Study Proves Exercise Staves Off Bad Cholesterol

I’ve been in an exercise black hole since January 29th – the day I hurt my elbow shoveling. Since I had tennis elbow surgery 10 years ago, I knew this time to immediately stop playing tennis and quit spin to let my elbow heal. Suddenly it was 4 months later and I’ve gained weight and am out of the regular exercise habit.

YES, I could have done some other exercise. YES, I have both a treadmill and an elliptical in my home. NO, I didn’t use them and instead wallowed in my sadness that I’d reinjured my elbow.

And YES, I regret my sloth as I gained 5 pounds in four short months.

My elbow is still not 100% but now I’m on the slow path to regaining cardio fitness – and hopefully losing the weight that irks me daily as my jeans don’t fit.

And while exercise is harder than ever for me (getting old really bites: various body parts scream in protest when pushed), the good news is that a recent study of 11,000+ men proves that exercise may delay age-related high cholesterol levels.

An article entitled,The Effect of Cardiorespiratory Fitness on Age-Related Lipids and Lipoproteins was published online in the Journal of the American College of Cardiology, on May 11, 2015. While I can’t read the actual article as it costs $35 to purchase (!) I’m writing based on several reputable sources who reported on this study.

Researchers used data from the Aerobics Center Longitudinal Study in Dallas, Texas, collected from more than 11,000 men between 1970 and 2006 to assess total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides.

As Lisa Rapaport of Reuters reported in her article, Men Who Exercise May Delay Age-Related High Cholesterol, in the study, “researchers followed thousands of men over several decades, periodically drawing blood to test their cholesterol and then making them run on treadmills to measure their cardiorespiratory fitness. Men who could run longer and faster – signs that their bodies more easily deliver oxygen to muscles – also had lower cholesterol.”

“The better men did on fitness tests, the more likely they were to have lower total cholesterol, as well as lower levels of what’s known as low-density lipoprotein (LDL), the bad kind of cholesterol that builds up in blood vessels and can lead to atherosclerosis, blood clots and heart attacks.

Fitter men also had higher levels of so-called high-density lipoprotein (HDL), the good cholesterol that helps purge the bloodstream of LDL.

Men with higher cardiorespiratory fitness levels had better cholesterol profiles than less fit men from their early 20s until at least their early 60s, though the difference diminished with older age.

At the same time, men with lower fitness levels reached abnormal cholesterol levels before age 40.”

Said differently, unfit men were at risk of developing high cholesterol in their early 30s, but those with better fitness levels did not see it rise until their mid-40s, around 15 years later.

Dr. Gregg Fonarow, professor of cardiology at the University of California, Los Angeles, was widely quoted about this article online: “Exercise is a vital component of achieving lifelong cardiovascular health. Regular physical activity and maintaining physical fitness has been shown to be associated with a lower risk of [heart attack], stroke, and premature cardiovascular death.”

How much exercise is needed? According to study co-author Dr. Xuemei Sui, an Assistant professor at the Arnold School of Public Health at the University of South Carolina, to achieve the fitness levels necessary to ward off age-related high cholesterol, men should get 150 minutes a week of moderate activity (gardening, dancing, brisk walking) or 75 minutes of vigorous activity (jogging, running, swimming, cycling).

That’s 30 minutes of aerobic activity (a brisk walk!) five days a week, or 3-4 runs a week (or for me: tennis or spin 2-3 times a week).

Of course this study was done just with men. Actually, healthy white men. Of course that is incredibly frustrating. But I am going to go out on a limb and assume the same healthy benefits may confer on men and women in general.

And hope that getting back to the regular/daily exercise that will make my jeans fit again will also keep bad cholesterol at bay.

 

 

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New Cholesterol Guidelines – An App For That

The American Heart Association and the America College of Cardiology released completely new, totally different guidelines for the treatment of high blood cholesterol back in November 2013.

As explained in my post, The NEW Guidelines For Cholesterol-Lowering Statin Meds, in broad strokes the new guidelines state that if you are in one of the following four groups you have elevated heart disease risk and should take statins:

  1. those who already have cardiovascular disease
  2. anyone with LDL (bad) cholesterol of 190 mg/dL or higher
  3. anyone between 40 and 75 years of age who has Type 2 diabetes
  4. people between 40 and 75 who have an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher.

To determine your personal 10-year risk of cardiac disease, the new guidelines included an online calculator * … and now that a few months have passed, there’s even AN APP FOR THAT (links to the app are on the online calculator webpage – or search ‘ASCVD Risk” in iTunes store). I downloaded the app for my iPhone and it’s quite handy as it saves your data and also provides articles about key topics like ‘diet and physical activity recommendations,’ and ‘common cardiovascular terms,’ and the like – right in the app.
* NOTE – if the link does not work, check for an updated link on my RESOURCES page.

One of the more interesting topics I found inside the app (in the Patients’ Blood Cholesterol Management Recommendations tab) discussed additional blood tests. After reviewing with your doctor your ‘lifetime risk estimate’ based on the inputs in the calculator/app, the article stated there were three additional tests your doctor may want to order:  Coronary Artery Calcium (CAC), High-Sensitivity C-Reactive Protein (CRP) and Ankle-Branchial Index (ABI).

The Coronary Artery Calcium test was one my doctor had talked with me about a few years ago. She asked me to find out whether anyone in my family (all of whom take a statin to manage high cholesterol) had had a Coronary Artery Calcium test done, and if so, what the results were. I failed at that. Apparently, I need to email all my cousins and aunts and uncles.  Today.

As I wrote about in Cholesterol Tests Your Doctor Hasn’t Told You About, the C-Reactive Protein test is a test (along with apo-B) that I would really like done to truly understand my cardiac risk. CRP is a measure of inflammation in the body and high levels have been associated with heart disease.  But my doctor declined to order either test for me back a year or two ago – said with my just-over-220 total cholesterol levels, I didn’t need these tests.

The Ankle-Branchial Index I’ve never heard of before. According to the ASCVD Risk app, ABI measures “the ratio of the blood pressure in the ankle compared to blood pressure in the arm, which can predict peripheral artery disease (PAD).”

So I will have to ask my doctor again about Coronary Artery Calcium, CRP, apo-B and ABI testing. I feel sure she won’t agree to this testing because my newly calculated lifetime risk is far below the 7.5% risk that indicates statin medication is needed.

That said, these tests are at least mentioned within the new guidelines, while others, like Non-HDL cholesterol are now no longer viewed as vital to determining cardiac disease risk and treatment plans. So even though my risk is low under the new guidelines and I am no longer in the group that should be taking statins, I want to ask about whether these tests might provide further insight into cardiac risk.

If you haven’t read about the new guidelines or found the new online calculator intimidating, download the new app.* Knowing your cardiac risk before you talk to your doctor will give you more confidence to ask questions about your risk of cardiac disease at your next appointment.

* You can’t use the calculator/app if you already have cardiac disease or take statins. If that’s you, best bet is to talk with your doctor about what the new guidelines mean for you and/or if a change in your statin medication is warranted.

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Why You Should Use the New Cholesterol Guideline Calculator

The new cholesterol treatment guidelines were unveiled on November 12, 2013 and controversy flared almost immediately.

The issue?

A duo of doctors are concerned that the new calculator used in one part of the guidelines seriously over-estimates heart disease risk (the calculator delivers a person’s 10-year risk of heart disease: the new guidelines state those with a risk above 7.5% should take a statin). If they are right, the result would be millions of new people taking a statin — who maybe don’t need this drug.

A serious concern, indeed.

Am about to go into a bit of detail about why it might be over-calculating: if you know already/have been following in the news (or don’t care for the details) skip down to BOLD below!

Harvard professors Dr. Paul M. Ridker and Dr. Nancy Cook tested the risk calculator using THREE studies they chose, of thousands of people over the last decade — and found the calculator over-predicted risk by 75-150 percent. One possible reason for the (alleged) over-prediction is that the new guidelines were based on MANY studies (usually a GOOD thing) but in this case, that means that some of these studies included people from more than a decade ago (a time when far more people smoked than currently do, and thus had more heart attacks.)

The AHA’s response?

As reported by the Boston Globe, “the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that patients and doctors should discuss treatment options rather than blindly following a calculator.”

The article goes on to state that according to Dr. Sidney Smith, executive chairman of the guideline committee, “the concerns “merit attention.” But, he continued, “a lot of people put a lot of thought into how can we identify people who can benefit from therapy.” Further, said Smith, a professor of medicine at the University of North Carolina, “What we have come forward with represents the best efforts of people who have been working for five years.”

So, what’s the deal? Should you use the calculator or not?

I vote YES, emphatically!

Of course, I’m not a doctor (and you shouldn’t believe everything you read on the internet)… but here’s let me tell you why I say YES, you should use the calculator.

As stated in my last post, The New Guidelines, the RATIONALE behind these new guidelines makes all the sense in the world.  The new guidelines no longer tie statin medication to achieving a particular cholesterol number.

Said differently, the new guidelines recommend statins only for those AT RISK of heart disease. For those who have high cholesterol but low heart disease risk, statins are NOT recommended.

This makes more sense conceptually (to me) than the prior mandate of hitting a certain cholesterol goal number – especially since those ‘goal numbers’ were not, apparently, tied to anything scientific!

To illustrate, I’ll use, um, me.  Yes, I totally get that an n=1 is not useful for anything other than as an example, but I’ll make an example nonetheless.

Under the old guidelines, statin medication was possibly warranted for me simply because my cholesterol numbers were near certain figures — even though I eat well, exercise a lot, and don’t have ANY OTHER risk factors. Net, under the old guidelines my doctor actually TALKED to me about taking a statin, even though I’m healthy and don’t have any heart disease risk factors EXCEPT for “high” cholesterol.

I decided no. But it wasn’t necessarily an easy thing to do.

Under the new guidelines?

Shocker –  I am nowhere near that 7.5% heart disease risk cutoff.

That’s because the new guidelines take into account the fact that:

  • My LDL (bad) cholesterol is far, far lower than 190
  • I’m a female (here’s another huge shock – the original guidelines were created using mostly data from white men.  Sigh.)
  • My blood pressure is low/normal, and I do not take blood pressure medication
  • I’m not diabetic
  • I do not smoke.

To me, even just reading this list of inputs into the heart disease risk calculator “proves” this is a significantly better way to estimate heart disease risk than the old guidelines, (which put me as at risk simply because “my cholesterol is above 200.”)  The new guidelines just make FAR more sense: they endeavor to predict risk, not get to a cholesterol goal.

So download the calculator (and do it soon in case the AHA gets under so much pressure they take it down) – just click the red button that says, “Download CV Risk Calculator” and save it to your desktop. USE IT!  (And if the above link doesn’t work, check my RESOURCES page for latest link.)

Yes, OK, there could be a problem with the calculator…

But don’t decide not to use it because of the potential issue.  Instead, use it wisely!

If your result is at or near that 7.5%, take that as a clue to talk to your doctor.  Don’t blindly decide you need to start a statin with that result — but do talk to your doctor. Maybe he or she will decide to run some further tests (like C-reactive protein, ApoB and LDL-P – read more here) to really understand your risk.

But do download the calculator and get a sense of your 10-year risk.

  • It could save your life. You could truly need a statin and not know it.
  • Or you could find out you are at/near the 7.5% risk – and if you do, you can decide what to do about it, with your doctor.
  • Or you could be like me and find out statins aren’t indicated – even if the calculator is over-estimating risk.

But now, at least, the calculator means your discussion with your doctor will be focused on the right thing – what, truly, is your individual level of heart disease risk. And you can form a plan based on that, rather than a (seemingly somewhat arbitrary) cholesterol goal number.

So even if the calculator is over-estimating, the most likely result will NOT be millions taking statins unnecessarily. The most likely result will be millions ASKING their doctors about their level of heart disease risk.  So they can create a plan together.

Which is the point, no?

To read more about the new guidelines – and why using the new online calculator makes sense – I found these articles particularly insightful:

And just a quick reminder: to use the calculator, you need three pieces of info: your total cholesterol, your HDL (good) cholesterol, and your systolic blood pressure (the first number in the blood pressure measurement).

And last but not least, the calculator cannot be used if you already have heart disease or if you currently take statins: if that’s you, best bet is to talk with your doctor about what the new guidelines mean for you.

 

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The NEW guidelines for cholesterol-lowering statin meds

It was another big week for cholesterol news.

Last week the FDA declared that partially hydrogenated oils (PHOs), a very common processed food ingredient, are now not safe. As explained in FDA: Trans Fats are not GRAS, if PHOs are indeed declared not GRAS (generally regarded as safe), FDA will have found a way to significantly reduce unhealthy trans fats from the American food supply. Which is huge.

Then this week, more enormous cholesterol news.  On November 12, 2013, the American Heart Association and the America College of Cardiology released new guidelines for the treatment of high blood cholesterol. The new guidelines will very likely result in a dramatic increase in the number of Americans taking statin medications to lower cholesterol and heart disease risk.

Both in the span of just one week

And it wasn’t even National Cholesterol Education Month.  (That was September.)

What gives? Why these two huge announcements now, within days of each other?

While I have no idea if the timing was coordinated (or not), I do know that both moves have the potential to significantly reduce cholesterol and heart disease risk. And that one move (banning PHOs) is a no-brainer while the other (the new statin guidelines) has many up in arms.

As you know, I am not statin-girl (unless clearly warranted) so it’s potentially troubling that the new guidelines will prompt millions of new statin prescriptions. So I empathize with those who are unhappy with the new guidelines. That said, I am all for the RATIONALE behind these new guidelines — which focus on heart disease risk, not on reducing a particular cholesterol number in an otherwise healthy, low-risk individual.

This makes sense to me.

And OK, so I’m not a doctor, so who cares that it makes sense to me? On the other hand, I do think a great deal about medical issues… and to me, these new guidelines are logical. And logical=good, right? In effect, the new guidelines recommend statins only for those AT RISK of heart disease. For those who have high cholesterol but low heart disease risk, statins are NOT recommended.

So, what exactly are the new guidelines? Broadly… if you are in one of the following four groups, you have elevated heart disease risk and should take statins:

  1. those who already have cardiovascular disease
  2. anyone with LDL (bad) cholesterol of 190 mg/dL or higher
  3. anyone between 40 and 75 years of age who has Type 2 diabetes
  4. people between 40 and 75 who have an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher. (And there’s a calculator available online ** so you can figure out if this applies to you. It’s an Excel spreadsheet download – click the red ‘Download CV Risk Calculator’ box and save it to your computer. Do it soon because they may take it down…)** NOTE – the ‘risk calculator’ is occasionally taken down, edited, etc.  If the above link doesn’t work, check my RESOURCES page as I’ll try to keep that one current.

That’s it in a nutshell (well, that and the elimination of the old guideline to get LDL to an ‘as-low-as-possible’ level — in the new guidelines, there is no set LDL goal level).

Is that all? Of course not – there was a ton of media coverage last week, and there’s a lot more in-depth understanding of the guidelines that can be had. As it’s an important (and can be confusing topic), I wanted to provide what I found to be the best primary sources in case you want to dive in and read more.

(If, on the other hand, you prefer to read one piece providing an overview of the new guidelines, how they are different from the old guidelines, and how to calculate your personal heart disease risk, you might find this article I just published on Answers.com more useful: “New Cholesterol Statin Drug Guidelines.”)

But if you want more in-depth information, here are some sources:

Perhaps the new guidelines will result in millions more Americans taking statin drugs – but perhaps, if they are the RIGHT people to take statins, that will be a good thing.  If you are wondering if you should take a statin, read up on the new guidelines, calculate your heart disease risk online, and talk to your doctor.

If you already take statins (or have heart disease already) the online calculator won’t work for you — in that case, talk to your doctor about what the new guidelines mean for you.  Maybe your doctor will recommend going off statins for a bit to see what your baseline cholesterol level is now. Or maybe your doc will want you to stay on statins, but will switch you to a different one.

Either way, the times have changed. Read up on the new guidelines and talk to your doctor about how they apply to your situation.

I know I will.

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