High LDL Cholesterol in Young Adults and Heart Disease Risk in Middle Age

 

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“A critical weekly review of important new research findings for health-conscious readers”


HIGH LDL CHOLESTEROL IN YOUNG ADULTS AND HEART DISEASE IN MIDDLE AGE

Most young adults look upon heart disease as an “old person’s” disease, and many young people therefore assume that they do not need to be concerned with their diet, or with their cholesterol profile, during this early stage of their adult lives.  However, a newly published prospective public health study, which appears in the current issue of the Annals of Internal Medicine, should certainly cause young adults to reconsider the relevance of these two very important health-related factors to them.

In this study, 3,258 men and women between the ages of 18 and 30 enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study between 1985 and 1986.  All of these research volunteers underwent blood tests for LDL cholesterol (the “bad cholesterol”), HDL cholesterol (the “good cholesterol”), and triglycerides (fat in the blood, which is also linked to cardiovascular disease risk).  Subsequently, these blood lipid tests were repeated throughout the 20-year course of this prospective public health research study.  Twenty years later, these now middle-aged adults underwent special scans of their hearts in order to detect and quantify calcium deposits in their coronary arteries (the “coronary calcium score” is used to predict a patient’s risk of experiencing future cardiac events like angina or heart attack).

The findings of this study are cause for considerable concern.  First of all, fully 87 percent of these volunteers were found to already have one or more abnormalities in their HDL, LDL or/and triglyceride levels, which are associated with an increased risk of cardiovascular disease.  Thus, nearly 90 percent of these young adults, who were recruited into this research study from nearby communities at 4 different locations in the United States, already had abnormal blood lipid test results at the time they entered into this clinical study!

After 20 years of observation, coronary calcium scores were obtained on each of these more than 3,000 study participants.  Once again, the results were striking (and concerning).  When the average LDL levels of these study volunteers were compared with their calcium scores, it quickly became apparent that elevation of LDL levels in the blood during young adulthood is associated with a rising and significant risk of coronary artery disease during middle age (based upon coronary calcium score results).  Among the volunteers who maintained normal LDL levels (<70 mg/dL, or <1.81 mmol/L) during their young adult years, there was an 8 percent incidence of coronary artery calcification (coronary artery atherosclerosis) 20 years later.   However, among the patients with elevated average LDL levels (160 mg/dL or higher, or 4.14 mmol/L or higher), the incidence of coronary artery disease was 44 percent. 

Even relatively mild increases in LDL levels during young adulthood were found, in this study, to be associated with an increased risk of coronary artery disease in mid-life.  When compared to patients with LDL levels <70 mg/dL (<1.81 mmol/L), patients with LDL levels of 70 to 99 mg/dL (1.81 to 2.56 mmol/L) were 50 percent more likely to have detectable coronary artery disease.  Patients with LDL levels between 100 and 129 mg/dL (2.59 to 3.34 mmol/L) were found have a 140 percent increased risk of coronary artery calcifications.  Patients with LDL levels between 130 and 159 mg/dL (3.37 to 4.12 mmol/L) experienced a 230 percent increased risk of developing coronary artery disease in middle age.  Finally, those patients with LDL levels of 160 mg/dl or higher (4.14 mmol/L or higher) had a whopping 460 percent increase in the risk of developing coronary artery disease by the time they reached middle age!

While the finding of coronary artery calcifications in these volunteers does not mean that every one of them will go on to experience heart attacks, or other serious complications of coronary artery disease, coronary artery calcium deposits (due to atherosclerosis) have been proven to significantly increase the risk of angina and heart attack, as well as other complications of cardiovascular disease.

This is a powerful public health study, because of its long-term follow-up of a relatively large group of patient volunteers.   Its findings tell us at least two very important things that we all should know regarding the risk of developing cardiovascular disease during middle age.  The first is that a strikingly large majority of young adults in the United States are already overweight, and already have abnormal blood lipid levels (and which are known to be associated with an increased lifetime risk of cardiovascular disease).  Secondly, even relatively mild increases in the level of LDL cholesterol in the blood during early adulthood are associated with a significant increase in the likelihood of having heart disease by middle age.  Moreover, significantly elevated LDL levels, over time, are associated with a huge increase in the risk of developing coronary artery disease by mid-life.

Based upon the findings of this important study, it is may be necessary to revisit the recommended age at which the routine annual testing of LDL cholesterol levels is initiated, particularly for young adults who are obese, or who have a family history of cardiovascular disease.  I also cannot stress enough the direct linkages that exist between diet and weight, on the one hand, and LDL cholesterol levels on the other had.  We are facing a true epidemic of obesity in this country, with two-thirds of the population already categorized as overweight or obese (and the proportion of the American population that is overweight or obese continues to rise every year).  The results of this study add to other prior research data regarding the lifetime health effects of poor lifestyle and diet choices, even when these poor choices are made during the very early years of our adult lives.

 

For a disturbing look at the links between obesity and cancer risk, watch for the publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in late August of this year.



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link:  http://www.youtube.com/watch?v=7-Tdv7XW0qg



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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Walnuts, Cholesterol, LDL & Triglycerides

March 7, 2010 by  
Filed under Uncategorized

 

Welcome to Weekly Health Update



  “A critical weekly review of important new research findings for health-conscious readers” 


WALNUTS, CHOLESTEROL, LDL & TRIGLYCERIDES

Walnuts are rich in anti-inflammatory nutrients, including omega-3 fatty acids and ellagic acid.   Previous research has shown that the regular consumption of walnuts appears to improve cardiovascular function following high-fat meals.  In diabetics, who face an increased risk of cardiovascular disease, walnuts also appear to improve cardiovascular function.

A newly published prospective, randomized clinical research trial, which appears in the European Journal of Clinical Nutrition, evaluated the effects of a walnut-supplemented diet on 87 adults with normal-to-high cholesterol levels in their blood.  This study used a “crossover” approach, in which all of the patient volunteers received walnut supplements for 6 months, and were then switched to a walnut-free diet for another 6 months.  During this 12-month study, blood tests were performed at the beginning of the study, and then at 4, 6, 10 and 12 months into the study.  Because of the crossover design of this study, the researchers were able to directly compare the effects of walnut supplementation on body weight, total cholesterol, LDL cholesterol (the “bad cholesterol”), HDL cholesterol (the “good cholesterol”), and fatty acids (triglycerides).  (Together, these compounds are referred to as “lipids.”)

As has been observed in previous clinical studies of shorter duration, this study found that a 6-month period of walnut supplementation resulted in significant reductions in total cholesterol and triglyceride levels.  LDL levels were also reduced, although this finding just barely failed to reach statistical significance.  Importantly, these favorable changes in blood lipid levels were found to be more pronounced in patients with elevated total cholesterol and LDL cholesterol levels.  (I should note that significant reductions in LDL blood levels have been observed in response to adding walnuts to the diet of patients with elevated LDL levels, in other studies.)

While statins, and other lipid-lowering drugs, have revolutionized the management of elevated cholesterol and triglycerides, and have been shown to significantly reduce the risk of cardiovascular disease (and death due to cardiovascular disease), not all patients with hyperlipidemia can tolerate these drugs.  Moreover, as with all medications, these lipid-lowering drugs are not equally effective in all patients, and many patients with hyperlipidemia will continue to have elevated LDL cholesterol and/or triglyceride levels despite taking lipid-lowering drugs.

Studies such as this one suggest that the addition of walnuts to one’s diet may be a useful adjunct in lowering elevated LDL cholesterol and triglyceride levels.  (As always, I encourage everyone to check with their doctor before making any significant alterations in their diet, especially if you have one or more chronic illnesses.)


For a detailed and comprehensive evaluation of the role of nuts, omega-3 fatty acids, ellagic acid, and other dietary modifications, as part of a cancer prevention lifestyle, look for the publication of my new book, “A Cancer Prevention Guide for the Human Race,” in the spring of this year.
 


In view of the extreme devastation and human misery brought about in Haiti and Chile by the recent earthquakes, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in those countries to assist the injured, the ill, and the homeless.  There are many such legitimate charities, including the following two:

http://www.redcross.org/

http://www.imcworldwide.org/haiti


Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg



I and the staff of Weekly Health Update would like to take this opportunity to thank the nearly 120,000 new and returning readers who visited our premier global health information website last month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. 

 

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Salt (Sodium) Intake, Stroke & Cardiovascular Disease

December 6, 2009 by  
Filed under diet, health, heart disease, Nutrition, stroke

Welcome to Weekly Health Update



 

“A critical weekly review of important new research findings for health-conscious readers”


 

Salt (Sodium) Intake, Stroke & Cardiovascular Disease

 

 

Table salt consists of the elements sodium and chloride, both of which are essential for life.  There is a great deal of clinical research suggesting that more than 5 to 6 grams of salt intake per day (which is equal to 2 to 2.4 grams of sodium)  is associated with a significant increase in the risk of developing high blood pressure which, in turn, is associated with a significantly increased risk of stroke and cardiovascular disease.  Unfortunately, in most countries, the average daily salt intake for adults is considerably greater than 6 grams per day.  Moreover, in many countries of the world, the average daily adult intake of salt is a whopping 12 grams per day, or almost 5 grams of sodium per day. 

 

In the United States, the American Heart Association (AHA) currently recommends no more than 2.3 grams of sodium intake per day (equivalent to 5 grams, or about one teaspoon, of salt per day).  At the same time, the AHA also states that the ideal daily intake of sodium should actually be about 1.5 grams per day but, in an acknowledgment regarding the high intake of salt-rich processed foods in the United States, the AHA considers the 2.3 gram per day dietary sodium target to be more “realistic” for Americans.

 

There is considerable public health research data suggesting that the reduction of average daily adult salt intake, to 6 grams per day, or less, would result in a significant lowering of blood pressure in both people with and without high blood pressure.  Based upon these research findings, some public health experts have predicted that lowering the average daily salt intake below 6 grams per day could reduce the incidence of stroke by almost 25 percent, and the incidence of cardiovascular disease by almost 20 percent.  Unfortunately, there have not been any large-scale prospective, randomized, placebo-controlled clinical research trials performed to validate these estimates.  On the other hand, there have been multiple short-term prospective public health trials that have followed groups (cohorts) of patients in terms of their dietary intake of salt and the incidence of stroke and cardiovascular disease events.  Now, a newly published research study, in the British Medical Journal, has performed a meta-analysis of 13 of these “prospective cohort” studies, encompassing a total of 177,025 patient volunteers, with average durations of patient follow-up ranging from 4 to 19 years.  (Meta-analysis is a method of combining the data from multiple different clinical studies into a single “super-study,” in an effort to improve the validity of the resulting data, as well as the conclusions that are reached from such data.)

 

Among these more than 177,000 patient volunteers, there were 11,000 “vascular events” observed, including stroke and heart attacks (myocardial infarctions).  When the incidence of these vascular events was analyzed, along with dietary salt intake, the patients with the highest daily salt intake were observed to experience a 23 percent greater risk of stroke, and a 17 percent greater risk of cardiovascular disease, when compared to the adults who consumed less salt on a daily basis.

 

The increasing consumption of salt-rich processed foods throughout both the developed and underdeveloped countries of the world has been pushing daily salt intake to ever higher levels, with many Western countries reporting average daily adult salt intake of nearly 10 grams per day.  In other countries, and most notably in Asia and Eastern Europe, dietary practices that include a high concentration of heavily salted foods have pushed daily salt intake into the 10 to 12 gram per day range for the average adult.

 

The World Heart Federation estimates that there are 5.5 million annual deaths from stroke across the globe, and an additional 17.5 million annual deaths from cardiovascular disease.  Based upon the increased incidence of stroke and cardiovascular disease predicted by this meta-analysis study, even a rather modest decrease in the average adult daily salt intake, to the World Health Organization’s target of 5 grams per day, should result in 1.25 million fewer deaths per year from stroke and nearly 3 million fewer annual deaths from cardiovascular disease around the world.  Needless to say, this is a tremendous potential public health dividend from a rather simple alteration in our dietary habits.  (On the surface, reducing our daily salt intake would appear to be a rather simple goal.  However, the more complicated reality is that to achieve even the World Health Organization’s rather liberal target of 5 grams of salt per day, our entire food chain would have to be comprehensively reexamined and overhauled.) 

 

The world’s increasing consumption of highly-processed foods, which often contain high levels of salt as a preservative, are largely responsible for the high levels of salt intake in the developed world (in addition to a preference for salt-cured foods in much of Asia and Eastern Europe).  In the United States, the sodium content of most processed foods is readily available on food packages.  Unfortunately, most restaurants in the United States have not been as forthcoming about the sodium content of the food on their menus (as well as other important nutritional information), and so it continues to be very difficult to determine the actual salt content of much of what we eat here in the United States and, indeed, throughout much of the world.

 

 

 

Note:  Weekly Health Update is currently undergoing an extensive upgrade to better serve its tens of thousands of health-conscious readers around the world.  Beginning in January 2010, newly archived columns will be available by selecting the “Archives” tab on the right side of your screen (all archived columns prior to January 2010 will continue to be available by selecting the “Archives 2007-2009” tab at the top of the screen.)


 


Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

 

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