New Study Suggests Statins For Those at Low Risk

A new study published in March 2016 by McGill University’s George Thanassoulis, MD in the Circulation journal of the American Heart Association suggests that many identified as ‘Low Risk’ by the latest cholesterol treatment guidelines should be taking cholesterol-lowering statins.

The current guidelines for treating cholesterol, published with much fanfare and controversy in November 2013, moved away from targeting treatment to reach a specific cholesterol level and instead include a ‘calculator’ that measures risk. If a person’s risk is lower than 7.5% chance of heart disease in 10 years, statins are NOT recommended. (Details, including a link to the calculator, found in my post: The NEW Guidelines for Cholesterol-Lowering Statin Meds.)

Personally, I fall into the ‘do not take statins’ pool using this calculator as:  a) I do not already have cardiovascular disease; b) my LDL (bad) cholesterol is less than 190; c) I do not have diabetes; and d) my 10-year risk is lower than 7.5%.

But according to this NEW March 2016 study, “Individualized Statin Benefit for Determining Statin Eligibility in the Primary Prevention of Cardiovascular Disease,” I might be one of the many at ‘low risk’ who should be taking statins!

Yikes.

The new study recommends “an INDIVIDUALIZED statin benefit approach” rather than relying on the calculator; using this approach, thousands who are currently at ‘low risk’ and not treated with statins would instead be treated with statins. According to the study authors, “Statin treatment in this group would be expected to prevent an additional 266,508 cardiovascular events over 10 years.”

Yikes times two.

And it was a large study. The study, “included 2134 participants representing 71.8 million American residents potentially eligible for statins in primary prevention from the National Health and Nutrition Examination Survey for the years 2005 to 2010.”  The study “compared statin eligibilities using 2 separate approaches: a 10-year risk-based approach (≥7.5% 10-year risk) and an individualized benefit approach (ie, based on predicted absolute risk reduction over 10 years [ARR10] ≥2.3% from randomized, controlled trial data).”

The risk-based approach (the ‘new’ 2013 guidelines that doctors are currently using) identified 15.0 million Americans who should take statins, versus 24.6 million Americans who should take statins according to the benefit-based approach. Thus, “the benefit-based approach identified 9.5 million lower-risk (<7.5% 10-year risk) Americans not currently eligible for statin treatment who had the same or greater expected benefit from statins (≥2.3% ARR10) compared with higher-risk individuals.

That’s 10 million Americans who should be taking statins who right now are not.

And I’m probably one of them!  Because the study goes on to say, “This lower-risk/acceptable-benefit group includes younger individuals (mean age, 55.2 versus 62.5 years) with higher low-density lipoprotein cholesterol (140 versus 133 mg/dL). Statin treatment in this group would be expected to prevent an additional 266,508 cardiovascular events over 10 years.

Yikes times three!  As this describes me: I’m under 55 and my LDL is 145.

I guess it’s time to put in a call to my cardiologist and ask what he thinks of this study.  I do not want to go on a statin medication, but I do want to understand his thoughts on both this study and what an “individualized benefit approach” to treating my high cholesterol looks like.

 

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Tangy, Healthy, Homemade Yogurt

Two things happened mid-February that messed with my decade-long half-bagel with smidge of cream cheese and slice of lox breakfast habit.

  1. My fabulous local delicatessen can no longer get the nirvana-like H&H bagels from NYC (yes, I know the real H&H closed years ago but the ‘other’ H&H bagels are great too). And I despise their CT-made replacement bagels. DESPISE.
  2. In the NYT, I read a Melissa Clark article about making homemade yogurt and became obsessed – especially because there was a kitchen gadget I could buy.

I tried to be more open — to embrace change and learn to love the new bagels. I could not. I then bought a dozen bagels from a deli in NYC and brought them home on the train. Nope. Tasted right but they are the size of a softball and I hate that.

Yes, I am picky. I know I am not flexible. It’s sad but I’m just not. I’d say I’m working on it, but at least food-wise, it’d be a lie.

So what’s a non-food-flexible girl to do? Well, that’s the upshot of the story because Melissa Clark’s homemade yogurt recipe was a revelation.

When I read How to Make Yogurt at Home, I was immediately intrigued by her statement that it’s both simple to make and delicious – far more delicious than store-bought and since I’m not a huge fan of yogurt I thought I should try it. And bonus: my doctor wants me to consume more calcium and, um, ice cream is not on the lo-co calcium list.

Then it got fun. As I re-read Ms. Clark’s article, I realized she inserted a mystery into her story. And who doesn’t love a good mystery:

“I fell in love with a whole-milk yogurt that was so smooth, thick and milky tasting that it blew away anything I’d had before. Naturally, it was made by a Brooklyn artisan, it cost a fortune, and it was in such high demand that the fancy shop where it was sold was often out of stock.”

Finding out what yogurt she was obsessed with became my obsession.

After a ridiculous number of hours reading yogurt reviews and searching online, I did not know the answer but narrowed it down to either The White Moustache or Sohha Savory Yogurt.  In NYC for the weekend, I could not find Sohha but did find The White Moustache, so I bought one of the single-serve jars for a whopping $6.

Then I re-read the ‘simple’ recipe and started laughing. Sure, it’s simple, if you have a lot of patience. But I’m neither flexible nor patient (at least I know my faults, right?)  Her two “tips” about how easy it was to make yogurt were what prompted me to immediately buy a yogurt maker.  To me, these did not sound easy:

Tip #1: “…rub an ice cube over the inside bottom of the pot before adding the milk. This keeps it from scorching as it heats.” (For me, this reads like a guarantee of a scorched pot and is thus to be avoided at all costs.)

Tip #2: “I’ve tried placing it in a turned-off oven with the oven light on, in a corner swathed in a heating pad, on the countertop wrapped in a big towel, and tucked on the top of the fridge. They all worked, though the warmer the spot, the more quickly the milk fermented.” (OMG…too many options / too many ways I could go wrong, so, um, no.)

When I told my sister what I was going to do, she said, “Oh, making yogurt at home is easy, you just cook it and leave it somewhere warm.”  Or something to that effect.  So I guess these ‘tips’ would act as ‘tips’ for some (most?) people, but for me it led me straight to the internet.

Where I realized there was one final challenge with making yogurt: timing. The entire process takes at least 18 hours. While none of it’s hard (except for that scorched pot part) and none of that time is actually active work, it does mean you need to plan out exactly when you start or you’ll need to get up at 3am to jam it into the refrigerator. And that’s a big no for me. Armed now with information, I searched on Amazon.

Cuisinart Electronic Yogurt MakerFirst I bought an “InstantPot”. Too many issues to enumerate so let me say, “just don’t believe the reviews; it’s not good as a yogurt maker.” I immediately returned it and bought the fabulous Cuisinart Electronic Yogurt Maker with Automatic Cooling.  At $99 it was not a small purchase but I’ve been thrilled with it – you just mix 2 cups of organic 2% milk (for lo-co yogurt I’m using 2%) with 3-4 TB of the White Moustache plain yogurt, turn it on for 12 hours and when it’s done, it then keeps it cool for 12 more hours – so at any normal time of day, you can remove it to the refrigerator. To me, that’s worth the cost of the pretty slim, nice-looking appliance!

Not only is this truly easy, but it makes yogurt that’s rich, creamy and tangy. With NO sugar, that tangy taste takes a bit of getting used to, but I’m trying (look at me, being flexible after all!)  I add fresh berries and mash them up to give the yogurt a bit of color and also a handful of granola for some crunch and texture.

The only problem is – I am eating it for lunch, not breakfast. Turns out I really crave hot (or at least, not cold) for breakfast.  So I’m still eating the last of my NYC frozen bagels (can’t let them go to waste, right?) and trying to gear myself up to try yogurt for breakfast.

If you are more flexible than me (a low bar indeed) and/or like yogurt for breakfast but would prefer a tangier, no-sugar option at a fraction of the cost of buying individual serve yogurts, give Melissa Clark’s recipe a whirl.

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Order Your Own Cholesterol Test

When my cardiologist and I had a small miscommunication about the tests he was ordering at the end of December (which mattered because I had hit my huge deductible so was trying to get all necessary medical expenses done in 2015!) I learned two things:

  • You can save HUNDREDS of dollars on lab tests if you shop around – key if you are paying out of pocket because you have a high deductible.
  • You can order your own lab tests – you don’t need a doctor’s prescription for many tests, including cholesterol testing!

Here’s what happened… and how you can save money and get your cholesterol tested at any time YOU choose.

I started out with an actual prescription; my cardiologist wrote me an Rx for a VAP Cholesterol Test, which included a diagnosis code. Googling it, I learned the VAP test was exactly what I was looking for – the ‘basic’ fasting lipid test. “The VAP test assesses levels of all the blood lipids measured in a standard lipid profile (total cholesterol, LDL, HDL, and triglycerides), plus subclasses of lipids that are known or emerging risk factors for cardiovascular disease, such as LDL particle size and lipoprotein(a).”

Then I called the two conglomerate blood drawing facilities I’m used to using with the test name and diagnosis code, and found this simple cholesterol blood panel was going to cost $210.

$210!

Yikes. Especially because if this test had been included – as I thought it had been – in the blood test my doctor ordered in December, it would have cost me ZERO out of pocket.

So I searched online and found a company called Walk-In Lab. Their website slogan is, “Convenient. Affordable. Confidential,” and that is exactly what it was. Instead of $210, I ordered the VAP test – the very same test – for a grand total of $82. I was thrilled to save $128 (!!!) and their blood drawing facility was actually closer – and cleaner – than the one I normally go to!

PLUS – you don’t even need the doctor’s Rx to get this test done. You just order it yourself, online. (NOTE: LabCorp does NOT operate in some New England states. According to their site, “New York, New Jersey, Rhode Island and Maryland state laws prohibit direct-access testing and LabCorp has temporarily suspended testing in Massachusetts.”)

So if you don’t want to spend money on a doctor visit but feel it’s time/important for a cholesterol check – OR – if you have an Rx from your doctor for a lipid panel but are paying out of pocket and would prefer NOT to pay $200+ for a test, check out Walk-In Lab for a VAP #1 Baseline test. Right now, instead of the $92 – $10 coupon total cost I paid in December, the VAP is a veritable bargain at $69!)

A few things to note:

  • Make sure there is a blood drawing laboratory convenient to you BEFORE you order your test online. There is a lab locator on the Walk-In Lab site (Walk-In Lab does not draw the blood – those are separate facilities and you must be sure you have one nearby BEFORE you buy your test!)
  • Watch and/or read the Walk-In Lab “How It Works” before you buy your test.
  • Cholesterol tests offered are listed here: Walk-In Lab Cholesterol Tests. As I’d had a detailed test done the prior year, I just needed the ‘baseline’ test…but you can order more detailed tests – for more money, of course.

While it’s critical to meet with your doctor about your cholesterol levels and heart disease risk, if you wind up like me, in a situation where you just need a simple test done quickly, check out Walk-In Lab!

P.S. Apologies for lack of posts: had a big technical issue that took a few weeks to solve.

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Hearty Mushroom-Spinach Soup

While I am not usually a fan of soup for dinner, my husband is, and this month I found two soup recipes that looked hearty enough to possibly satisfy. Plus they both had the alluring added bonus of “requiring” the purchase of a new kitchen gadget. Though there’s barely room in my ‘magic closet,’ I could not resist.

So two weeks ago, I made New York Times “Recipes For Health” columnist Martha Rose Shulman’s Winter Vegetable Soup With Turnips, Carrots, Potatoes and Leeks – because it looked tasty and required a food mill, a kitchen implement I’ve often wondered about. More on that adventure in another post.

Last night, I was tempted by a recipe that appeared that day (oh the spontaneity!) in the NYT. I always have good luck with Melissa Clark recipes, so I went right on out and purchased an immersion blender and ingredients for her Mushroom-Spinach Soup With Middle Eastern Spices.

The immersion blender was a bust. Literally. I need to find and buy a different brand; luckily I have an old fashioned blender, so that saved the day. Which was good because this recipe was delicious – both very tasty and hearty enough for the not-soup-lover in me. Beyond a new lo-co meal, the whole reason I tried it (besides the fact that I love mushrooms) was Ms. Clark’s quite accurate description:

Andrew Scrivani for The New York Times

Andrew Scrivani for The New York Times

“This is a very hearty, chunky soup filled with bits of browned mushroom and silky baby spinach. A combination of sweet and savory spices – cinnamon, coriander and cumin – gives it a deep, earthy richness.”

Sounds good, right? It was. It even looks hearty, as you can see in this picture that accompanied the recipe.

The picture and description enticed me to try the recipe – to run right out and buy the ingredients, actually.

But I have two quibbles with the recipe as Ms. Clark published it.

First, it does NOT take one hour. It took me 1.5 hours – and I didn’t even dice shallots.  So if you are going to try this recipe, give yourself at least 90 minutes. AT LEAST. Nothing’s hard, it just takes time.

Second, once the soup is cooked, step 4 of the recipe is not quite accurate. The recipe says, “Using an immersion blender or food processor, coarsely purée soup.” After my immersion blender mishap, I poured the soup – nearly all of it – into my blender and hit puree. Once back in the soup pot, I realized the recipe was not accurate for use of an – oh wait – she said food processor, not old fashioned blender.  My bad.

OK, so what I was going to say is that the directions should say to purée only half of the soup or something to that effect – because Ms. Clark’s soup has some beautiful big chunks of mushrooms in it post-puréeing (and mine did too, before I puréed it – see picture below on the left.) But puréeing pulverized nearly all of my mushroom chunks (see photo on right). I was a little sad about that – but now see that was my fault (though actually, I’m not entirely convinced that if you put ALL of the soup in a food processor and coarsely puréed it, you’d still have some nice big mushroom slices. A guess on my part, but I still think you should not food processor purée ALL of it!).

MushroomSoup2

Pre-purée: looks like recipe pic!

MushroomSoupBlended

Post blender: few mushroom chunks

 

 

 

 

 

 

 

 

 

Sadly that was not my only error. I also forgot to buy shallots. This recipe calls for 1/2 pound of diced shallots – that is a LOT of shallots: far more than the 1 head I had on hand. Instead, I used fresh pre-diced onions and diced them further. (And still, it took me 1.5 hours to make this soup without peeling and dicing a huge number of shallots!)

MushroomSoupFinalMy mistake(s) notwithstanding, this was still delicious. It does have a vaguely Indian flavor profile – so if that’s not your deal, you may prefer different spices. You can see from my terrible picture that I served this as suggested, with a dollop of plain greek yogurt. Along with a nice loaf of fresh French bread, both my husband and I enjoyed this dinner. It’s a tasty lo-co meal that’s a great change of pace from a meat-based meal, and to my surprise this was a totally satisfying dinner. Plus, it’s easy to make on a weeknight – as long as you have the time for and don’t mind dicing.

So, another Melissa Clark recipe win.

I’ll let you know if the immersion blender works better than a regular blender when the one I ordered from Amazon arrives!  I hope it’s not too big; my magic closet is filled to the ceiling. Literally.

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Why You Should Ask Your Doctor About HS-CRP

If you have high cholesterol but no other cardiac disease risks, ask your doctor about the High Sensitivity C-Reactive Protein (HS-CRP) test.

The HS-CRP test is an important predictor of heart disease risk. Actually, as explained in Why You Should Ask For Advanced Lipid Testing, if you are concerned about heart disease risk, you might want to ask your doctor about three key tests: HS-CRP, ApoB and LDL Pattern Type. (While they’re separate tests, all are included in one single Advanced Lipid Panel blood test.)

The HS-CRP test in particular predicts heart disease risk by measuring inflammation in the blood vessels. That the HS-CRP blood test is an excellent predictor of heart disease risk has been widely established. A page on the National Institute of Health about HS-CRP states, “Evidence supporting the hypothesis that elevated CRP levels contributes to increased cardiovascular risk is now available from at least six major prospective studies…”

The HS-CRP is particularly relevant for women. WebMD’s Heart Disease and C-Reactive Protein (CRP) Testing article explains that in the large Harvard Women’s Health study (WHS), “results of the CRP test were more accurate than cholesterol levels in predicting heart problems. Twelve different markers of inflammation were studied in healthy, postmenopausal women. After three years, CRP was the strongest predictor of risk. Women in the group with the highest CRP levels were more than four times as likely to have died from coronary disease, or to have suffered a nonfatal heart attack or stroke compared to those with the lowest levels. This group was also more likely to have required a cardiac procedure such as angioplasty (a procedure that opens clogged arteries with the use of a flexible tube) or bypass surgery than women in the group with the lowest levels.”

That said, if you are already taking a statin or being treated for high blood pressure, the HS-CRP test might not be appropriate. According to Dr. Andrew Weil’s What is elevated C-reactive protein? article, “CRP levels don’t appear to help predict the risk of heart disease in patients already being treated for risks such as high blood pressure or high LDL (“bad”) cholesterol. A 2010 analysis of British data on 4,853 patients found that C-reactive protein levels didn’t yield any more information about the risk of heart disease than LDL (“bad”) cholesterol levels or high blood pressure in patients who already were being treated with a cholesterol-lowering statin drug or with medication to lower blood pressure.”  However, it goes on to say that, “Other physicians, including Dr. Weil, think that all adults should have an hs-CRP test whenever their cholesterol is tested.”

A powerful statement.

My cardiologist appears to agree; at my visit on Christmas Eve, he ordered an advanced lipid panel and an HS-CRP test. There was a mixup on the advanced lipid panel prescription (more on that in another post) so I don’t yet have those results, but I was delighted to see that my HS-CRP test came back with even lower risk than last year.

I was surprised at this result, but apparently should not have been. With a bit of research I found that HS-CRP should be measured over time, as there is high variability in this test. According to the Mayo Clinic, “C-reactive protein (CRP) is an acute-phase reactant and has high intraindividual variability. Therefore, a single test for high-sensitivity CRP (hs-CRP) may not reflect an individual patient’s basal hs-CRP level. Repeat measurement may be required to firmly establish an individual’s basal hs-CRP concentration. The lowest of the measurements should be used as the predictive value.”  I saw this in my own results: in December 2014 my HS-CRP level was 0.8 and in December 2015 it was 0.3.

As both of my HS-CRP measurements are below 1.0 mg/L, that puts me at “lower relative cardiovascular risk” according to the goals printed at the bottom of my test results.  Here are the guidelines:

HS-CRP Guidelines

Do you know your heart disease risk as measured by HS-CRP? If you fall into the category of those for whom the HS-CRP test is a good predictor of heart disease risk (meaning, you aren’t already being treated for heart disease or you have an inflammatory disease), ask your doctor about this simple blood test and get more insight into your heart disease risk.

 

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