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Medical Forum / General / Cardiology / May 2005

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LDL cholesterol question

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Jim-Poncin - 24 May 2005 19:41 GMT
A recent blood panel shows my cholesterol = 217; LDL = 145.

I already avoid high/bad fat foods, exercise 6 times a week, am not
overweight. My BP is a bit high (132/78). What the hell can I do to get the
LDL down?

Thnx for any intelligent advice.
Owen Lowe - 24 May 2005 21:23 GMT
> I already avoid high/bad fat foods, exercise 6 times a week, am not
> overweight. My BP is a bit high (132/78). What the hell can I do to get the
> LDL down?

Here's just some dietary items to consider and do further research on -
I don't recall exactly what some of the items address what but they're
all good for heart health:

Soy protein (this WILL have a positive effect on LDL)
Fish oil - 1200mg
Walnuts, Almonds (also positive effect on LDL)
Niacin rich foods (again positive to lower LDL)
Olive oil - up to 1/4 cup/day
Eliminate transfats completely (partially hydrogenated oils)

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outrider - 24 May 2005 22:07 GMT
There is nothing wrong with your cholesterol levels. Nor your blood
pressure. Both are perfectly normal. Stop relying on drug pushers to
tell you what is right and wrong about your body.

Now go for a run.

Zee
hawki63 - 25 May 2005 02:33 GMT
> There is nothing wrong with your cholesterol levels. Nor your blood
> pressure. Both are perfectly normal. Stop relying on drug pushers to
[quoted text clipped - 3 lines]
>
> Zee

please listen to your doc..and not to the non docs on this board such as Zee

most current "acceptable" blood pressure state that 120 systolic (top
number) is statistically better...I would place you in the category of
"slightly elevated..

as for LDL...currenty guidelines for NON high risk folks state about 120 is
the "number" to aim for..

now...I would surely not suggest you take statins...no reason to take any
risks for side effects...

but running alone is unlikely to lower either of the numbers you are
concerned with..

also...perhaps you don't know that Zee walks/runs around with a total
cholesterol in the 500 range..so she is hardly in a position to be making
medical suggestions..

those who suggest certain supplements,,ie niacin,,,low salt..and all
that...are on the right track..

remember...doctors went to school for a reason...

good luck..
elgoog - 25 May 2005 05:15 GMT
<<snip>>
> most current "acceptable" blood pressure state that 120 systolic (top
> number) is statistically better...I would place you in the category of
> "slightly elevated..

The JNC 7 suggests lifestyle modification for those that are
prehypertensive (SBP 120-139 or DBP 80-89). While you are correct that
drug therapy would likely not be a good option without some other risk
factors, I feel it is less than helpful to not encourage the patient to
make lifestyle changes (lose excess weight, diet counseling, exercise)
just as the JNC 7 guidelines dictate. See the full report - available
in pdf from
http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm
...with all due respect.

> as for LDL...currenty guidelines for NON high risk folks state about 120 is
> the "number" to aim for..
[quoted text clipped - 4 lines]
> but running alone is unlikely to lower either of the numbers you are
> concerned with..

Good.

> also...perhaps you don't know that Zee walks/runs around with a total
> cholesterol in the 500 range..so she is hardly in a position to be making
> medical suggestions..

Completely and totally irrelevant information. Make your arguments with
valid information and you will earn greater respect.

> those who suggest certain supplements,,ie niacin,,,low salt..and all
> that...are on the right track..

Good.

> remember...doctors went to school for a reason...

Alas, let the doctors remember why they went to school (to learn).
Leave the pontificating to the preachers.

> good luck..

Respectfully,
-elgoog, the more I learn, the less I know.
hawki63 - 25 May 2005 07:18 GMT
> <<snip>>
> > most current "acceptable" blood pressure state that 120 systolic (top
[quoted text clipped - 28 lines]
> Completely and totally irrelevant information. Make your arguments with
> valid information and you will earn greater respect.

funny that you made no mention of Zee's comment to this poster that his
blood pressure and lipids were both perfectly acceptable...

funny also that you seem NOT to have noticed that my reply included "current
guideline" advice..

perhaps it would be far more helpful to challenge comments that are sooooo
outrageous...than to nit pick mine..

> > those who suggest certain supplements,,ie niacin,,,low salt..and all
> > that...are on the right track..
[quoted text clipped - 10 lines]
> Respectfully,
> -elgoog, the more I learn, the less I know.
elgoog - 25 May 2005 12:52 GMT
> > <<snip>>
> > > most current "acceptable" blood pressure state that 120 systolic (top
[quoted text clipped - 34 lines]
> funny that you made no mention of Zee's comment to this poster that his
> blood pressure and lipids were both perfectly acceptable...

I generally agreed with your comments. I hope that you do not see my
suggestion as persecution.

> funny also that you seem NOT to have noticed that my reply included "current
> guideline" advice..

But, JNC 7 are current guidelines. There is some discussion that would
make the current guidelines even stricter by considering other risk
factors in the classification of hypertension - these guidelines are
however, not current.

> perhaps it would be far more helpful to challenge comments that are sooooo
> outrageous...than to nit pick mine..

I think the poster now knows what the guidelines are, and hopefully
understands that he/she can improve both cholesterol and BP today
through lifestyle modifications that may help them to forgo medical
drug treatments in the future (or at least delay them until later in
life).

> > > those who suggest certain supplements,,ie niacin,,,low salt..and all
> > > that...are on the right track..
[quoted text clipped - 10 lines]
> > Respectfully,
> > -elgoog, the more I learn, the less I know.

I know a doctor who seeing the nursing staff struggle to move a heavy
man from a gurney, refused to help. He said that he didn't go to 10
years of medical school to help move patients.

"Sto ancora imparando (I am still learning)." - Michelangelo
-elgoog
Susan - 24 May 2005 22:23 GMT
> A recent blood panel shows my cholesterol = 217; LDL = 145.
>
[quoted text clipped - 3 lines]
>
> Thnx for any intelligent advice.

Here's what helped me; you may want to discuss with your doctor.  I
lowered my LDL 70 points while eating a highish fat, low carb diet.

1: Minerva Med. 1990 Jun;81(6):475-9.     Related Articles, Links

[Evaluation of the cholesterol-lowering effectiveness of pantethine in
women in perimenopausal age]

[Article in Italian]

Binaghi P, Cellina G, Lo Cicero G, Bruschi F, Porcaro E, Penotti M.

Servizio di Cardiologia, Istitut Clinici di Perfezionamento, Milano.

Cardiovascular diseases are the main cause of death also in women. Their
incidence, rapidly growing in the peri-menopausal period, is related to
serum levels of total cholesterol and its LDL fraction. It was also
shown that the peroxidation of LDL is an additional factor in the
genesis of atherosclerotic vascular disease. As long-term treatments
with synthetic lipid-lowering drugs may cause undesirable side effects,
while pantethine is known to be well tolerated, we treated 24
hypercholesterolemic women (total serum cholesterol greater than or
equal to 240 mg/dl), in perimenopausal age (range: 45-55 years, mean +/-
SD = 51.6 +/- 2.4) with 900 mg/day of pantethine. This is a precursor of
coenzyme A, with an antiperoxidation effect in vivo, and our aim was to
confirm its lipid lowering activity in this particular type of patients.
After 16 weeks of treatment, significant reductions of total
cholesterol, LDL-cholesterol and LDL-C/HDL-C ratio could be observed. No
remarkable changes of the main laboratory parameters (fasting blood
sugar, B.U.N., creatinine, uric acid) were seen. Efficacy percentages of
the treatment were about 80%. None of the patients complained of adverse
reactions due to the treatment with pantethine. In conclusion, we
suggest that pantethine should be considered in the long-term treatment
of lipid derangements occurring in the perimenopausal age.

PMID: 2359503 [PubMed - indexed for MEDLINE]
1: Acta Biomed Ateneo Parmense. 1984;55(1):25-42.     Related Articles, Links

[Hyperlipidemia, diabetes and atherosclerosis: efficacy of treatment
with pantethine]

[Article in Italian]

Arsenio L, Caronna S, Lateana M, Magnati G, Strata A, Zammarchi G.

The hypolipidemizing effects of Pantethine were investigated by the
Authors in 37 hypercholesterolemic and/or hypertriglyceridemic patients.
Of these, 21 were also diabetic, in a satisfying glucidic compensation,
in order to verify the action of this drug also in this metabolic
condition. The study was carried out for three months and during this
period the patients were given Pantethine at the dose of 600 mg/die
orally. At the 30th, the 60th, the 90th day of treatment the following
parameters were controlled: cholesterolemia, HDL cholesterol,
apolipoproteins A and B, triglyceridemia, systolic and diastolic
arterial pressure, uricemia, body weight. Thirty days after suspending
the treatment, the parameters were controlled again to detect a possible
"rebound" effect. The results were analyzed on the whole case-record,
subdividing the patients in dislipidemic and diabetic-dislipidemic, and
on the basis of the Fredrickson's classification. Pantethine induced in
all groups a quick and progressive decrease of cholesterolemia,
triglyceridemia, LDL cholesterol and Apolipoproteins B with increased
HDL cholesterol and Apolipoproteins A. After suspending the treatment,
there is a clear inversion of the state of these parameters. The Authors
conclude that the present work shows that Pantethine, a natural and
atoxic substance, an important component of Coenzyme A, is efficacious
in determining a clear tendency towards normalization of the lipidic values.

PMID: 6232801 [PubMed - indexed for MEDLINE]
1: Atherosclerosis. 1984 Jan;50(1):73-83.     Related Articles, Links

Controlled evaluation of pantethine, a natural hypolipidemic compound,
in patients with different forms of hyperlipoproteinemia.

Gaddi A, Descovich GC, Noseda G, Fragiacomo C, Colombo L, Craveri A,
Montanari G, Sirtori CR.

Pantethine (P), the stable disulphate form of pantetheine, major
component and precursor of coenzyme A, was evaluated within a
double-blind protocol (8 weeks for P or for a corresponding placebo) in
29 patients, 11 with type IIB hyperlipoproteinemia, 15 with type IV, and
3 with an isolated reduction of high density lipoprotein cholesterol
(HDL-C) levels. In type IIB patients, P (300 mg t.i.d.) determined a
highly significant lowering of plasma total and low density lipoprotein
(LDL) associated cholesterol (-13.5% for both parameters). In the same
patients, HDL-C levels increased about 10% at the end of treatment.
Switching from P to placebo was associated with a rapid return to the
baseline cholesterolemia. Both in type IIB and type IV patients, plasma
triglyceride levels were reduced around 30%, when P was given as the
first treatment; when it was preceded by placebo, reductions were less
striking (respectively, -17.8% for type IIB and -13.0% for type IV, at
the end of P treatment). HDL-C levels were not increased by P, either in
type IV, and in the patients with low HDL cholesterolemia. In type IV,
LDL cholesterol levels showed a variable response to P: they tended to
increase when below 132 mg/dl, prior to treatment, and to be reduced
when above this level. This study provides evidence for a significant
hypocholesterolemic effect of P, a natural compound free of overt side
effects. It also indicates that P may raise HDL-C levels in type IIB
patients, while moderately reducing triglyceridemia.

Publication Types:
•    Clinical Trial
•    Controlled Clinical Trial

PMID: 6365107 [PubMed - indexed for MEDLINE]
1: Int J Clin Pharmacol Ther Toxicol. 1986 Nov;24(11):630-7.     Related
Articles, Links

Lipoprotein changes induced by pantethine in hyperlipoproteinemic
patients: adults and children.

Bertolini S, Donati C, Elicio N, Daga A, Cuzzolaro S, Marcenaro A,
Saturnino M, Balestreri R.

Following a brief outline of current knowledge concerning
atherosclerosis and its treatment, the authors describe the results
obtained by treating with pantethine (900-1200 mg daily for 3 to 6
months) a series of 7 children and 65 adults suffering from
hypercholesterolemia alone or associated with hypertriglyceridemia
(types IIa and IIb of Fredrickson's classification). Pantethine
treatment produced significant reduction of the better known risk
factors (total cholesterol, LDL-cholesterol, triglycerides, and apo-B)
and a significant increase of HDL-cholesterol (signally HDL2) and
apolipoprotein A-I. The authors conclude with a discussion of these
results and of the possible role of pantethine in the treatment of
hyperlipoproteinemia, in view of its perfect tolerability and
demonstrated therapeutic effectiveness.

PMID: 3098691 [PubMed - indexed for MEDLINE]
: Atherosclerosis. 1984 Dec;53(3):255-64.     Related Articles, Links

Pantethine reduces plasma cholesterol and the severity of arterial
lesions in experimental hypercholesterolemic rabbits.

Carrara P, Matturri L, Galbussera M, Lovati MR, Franceschini G, Sirtori CR.

Pantethine (P), a coenzyme A precursor, was administered to
cholesterol-fed rabbits (0.5% cholesterol diet + 1% pantethine) for 90
days. At the end of treatment, plasma total cholesterol levels were
reduced 64.7% and the HDL/total cholesterol ratio increased in P-treated
animals; a significant rise of the apo A-I/A-II ratio was detected in
HDL. VLDL lipid and protein levels were, on the other hand, reduced by
P. The cholesterol-ester content of both liver and aortic tissues was
not significantly affected by P. Although the total aortic area with
evident plaques was reduced only 18.2%, the microscopical examination of
sections from the major vessels of P-treated animals, showed a reduction
in the severity of lesions, both in the aorta and in the coronary
arteries. These findings suggest that P, in addition to significantly
lowering plasma cholesterol levels in rabbits on an experimental diet,
may modify lipid deposition in major arteries, possibly by affecting
lipoprotein composition and/or exerting an arterial protective effect.

PMID: 6442152 [PubMed - indexed for MEDLINE]
Clin Ther. 1986;8(5):537-45.     Related Articles, Links

Effectiveness of long-term treatment with pantethine in patients with
dyslipidemia.

Arsenio L, Bodria P, Magnati G, Strata A, Trovato R.

A one-year clinical trial with pantethine was conducted in 24 patients
with established dyslipidemia of Fredrickson's types II A, II B, and IV,
alone or associated with diabetes mellitus. The treatment was well
tolerated by all patients with no subjective complaints or detectable
side effects. Blood lipid assays repeated after 1, 3, 6, 9, and 12
months of treatment revealed consistent and statistically significant
reductions of all atherogenic lipid fractions (total cholesterol,
low-density lipoprotein cholesterol, and apolipoprotein B) with parallel
increases of high-density lipoprotein cholesterol and apolipoprotein A.
The results were equally good in patients with uncomplicated
dyslipidemia and in those with associated diabetes mellitus. The authors
conclude that pantethine (a drug entity related to the natural compound,
pantetheine) represents a valid therapeutic support for patients with
dyslipidemia not amenable to satisfactory correction of blood lipids by
diet alone.

PMID: 3094958 [PubMed - indexed for MEDLINE]
Acta Biomed Ateneo Parmense. 1987;58(5-6):143-52.     Related Articles, Links

[Clinical use of pantethine by parenteral route in the treatment of
hyperlipidemia]

[Article in Italian]

Arsenio L, Bodria P, Bossi S, Lateana M, Strata A.

Servizio di Malattie del Ricambio e Diabetologia, Ospedali Riuniti, Parma.

Recent investigations have confirmed the effectiveness and the excellent
tolerability of pantethine, a derivative of pantetheine, an essential
part of the acetylation coenzyme CoA, administered P.O., in normalizing
the blood lipid concentrations of patients with hyperlipidemias. A group
of 18 patients with hyperlipidemias (9 M, 9 F), with an average age of
52.6 years, was submitted to pantethine parenteral treatment. After a 20
days wash-out, pantethine (400 mg/day; BID) was administered
intramuscularly, for 20 days. Total cholesterol, triglycerides,
HDL-cholesterol, apo A-1 and B lipoprotein, uric acid in serum,
glycemia, CBC, B.U.N., creatininemia, E.S.R., SGOT, SGPT, bilirubinemia,
cardiac frequency, blood pressure and body weight were controlled before
and after treatment. The drug showed to have a therapeutic effectiveness
by a rapid and significant improvement in the blood lipid pattern with
reduction of total cholesterol, triglycerides and apo-B lipoprotein and
increase of HDL-cholesterol and apo A-1 lipoprotein. The tolerability of
pantethine at the stated dosage and mode of administration was
invariably excellent, with non complaints or visible side effects
imputable to the test drug. BUN, creatininemia, glycemia, SGOT, SGPT,
bilirubinemia, E.S.R., CBC, cardiac frequency and blood pressure
readings showed no noteworthy changes throughout the study.

PMID: 2970754 [PubMed - indexed for MEDLINE]

Susan
elgoog - 25 May 2005 04:59 GMT
> A recent blood panel shows my cholesterol = 217; LDL = 145.
>
[quoted text clipped - 3 lines]
>
> Thnx for any intelligent advice.

If you are willing to consider lifestyle changes, modifying your diet
and physical activity (yes, exercise); then, you may be interested in
the following.

There are quite a few dietary steps you can take to improve your
cholesterol numbers. Celery, onions, garlic help lower cholesterol. See
http://www.hsph.harvard.edu/nutritionsource/fats.html - article on fats
and cholesterol, it's a good place to start.

Your BP is also a bit high, The JNC 7 report classifies
prehypertension as systolic blood pressure 120-139 mm Hg or diastolic
blood pressure 80-89 mm Hg
stage 1 hypertension as systolic 140-159 mm Hg or diastolic 90-99 mm Hg

stage 2 hypertension as systolic >= 160 mm Hg or diastolic >= 100 mm Hg

Because your systolic is 132 and over 120, you should be encouraged to
consider lifestyle modifications such as losing extra weight, modifying
your diet (eat more fruit and veggies, and less fats and salt). You
might benefit from the DASH eating plan, which has been clinically
proven to lower blood pressure. See
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/

-elgoog
Andrew B. Chung, MD/PhD - 26 May 2005 14:02 GMT
> A recent blood panel shows my cholesterol = 217;

Not optimal.

> LDL = 145.

Not optimal.

> I already avoid high/bad fat foods, exercise 6 times a week, am not
> overweight.

Before accepting the latter, what is your height and weight ?

> My BP is a bit high (132/78).

The systolic is a bit higher than "optimal."

> What the hell can I do to get the
> LDL down?

Additional lifestyle changes especially losing weight permanently if you
are heavier than "ideal."

> Thnx for any intelligent advice.

You are welcome :-)


In Christ's love and service,

Andrew

--
Andrew B. Chung, MD/PhD
Board-Certified Cardiologist

**
Suggested Reading:
(1) http://makeashorterlink.com/?G1D5217EA
(2) http://makeashorterlink.com/?W13A4250B
(3) http://makeashorterlink.com/?X1C62661A
(4) http://makeashorterlink.com/?U1E13130A
(5) http://makeashorterlink.com/?K6F72510A
(6) http://makeashorterlink.com/?I24E5151A
(7) http://makeashorterlink.com/?I22222129
Jim-Poncin - 26 May 2005 22:23 GMT
>> A recent blood panel shows my cholesterol = 217;
>
[quoted text clipped - 8 lines]
>
> Before accepting the latter, what is your height and weight ?

6 ft, 178 pds.

>> My BP is a bit high (132/78).
>
[quoted text clipped - 5 lines]
> Additional lifestyle changes especially losing weight permanently if you
> are heavier than "ideal."

Like what?
HT/WT =  6ft / 178.  My diet is already oriented away from standard American
"fat fare". I already take supplements like fish oil, K pills, niacin, folic
acid, Mg/Ca/Zn etc. and regular multi-vits. I already exercise 6 times a
week.

Another question:
           At a health fair I had a quick total cholesterol test using a
small amount of blood and some sort of electronic hand-held device; result
176 tot.
           A regular "draw blood send to lab" test done 6 weeks later gave
217 tot, 145 LDL.
Do I need a third test? Are any of the do it yourself test kits reliable?

Thnx
George - 27 May 2005 00:26 GMT
>> Additional lifestyle changes especially losing weight permanently if you
>> are heavier than "ideal."
[quoted text clipped - 4 lines]
>acid, Mg/Ca/Zn etc. and regular multi-vits. I already exercise 6 times a
>week.

Like his goofy 2pd, his contribution to the world.
 
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