg/dL. However, people who already have heart disease may need to aim for under 70 mg/dL.
HDL is "good cholesterol." Imagine the "H" stands for healthy, Sperling suggests. This type of cholesterol attaches to bad cholesterol and brings it to the liver, where it's filtered out of the body. So HDL cholesterol reduces the amount of bad cholesterol in your system. You should aim for 60 mg/dL or higher.
Triglycerides are not cholesterol but another type of fat floating in your blood. Just as with bad cholesterol, having a high level of triglycerides increases your risk of cardiovascular problems. Aim for a level of less than 150 mg/dL.
So although we all talk about high cholesterol risks, the term is a little misleading. What we really mean is high levels of bad LDL cholesterol and triglycerides and a low level of good HDL cholesterol.
What about total cholesterol, which is the sum of your LDL and HDL? While anything under 200 mg/dL is still considered the target, most experts don't focus on the number. It doesn't mean all that much. "Someone can have a total cholesterol of under 200 -- which is lower than average for Americans -- but still have unhealthy levels of HDL or LDL," says Sperling.
Drugs Before Stents for Stable Heart Disease
This is the best way to understand that can cancel the heart attack.
HealthDay ReporterLatest Heart News
Drugs Before Stents for Stable Heart Disease
Aging Baby Boomers May Swamp Cardiac Care
New Test Seems to Spot Deadly Heart Condition
Neck Size Linked to Heart Risk
Ankle Blood Pressure Test May Spot Heart Risks
THURSDAY, March 12 (HealthDay News) -- Treating people with non-acute heart problems should start with drug therapy, not invasive techniques such as angioplasty or implanting stents, because there is no difference between the two approaches in outcomes, a new study finds.
There has been an ongoing debate over whether initial treatment of people with non-acute heart problems should be with drugs or whether it would be better to open blocked heart arteries with a catheter -- called percutaneous transluminal balloon coronary angioplasty -- with or without a bare-metal or drug-coated stent, a wire mesh tube used to prop open an artery.
"In the short run, angioplasty procedures among stable patients can improve symptoms but are not lifesaving," said Dr. David J. Moliterno, chief of cardiovascular medicine at the University of Kentucky's Gill Heart Institute.
"To improve life span takes more than a few minutes in the catheterization laboratory," he said. "Rather, a lifetime of change is usually needed."
The report was published in the March 14 issue of The Lancet, in advance of an American College of Cardiology meeting in Orlando, Fla. Moliterno wrote an accompanying editorial in the journal.
For the study, a team led by Dr. Thomas A. Trikalinos, from the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, identified 61 clinical studies that compared medical therapy, or drug treatment, with angioplasty and stents. The trials included a total of 25,388 people. The researchers documented deaths, heart attacks and cardiac bypass surgeries, and repeated procedures after initial treatment.
They found that angioplasty and either bare-metal or drug-coated stents did not result in fewer deaths or heart attacks compared with medical therapy.
"The reason for the similar outcome is likely that these hardest endpoints occur at a relatively low rate among stable cardiac patients when followed for a short period of time and are more affected by risk factor and lifestyle modifications," Moliterno said.
People with stable coronary artery disease, he said, should not expect angioplasty, with or without use of a stent, to affect mortality or the occurrence of a heart attack.
"Rather, regardless of whether a patient requires angioplasty for symptoms, all patients should continue, as a primary treatment, to focus attention to aggressive risk factor modification," Moliterno said. "In other words, it's not just about the current severe blockages but about the underlying pathology causing the blockages."
Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said he agrees that invasive procedures should be reserved for people with unstable cardiac problems.
"Percutaneous coronary interventions have been demonstrated to substantially improve clinical outcomes in patients with ST segment elevation, acute myocardial infarction and, in select groups of patients, with unstable angina and non-ST segment elevation acute myocardial infarction," Fonarow said. "Percutaneous coronary intervention is evidence-based, guideline-recommended therapy for these indications."
Though angioplasty might reduce symptoms in some people with stable coronary artery disease, he said, no individual study has demonstrated a comparative reduction in the number of heart attacks or deaths.
"This new meta-analysis demonstrates that balloon angioplasty, bare-metal stents and drug-eluting stents do not improve the clinical outcomes of death or myocardial infarction compared to medical therapy," he said.
Most people with stable coronary artery disease "are better off with initial treatment with optimal medical therapy, reserving percutaneous coronary intervention for those patients with persistent symptoms despite optimal medical therapy," Fonarow said.
Another report in the same issue of The Lancet found that, after two years of follow-up, bioabsorbable polymer drug-eluting stents, which are reabsorbed by the body, were safe and effective.
None of the 30 people who participated in the study died or needed further treatment of the stented artery during those two years, and there were no new blockages of the artery caused by the stent, the researchers found.
Biodegradable stents were developed to eliminate problems with metal stents, which can cause new blockages and can interfere with magnetic resonance imaging.
"All these findings need to be confirmed in larger studies, but this or similar devices could become of paramount importance for the restoration of vascular integrity in the treatment of flow-limiting plaque," the authors concluded.
HealthDay ReporterLatest Heart News
Drugs Before Stents for Stable Heart Disease
Aging Baby Boomers May Swamp Cardiac Care
New Test Seems to Spot Deadly Heart Condition
Neck Size Linked to Heart Risk
Ankle Blood Pressure Test May Spot Heart Risks
THURSDAY, March 12 (HealthDay News) -- Treating people with non-acute heart problems should start with drug therapy, not invasive techniques such as angioplasty or implanting stents, because there is no difference between the two approaches in outcomes, a new study finds.
There has been an ongoing debate over whether initial treatment of people with non-acute heart problems should be with drugs or whether it would be better to open blocked heart arteries with a catheter -- called percutaneous transluminal balloon coronary angioplasty -- with or without a bare-metal or drug-coated stent, a wire mesh tube used to prop open an artery.
"In the short run, angioplasty procedures among stable patients can improve symptoms but are not lifesaving," said Dr. David J. Moliterno, chief of cardiovascular medicine at the University of Kentucky's Gill Heart Institute.
"To improve life span takes more than a few minutes in the catheterization laboratory," he said. "Rather, a lifetime of change is usually needed."
The report was published in the March 14 issue of The Lancet, in advance of an American College of Cardiology meeting in Orlando, Fla. Moliterno wrote an accompanying editorial in the journal.
For the study, a team led by Dr. Thomas A. Trikalinos, from the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, identified 61 clinical studies that compared medical therapy, or drug treatment, with angioplasty and stents. The trials included a total of 25,388 people. The researchers documented deaths, heart attacks and cardiac bypass surgeries, and repeated procedures after initial treatment.
They found that angioplasty and either bare-metal or drug-coated stents did not result in fewer deaths or heart attacks compared with medical therapy.
"The reason for the similar outcome is likely that these hardest endpoints occur at a relatively low rate among stable cardiac patients when followed for a short period of time and are more affected by risk factor and lifestyle modifications," Moliterno said.
People with stable coronary artery disease, he said, should not expect angioplasty, with or without use of a stent, to affect mortality or the occurrence of a heart attack.
"Rather, regardless of whether a patient requires angioplasty for symptoms, all patients should continue, as a primary treatment, to focus attention to aggressive risk factor modification," Moliterno said. "In other words, it's not just about the current severe blockages but about the underlying pathology causing the blockages."
Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said he agrees that invasive procedures should be reserved for people with unstable cardiac problems.
"Percutaneous coronary interventions have been demonstrated to substantially improve clinical outcomes in patients with ST segment elevation, acute myocardial infarction and, in select groups of patients, with unstable angina and non-ST segment elevation acute myocardial infarction," Fonarow said. "Percutaneous coronary intervention is evidence-based, guideline-recommended therapy for these indications."
Though angioplasty might reduce symptoms in some people with stable coronary artery disease, he said, no individual study has demonstrated a comparative reduction in the number of heart attacks or deaths.
"This new meta-analysis demonstrates that balloon angioplasty, bare-metal stents and drug-eluting stents do not improve the clinical outcomes of death or myocardial infarction compared to medical therapy," he said.
Most people with stable coronary artery disease "are better off with initial treatment with optimal medical therapy, reserving percutaneous coronary intervention for those patients with persistent symptoms despite optimal medical therapy," Fonarow said.
Another report in the same issue of The Lancet found that, after two years of follow-up, bioabsorbable polymer drug-eluting stents, which are reabsorbed by the body, were safe and effective.
None of the 30 people who participated in the study died or needed further treatment of the stented artery during those two years, and there were no new blockages of the artery caused by the stent, the researchers found.
Biodegradable stents were developed to eliminate problems with metal stents, which can cause new blockages and can interfere with magnetic resonance imaging.
"All these findings need to be confirmed in larger studies, but this or similar devices could become of paramount importance for the restoration of vascular integrity in the treatment of flow-limiting plaque," the authors concluded.
The way to cut cholesterol
High Cholesterol: Stocking a Heart-Healthy Kitchen
Heart-healthy foods are essential to a heart-healthy diet.
If you want to eat a heart-healthy diet but are not sure what foods you should buy, check out this heart-healthy kitchen essentials guide. From fruits and vegetables to whole grain goodness, learn what foods to keep on hand.
Fresh Fruits & Vegetables
Fill your fridge with seasonal fruits such as berries, oranges, apples, pears, and grapes, and vegetables such as bell peppers, broccoli, kale, cauliflower, tomatoes, dark leafy greens, celery, eggplant, zucchini, and squash.
Dairy and Dairy Alternatives
Skim or 1% milk
Soymilk (plain, unsweetened, vanilla, or chocolate)
Low - or nonfat buttermilk
Nonfat half-and-half or nonfat creamers
Nonfat or reduced-fat cheese (bricks, slices, or shredded)
Soy-based cheeses (bricks, slices, or shredded)
Nonfat or light cream cheese
Nonfat or 1% fat cottage cheese or ricotta cheese
Nonfat or 1% fat yogurt (includes fruited, vanilla, or plain)
Soy-based yogurts
Nonfat sour cream
Egg substitutes, egg whites
Meat, Poultry, Fish & Meat Substitutes
Skinless, boneless chicken or turkey breasts and tenders
Skinless, white breast meat ground chicken or turkey
Pork tenderloin, trimmed of fat
Lean ground beef such as ground round or ground sirloin (Note: When buying beef, look for words like "round" or "loin" and choose lean cuts -- the less marbling, the lower the fat content.)
Assorted fish: salmon, mackerel, tilapia, trout, herring, tuna
Tofu silken, soft, firm, or extra firm
Tempeh
Seitan
Frozen Foods
Frozen vegetables and vegetable blends without added sauces, gravies, and added sodium
Frozen fruits without added sugar (for example, frozen blueberries, strawberries, or raspberries)
Frozen soybeans (edamame)
Frozen vegetarian burgers, sausage patties, or links (For example, Boca Burgers, Yves, Morningstar Farms or Gardenburger)
Reduced-fat and sodium vegetarian chili, burritos, and entrees like Amy's Organic and Health Valley.
Fats, Cooking Oils
Assorted cooking oils (olive, canola, walnut, grapeseed, peanut, and sesame)
Non-fat cooking sprays (for example, Spectrum Naturals, Pam)
Baking fat replacements (for example, pureed prunes, applesauce, or Smucker's Baking Healthy)
Non-hydrogenated shortening (for example, Spectrum Naturals)
Trans-free liquid or tub margarine (for example, Promise Activ, Benecol, Fleischmann's Light, Smart Balance)
Reduced-fat or nonfat salad dressings
Herbs, Seasonings & Spices
Here are some delicious seasonings to take the place of salt.Allspice Basil Bay Leaves Black pepper
Caraway seeds Cayenne Chili powder Chinese five-spice
Cinnamon Cloves Coriander Cumin
Curry powder Dill Garlic powder Ginger, ground
Italian seasoning Marjoram Mint Nutmeg
Onion powder Oregano Paprika Parsley
Red pepper flakes Rosemary
Assorted sodium-free Mrs. Dash seasonings
Sweeteners
Splenda, Equal, Nutra Sweet, Sugar Twin, and Brown Sugar Twin (sugar substitutes)
Sugar free or "light" maple syrups
Honey
Brown rice syrup for a sweetening alternative to use when baking
Pantry Essentials
Snacks
Assorted raw nuts and seeds (almonds, walnuts, sunflower seeds, sesame seeds)
Dried fruits
Whole-grain breads, tortillas, pitas
Whole-grain, trans-fat free crackers (such as Health Valley whole wheat crackers, Kashi TLC crackers, Reduced Fat Triscuits, Fat Free Rye Crisp, Wasa)
Baked, trans-fat-free tortilla chips
Brown rice cakes, popcorn cakes
Whole-grain pretzels (such as Snyder's oat bran or honey wheat)
Plain popcorn or light microwave popcorn
Heart-healthy foods are essential to a heart-healthy diet.
If you want to eat a heart-healthy diet but are not sure what foods you should buy, check out this heart-healthy kitchen essentials guide. From fruits and vegetables to whole grain goodness, learn what foods to keep on hand.
Fresh Fruits & Vegetables
Fill your fridge with seasonal fruits such as berries, oranges, apples, pears, and grapes, and vegetables such as bell peppers, broccoli, kale, cauliflower, tomatoes, dark leafy greens, celery, eggplant, zucchini, and squash.
Dairy and Dairy Alternatives
Skim or 1% milk
Soymilk (plain, unsweetened, vanilla, or chocolate)
Low - or nonfat buttermilk
Nonfat half-and-half or nonfat creamers
Nonfat or reduced-fat cheese (bricks, slices, or shredded)
Soy-based cheeses (bricks, slices, or shredded)
Nonfat or light cream cheese
Nonfat or 1% fat cottage cheese or ricotta cheese
Nonfat or 1% fat yogurt (includes fruited, vanilla, or plain)
Soy-based yogurts
Nonfat sour cream
Egg substitutes, egg whites
Meat, Poultry, Fish & Meat Substitutes
Skinless, boneless chicken or turkey breasts and tenders
Skinless, white breast meat ground chicken or turkey
Pork tenderloin, trimmed of fat
Lean ground beef such as ground round or ground sirloin (Note: When buying beef, look for words like "round" or "loin" and choose lean cuts -- the less marbling, the lower the fat content.)
Assorted fish: salmon, mackerel, tilapia, trout, herring, tuna
Tofu silken, soft, firm, or extra firm
Tempeh
Seitan
Frozen Foods
Frozen vegetables and vegetable blends without added sauces, gravies, and added sodium
Frozen fruits without added sugar (for example, frozen blueberries, strawberries, or raspberries)
Frozen soybeans (edamame)
Frozen vegetarian burgers, sausage patties, or links (For example, Boca Burgers, Yves, Morningstar Farms or Gardenburger)
Reduced-fat and sodium vegetarian chili, burritos, and entrees like Amy's Organic and Health Valley.
Fats, Cooking Oils
Assorted cooking oils (olive, canola, walnut, grapeseed, peanut, and sesame)
Non-fat cooking sprays (for example, Spectrum Naturals, Pam)
Baking fat replacements (for example, pureed prunes, applesauce, or Smucker's Baking Healthy)
Non-hydrogenated shortening (for example, Spectrum Naturals)
Trans-free liquid or tub margarine (for example, Promise Activ, Benecol, Fleischmann's Light, Smart Balance)
Reduced-fat or nonfat salad dressings
Herbs, Seasonings & Spices
Here are some delicious seasonings to take the place of salt.Allspice Basil Bay Leaves Black pepper
Caraway seeds Cayenne Chili powder Chinese five-spice
Cinnamon Cloves Coriander Cumin
Curry powder Dill Garlic powder Ginger, ground
Italian seasoning Marjoram Mint Nutmeg
Onion powder Oregano Paprika Parsley
Red pepper flakes Rosemary
Assorted sodium-free Mrs. Dash seasonings
Sweeteners
Splenda, Equal, Nutra Sweet, Sugar Twin, and Brown Sugar Twin (sugar substitutes)
Sugar free or "light" maple syrups
Honey
Brown rice syrup for a sweetening alternative to use when baking
Pantry Essentials
Snacks
Assorted raw nuts and seeds (almonds, walnuts, sunflower seeds, sesame seeds)
Dried fruits
Whole-grain breads, tortillas, pitas
Whole-grain, trans-fat free crackers (such as Health Valley whole wheat crackers, Kashi TLC crackers, Reduced Fat Triscuits, Fat Free Rye Crisp, Wasa)
Baked, trans-fat-free tortilla chips
Brown rice cakes, popcorn cakes
Whole-grain pretzels (such as Snyder's oat bran or honey wheat)
Plain popcorn or light microwave popcorn
The Important of Meditation
When Your Doctor Orders Cholesterol-Lowering Medications
You’ve just left your doctor’s office with a prescription for a statin medication to help lower your cholesterol. But you may be nervous. You’ve heard that you’ll have to take this cholesterol-lowering medication for the rest of your life. And your doctor noted that statins, like all medicine, can cause side effects.
Why should you take a statin? Can’t you just improve your cholesterol levels by eating right and exercising? The answer is yes -- and no. Healthy cholesterol and triglyceride levels look like this:
Total cholesterol: less than 200 mg/dL
HDL (“good” cholesterol): 40 mg/dL or more for men, 50 or more for women
LDL (“bad” cholesterol): less than 130 mg/dL
Triglycerides: less than 150 mg/dL
Many people can get their cholesterol and triglyceride levels into these healthy ranges through a combination of a healthy diet and an active lifestyle. But for many others, these lifestyle changes help, but are not enough.
Measuring the Benefits of Statins, Diet, and Exercise
“Lifestyle changes certainly are the cornerstone of cholesterol reduction,” says Michael Miller, MD, director of the Center for Preventive Cardiology at the University of Maryland Medical Center.
Exercising, eating a healthy diet, and losing weight can result in:
A 5% to 10% reduction in LDL cholesterol
A 10% to 30% reduction in triglycerides
But for those with very high LDL cholesterol or triglycerides, those lifestyle measures may be insufficient. “If your lipid levels are way out of whack, for example, reducing your LDL by 10% may not get you down to a healthy level,” Miller says.
Statin medications act quickly and can help reduce LDL or “bad” cholesterol by up to 50% or more.
Statins also help increase HDL or “good” cholesterol by up to 15%.
If you’re making healthy lifestyle changes at the same time, says Miller, you should see major changes in your cholesterol levels within two to four weeks after beginning lipid-lowering therapy.
“Statins are very simple: you take them once a day, and their effects are quite profound,” says Patrick McBride, MD, MPH, director of the preventive cardiology program and the cholesterol clinic at the University of Wisconsin School of Medicine and Public Health.
“Not only do statins improve your cholesterol levels, but they reduce your risk of heart attack, stroke, and cardiovascular events. They’re one of the great success stories of modern medicine,” says McBride.
Most recently, the JUPITER trial showed that statins can also slash the risk of heart attack nearly in half for people with normal cholesterol but high levels of a protein associated with inflammation.
Statin Side Effects and Other Worries
What about side effects from taking statins? It’s true that any medication comes with side effects. Side effects most commonly seen with statins are headache, GI tract upset, muscle and joint aches, or rash. Very rarely, patients may experience muscle or liver damage.
You’ve just left your doctor’s office with a prescription for a statin medication to help lower your cholesterol. But you may be nervous. You’ve heard that you’ll have to take this cholesterol-lowering medication for the rest of your life. And your doctor noted that statins, like all medicine, can cause side effects.
Why should you take a statin? Can’t you just improve your cholesterol levels by eating right and exercising? The answer is yes -- and no. Healthy cholesterol and triglyceride levels look like this:
Total cholesterol: less than 200 mg/dL
HDL (“good” cholesterol): 40 mg/dL or more for men, 50 or more for women
LDL (“bad” cholesterol): less than 130 mg/dL
Triglycerides: less than 150 mg/dL
Many people can get their cholesterol and triglyceride levels into these healthy ranges through a combination of a healthy diet and an active lifestyle. But for many others, these lifestyle changes help, but are not enough.
Measuring the Benefits of Statins, Diet, and Exercise
“Lifestyle changes certainly are the cornerstone of cholesterol reduction,” says Michael Miller, MD, director of the Center for Preventive Cardiology at the University of Maryland Medical Center.
Exercising, eating a healthy diet, and losing weight can result in:
A 5% to 10% reduction in LDL cholesterol
A 10% to 30% reduction in triglycerides
But for those with very high LDL cholesterol or triglycerides, those lifestyle measures may be insufficient. “If your lipid levels are way out of whack, for example, reducing your LDL by 10% may not get you down to a healthy level,” Miller says.
Statin medications act quickly and can help reduce LDL or “bad” cholesterol by up to 50% or more.
Statins also help increase HDL or “good” cholesterol by up to 15%.
If you’re making healthy lifestyle changes at the same time, says Miller, you should see major changes in your cholesterol levels within two to four weeks after beginning lipid-lowering therapy.
“Statins are very simple: you take them once a day, and their effects are quite profound,” says Patrick McBride, MD, MPH, director of the preventive cardiology program and the cholesterol clinic at the University of Wisconsin School of Medicine and Public Health.
“Not only do statins improve your cholesterol levels, but they reduce your risk of heart attack, stroke, and cardiovascular events. They’re one of the great success stories of modern medicine,” says McBride.
Most recently, the JUPITER trial showed that statins can also slash the risk of heart attack nearly in half for people with normal cholesterol but high levels of a protein associated with inflammation.
Statin Side Effects and Other Worries
What about side effects from taking statins? It’s true that any medication comes with side effects. Side effects most commonly seen with statins are headache, GI tract upset, muscle and joint aches, or rash. Very rarely, patients may experience muscle or liver damage.
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