Hope this is on topic enough.  

Enjoy

Bill

PS

Free for two weeks Hurricane software Mac & PC

http://www.starstonesoftware.com/eots/index.htm

......................................

http://www.newswise.com/articles/view/514690/?sc=dwhn

Source: Johns Hopkins Medical Institutions 
  
Released: Tue 20-Sep-2005, 13:40 ET 
Embargo expired: Wed 21-Sep-2005, 17:00 ET 

Strategies for People to Raise Their Levels of Good HDL Cholesterol
Libraries
Medical News
 
Keywords
HEART DISEASE, CHOLESTEROL, HIGH-DENSITY LIPOPROTEIN
Contact Information
Available for logged-in reporters only
Description
Cardiology experts at Johns Hopkins have issued interim guidelines for
physicians on how best to treat low levels of HDL cholesterol, the
so-called good cholesterol, which helps keep arteries clear from the
buildup of LDL cholesterol, the so-called bad cholesterol.

Newswise ‹ Cardiology experts at Johns Hopkins have issued interim
guidelines for physicians on how best to treat low levels of HDL
cholesterol, the so-called good cholesterol, which helps keep arteries
clear from the buildup of LDL cholesterol, the so-called bad
cholesterol. More than 54 million Americans are estimated to need higher
levels of HDL, according to the American Heart Association.
In an article to be published in The New England Journal of Medicine
online Sept. 22, the Hopkins researchers report that existing strategies
to prevent heart disease have not addressed the best means to raise HDL
cholesterol and instead have focused heavily on lowering LDL
cholesterol, which leads to plaque formation and narrowing of the
arteries that can cause heart attack.
³We have reached a turning point in the prevention of coronary heart
disease from an emphasis during the last 15 years on lowering LDL
cholesterol levels to an emphasis in the next decade on raising levels
of HDL cholesterol,² says article lead author and cardiologist Roger
Blumenthal, M.D., an associate professor and director of the Ciccarone
Preventive Cardiology Center at The Johns Hopkins University School of
Medicine and its Heart Institute.
According to Blumenthal, existing guidelines from the U. S. National
Institutes of Health and its National Cholesterol Education Program
primarily emphasize lowering LDL cholesterol to control blood lipid
levels without considering the alternative of raising HDL cholesterol as
the primary or even secondary goal.
However, Blumenthal notes that every single milligram per deciliter
increase in HDL cholesterol lowers a person¹s risk of suffering a fatal
heart attack by about 3 percent. Low levels of HDL cholesterol are known
to increase overall risk of dying from heart disease and, specifically,
to increase risk of arteries narrowing again after angioplasty surgery
to clear them. Low levels of HDL cholesterol, he says, are defined as
less than 40 milligrams per deciliter of blood in men and 50 milligrams
per deciliter in women.
In the NEJM report, Blumenthal and fellow expert, nurse practitioner
Dominique Ashen, Ph.D., C.R.N.P., an assistant professor at Hopkins¹
School of Nursing, provide a comprehensive review and summary of the 50
most significant research studies on how best to manage peoples¹
HDL-cholesterol levels through modification of lifestyle risk factors
for developing heart disease and use of drug therapy.
In addition, the researchers support their summary findings with a
concise table listing heart medications with guidelines about how and
when the drugs - niacin, fibrates and statins, or various combinations -
can be used to raise HDL cholesterol levels. Also provided in the table
are details on the drugs¹ chemical properties, or mechanism of action,
and possible side effects.
However, Blumenthal and Ashen point out that research to date has not
yet clearly distinguished which reductions in risk from heart disease
are due to drug gains in HDL levels or other direct effects on the
arteries. ³That has been responsible for delaying revisions to national
guidelines on HDL cholesterol,² Blumenthal says.
Using a recent patient case study from Hopkins involving a 41-year-old
man with low levels of HDL cholesterol (28 milligrams per deciliter),
the researchers reviewed how over a period of three years his HDL levels
were raised to above normal by modifying his lifestyle risk factors.
These modifications included making sure the patient engaged in regular
exercise, ceased smoking, assumed control over his weight as measured by
body mass index, limited alcohol intake, and monitored dietary fat
intake. The patient lost nearly 50 pounds while undergoing treatment.
To raise HDL cholesterol levels, the researchers recommend a regular
exercise program of brisk aerobic exercise for 30 minutes, several times
per week, if not every day.
Quitting smoking, they point out, provides an average increase in HDL
levels of 4 milligrams per deciliter. Aids such as drug therapy,
nicotine replacement products and counseling can help patients quit.
Weight control is also highlighted as critical to raising HDL levels,
with the researchers noting that every kilogram of weight lost raises a
patient¹s HDL levels by an average 0.35 milligrams per deciliter. A
reasonable weight loss goal, they suggest, for overweight or obese
patients is 1 pound, or 0.45 kilograms, per week, with a target body
mass index of less than 25.
Mild to moderate consumption of alcohol, no more than one to two drinks
per day, they say, has been shown beneficial in raising HDL levels by an
average of 4 milligrams per deciliter, irrespective of type of alcohol
consumed. But the researchers caution that the potential risks here may
outweigh the benefits in people with liver or addiction problems.
For dietary control, the researchers recommend a diet low in saturated
fat and rich in the polyunsaturated fatty acids found in foods such as
oils (olive, canola, soy and flaxseed), nuts (almonds, peanuts, walnuts
and pecans), and cold-water fish (salmon and mackerel), and shellfish.
Consumption of carbohydrates, they say, should be restricted because
high glycemic products, such as processed cereals and breads, are
associated with lower HDL levels.
In the report, the researchers cite niacin, also called nicotinic acid
or vitamin B3, as the most effective medication for raising HDL
cholesterol, leading to increases of 20 percent to 35 percent. Fibrate
therapy is also effective, they say, producing an average increase of 10
percent to 25 percent. Statins are the least effective of the three drug
classes, used primarily to reduce LDL cholesterol, raising HDL levels by
2 percent to 15 percent. When used in combination, low-dose statins and
high-dose niacin have been shown to produce benefits of 21 percent to 26
percent.
³Our report offers people interim guidelines on how best to manage HDL
cholesterol levels while awaiting the results of national clinical
trials, which could prove more definitive,² says Ashen, who was lead
author of the article. ³These guidelines also offer a good description
of the problem posed by low levels of HDL cholesterol, along with
details on how HDL cholesterol metabolism works in the body with LDL
cholesterol.
³The guidelines should help physicians and nurses to manage their
patients¹ blood lipid levels, including HDL cholesterol, with drug
therapies currently available, and should help prepare them to manage
future therapies, expected to be developed within the next five years,
that focus on raising HDL-cholesterol levels.²
Funding support for the researchers was provided by the Maryland
Athletic Club & Wellness Center Charitable Foundation in Lutherville, Md.

2005 Newswise.  All Rights Reserved.