TIME Heart Disease

A Common Cholesterol Drug’s Safety Is In Question

New studies suggest Niacin doesn't help, but harms users

Two new studies suggest significant dangers from the common cholesterol drug niacin, and some doctors say the risks are not worth it.

One of the studies published in New England Journal of Medicine looked at extended-release niacin, and the other study looked at the combination of extended-release niacin and another drug, laropiprant, that makes it more effective. Neither found significant benefits, and both found high risk for adverse side effects in the gastrointestinal and musculoskeletal systems like bleeding, diarrhea and even gout. The niacin-laropiprant study found a 9% increase in death risk.

In a corresponding editorial, “Niacin and HDL Cholesterol — Time to Face Facts,” Dr. Donald Lloyd-Jones of Northwestern University in Chicago writes, “on the basis of the weight of available evidence showing net clinical harm, niacin must be considered to have an unacceptable toxicity profile for the majority of patients, and it should not be used routinely.” He notes that niacin may still have a role for patients at a very high risk for cardiovascular disease who do not tolerate statins.

It’s been thought in the past that niacin, a type of B vitamin, are a viable alternative or complement to statins. But the NEJM studies show that not only does niacin not work as well as statins, but it has some serious side effects. The researchers found that people taking niacin had about the same rates of disease as people on placebos, suggesting that the drug is not as effective as it’s thought to be.

Though many people will likely remain on niacin, members of the medical community caution people on the drugs, warning they should talk to their doctors about whether or not they should continue.

TIME Heart Disease

Americans Are Having Fewer and Fewer Strokes

Blood pressure check-up
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In the last two decades the stroke rate among Americans has dropped, and those that do have strokes have a lower risk of dying from then than they did in the past.

In a new study, researchers followed 14,357 Americans who were stroke-free in 1987 until 2011. They found a 24% overall drop in first-time strokes in each of the last two decades and an overall 20% decline per decade in deaths after stroke. The authors note that progress in stroke rates was primarily seen in the over-65 age group and stressed the continued need to lower the number of strokes in younger people.

The study, published in the Journal of the American Medical Association (JAMA), reports that the declines can be credited to better control over risk factors like blood pressure, getting people to quit smoking, and the fact that so many Americans are on cholesterol-controlling statins.

There’s still concern, however, over the high number of Americans suffering from obesity and type 2 diabetes, since both can increase the risk for stroke. About a third of American adults are obese, and if trends continue, one in three Americans will have a form of diabetes by 2050, according to CDC data. Considering already about 80,000 people in the U.S. have a stroke each year, the number still needs to drop, and addressing all risk factors is one way to get Americans’ overall health in check and continue to lower the stroke rate.

TIME Breast Cancer

Why Statins Could Be the Next Treatment for Breast Cancer

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Research connects high cholesterol levels with increased risk of breast cancer.

Cholesterol and cancer may not seem to have much in common, but scientists are increasingly seeing some intriguing connections between the two. In the latest study on the topic, presented at the Frontiers in Cardiovascular Biology in Barcelona, Spain, researchers report on preliminary but strong evidence that women with high cholesterol levels had a 1.6 times greater risk of developing breast cancer over 14 years than women with lower levels.

While the association doesn’t prove that cholesterol can cause breast cancer, the strength of the study comes from its numbers – the data emerged from 664,000 women enrolled in an ongoing study in the UK.

MORE: The Serious Heart Risks That Come With Chemo

Earlier studies have suggested that obesity may be tied to an increased risk of breast cancer, but more recent trials raised the possibility that cholesterol was the driving factor in this correlation – animal studies found, for example, that lowering cholesterol can inhibit tumor cell growth.

So Dr. Rahul Potluri, from Aston University in the UK, decided to investigate the relationship with the database he had established known as the Algorithm for Comorbidities, Associations Length of Stay and Mortality (ACALM) study, focusing on a subset of data from among 1.2 million women in the UK between 2000 and 2013. And indeed, those whose records showed cholesterol levels of 200mg/dL or more were more likely to develop breast cancer. (In the U.S., recent changes to cholesterol guidelines by the American Heart Association and the American College of Cardiology mean that doctors no longer focus on target cholesterol levels but include cholesterol as part of a heart disease risk calculation that includes age, smoking history, blood pressure and diabetes. In previous guidelines, levels between 200mg/dL and 239 mg/dL were considered borderline high.)

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

“It’s a starting point for looking at the relationship in human populations,” says Potluri, who is cautious about overstating what the correlation means. He says that the database did not include information on medications, for example, so he and his colleagues could not adjust for other factors that could explain the association, such as whether the women smoked, or their exposure to other things that could increase their risk for breast cancer.

MORE: Treating Cancer With A Malaria Drug

Still, says Dr. Clifford Hudis, chief of the breast cancer medicine service at Memorial Sloan Kettering Cancer Center who was not involved in the study, “I think this is an important observation. It’s interesting when a big study like this supports some evolving basic science.”

Hudis suspects that the explanation for how cholesterol is involved in breast cancer – or potentially in other types of cancers – may be quite complex, and certainly requires deeper investigation. His own work, for example, explores how obesity and its related metabolic syndrome, which involves resistance to the effects of insulin and low levels of inflammation, could be activating some tumor triggers in breast tissue. Cholesterol is also part of the body’s steroid hormone pathways, which can play a role in certain cancers.

MORE: New Guidelines for Cholesterol Treatments Represent “Huge Change”

“The problem of obesity is going to have profound public health repercussions,” says Hudis; these results are just another reminder of how insidious the health effects of obesity can be.

 

 

 

 

 

 

 

 

TIME Aging

7 Medical Tests Every Man Needs

Medical patient and doctor
Lee Edwards—Getty Images/Caiaimage

Admit it, guys: You don’t even like going to the doctor when there’s something wrong, let alone for preventative check-ups. But being proactive about your health—by getting recommended screenings for serious conditions and diseases—could mean you’ll spend less time at the doctor’s office down the road.

Depending on age, family history, and lifestyle factors, people need different tests at different times in their lives. Here’s a good overview for all men to keep in mind.

Diabetes

You may never need a screening for diabetes if you maintain a healthy weight and have no other risk factors for the disease (such as high cholesterol or high blood pressure). But for most men over 45—especially overweight men—a fasting plasma glucose test, or an A1C test, is a good idea, says Kevin Polsley, MD, assistant professor of internal medicine at Loyola University Health System in Chicago.

The U.S. Department of Health and Human Services also recommends diabetes screenings for overweight adults younger than 45 who have a family history of the disease, or who are of African American, Asian American, Latino, Native American, or Pacific Islander descent.

Fasting plasma glucose and A1C are both blood tests that should be done in your doctor’s office. The A1C test does not require fasting beforehand, but if your doctor wants to test you using fasting plasma glucose, you will be asked not to eat or drink anything but water for eight hours beforehand.

Health.com: Could You Have Type 2? 10 Diabetes Symptoms

Sexually Transmitted Infections

Even if you’ve been in a monogamous relationship for years, it’s not a bad idea to get tested if you haven’t already done so. Many common sexually transmitted infections can go undiagnosed for years. For example, people can go as long as 10 years without showing symptoms of HIV. The U.S. Preventive Services Task Force recommends that everyone ages 15 to 65 be screened for HIV at least once. This is especially important, Dr. Polsley says, if you have had unprotected sex, used injected drugs, or had a blood transfusion between 1978 and 1985.

In addition, the Centers for Disease Control and Prevention recommends a one-time hepatitis C screening for all adults born between 1945 and 1965, regardless of risk factors. “Believe it or not, there’s a lot of hepatitis C cases out there in which people either don’t have symptoms yet or don’t know what’s causing their symptoms,” says Dr. Polsley. “Screening for STIs is something I offer as routine at just about every physical, regardless of a patient’s age or health history.”

Health.com: Best and Worst Foods for Sex

Body Mass Index

You don’t need to make an appointment to figure out your body mass index, a measure of body fat based on your height and weight. Regardless of whether you calculate this stat yourself or your physician does the math for you, it’s important to be aware of this number, says Dr. Polsley.

A BMI between 18.5 and 24.9 is considered normal weight. Although this calculation isn’t perfect—and can sometimes label healthy people as overweight or vice versa—most doctors agree that it’s still an important component of assessing overall health. “It can be a very good opportunity to discuss diet and exercise, and to show our patients how important these things are,” Dr. Polsley says.

Health.com: 11 Reasons Why You’re Not Losing Belly Fat

Cholesterol

The American Heart Association recommends men have their cholesterol levels tested every four to six years once they turn 20. “Men have an overall higher risk for cardiovascular disease than women, and high cholesterol is often a big part of that,” Dr. Polsley says. But your doctor may want to screen you earlier (and more often) if you have heart disease risk factors such as diabetes, tobacco use, or high blood pressure.

Cholesterol is measured by a blood test, and your doctor may ask you not to eat for 9 to 12 hours beforehand. Generally, a cholesterol test will measure your levels of total cholesterol, HDL (good) cholesterol, LDL (bad) cholesterol, and triglycerides. Depending on your results, your doctor may make dietary recommendations or prescribe a cholesterol-lowering medication like a statin.

Blood pressure

Like high cholesterol, high blood pressure is often a symptomless condition—but luckily, the test for hypertension is quick and painless, involving a rubber cuff that squeezes the arm and measures the flow of blood through a large artery in the bicep. “You should have your blood pressure checked pretty much every time you see your doctor,” says Dr. Polsley, starting at age 18.

Don’t get to the doc often? Have it checked at least every two years, or yearly if your numbers were previously considered borderline (a top “systolic” number above 120 or bottom “diastolic” number higher than 80).

You can check your blood pressure at health fairs, in pharmacies, or at home with a monitoring device. If your systolic pressure cracks 130 or your diastolic goes over 85, your doctor may recommend lifestyle modifications—like exercising more and eating less salt—or they might prescribe medication.

Health.com: 31 Fat-Burning Recipes

Colonoscopy

Most men should be screened for colon cancer beginning at age 50, but those with a family history of the disease may benefit from earlier testing. Men and women alike tend to dread this test—in which a small camera is inserted into the anus and explores the large intestine for polyps or other signs of cancer—but Dr. Polsley says it’s not as bad as it sounds.

“The preparation for the test is actually the worst part,” he says: You’ll need to empty your bowls completely before the exam, which may involve not eating solid foods for one to three days, drinking lots of clear liquids, or taking laxatives. “The actual colonoscopy shouldn’t be too uncomfortable, because you’re sedated through the whole thing.”

But here’s the bright side: If your doctor doesn’t find anything suspicious, you won’t need another colonoscopy for up to 10 years.

Prostate exam

Screening for prostate cancer is more controversial than for other cancers, says Dr. Polsley, and some studies have shown that these tests can be expensive and unnecessary, and may do more harm than good. But he suggests that all men over 50 at least talk with their doctors about the pros and cons of these tests—usually either a digital rectal exam (in which the doctor inserts a gloved finger, or digit, into the rectum to feel for lumps and abnormalities) and a PSA test, which measures a protein called prostate-specific antigen in the blood.

Prostate cancer screenings can and do save lives, but they may also result in false-positive or false-negative results. And because many cases of prostate cancer progress very slowly, some men (especially older men) don’t benefit from aggressive treatment. Whether you decide to get screened for prostate cancer should be a decision you make with your doctor, says Dr. Polsley. In the meantime, it’s important to know the symptoms of an enlarged prostate—like having to urinate frequently or having trouble urinating—which could also signal cancer.

This article originally appeared on Health.com.

TIME Heart Disease

A ‘Vaccine’ for Heart Disease Could Mean No Pills, Lettuce or a Gym

It’s the latest in gene therapy, and it’s lowered cholesterol and heart attacks in mice. People are next

Doctors, and especially doctors who do research, don’t like to use the words cure or eradicate. They know how dangerous that can be, since the human body is so unpredictable. But Dr. Kiran Musunuru is showing some uncharacteristic swagger about his latest success in lowering heart attack risk among some lucky mice.

Taking advantage of advances in genetic engineering, a team lead by Musunuru, who holds positions at Harvard University’s Department of Stem Cell and Regenerative Biology and Brigham and Women’s Hospital, have edited the genomes of mice and successfully protected them from heart disease. The results, published in the journal Circulation Research, hint at an entirely new way of avoiding the leading killer of Americans by possibly cutting heart attack risk by up to 90%. “What has me excited as a cardiologist is that my goal is eradicating disease,” says Musunuru. “There is no bolder way I can put it. I want to eradicate the disease and this offers one potential way to do it.”

MORE: Experimental Cholesterol-Lowering Drug Shows Promise

He admits that it may be 10 years or more before the technique is ready for testing in people, but these first results are enough to justify the research that could make that happen. “This approach in general will be a game changer,” says Dr. Deepak Srivastava, director of cardiovascular disease and stem cell biology and regenerative medicine at the Gladstone Institutes, who was not affiliated with the study.

Here’s how they did it. In 2003, genetic information was gleaned from a French family that carried a genetic mutation giving them low LDL cholesterol, the kind that, when it’s high, can lead to heart disease. Using a new genetic engineering technique that allows scientists to splice more efficiently into specific locations on a genome, Musunuru was able to essentially bestow the genetic advantage from the French family onto his mice, slowing down production of a protein that normally keeps LDL circulating in the blood. With less of the protein around, less LDL remains in the blood; those with the PCSK9 mutation showed as much as an 88% lower risk of heart disease compared to people without the genetic change.

The genetic monkeying was accomplished with the help of a virus, which has a remarkable ability to get into cells. The virus was injected, along with the DNA-disrupting machinery, into the liver of the mice. Within days, more than half of the liver cells had been genetically edited and the mice showed 35% to 40% less cholesterol in the blood.

So far, says Musunuru, there have been no negative effects of the genetic disruption. But he says more research needs to be done to make sure that introducing the changes won’t come with unforeseen consequences. “When we go in there we want to make sure we are not introducing new spelling errors in the genome,” says Srivastava, who is also using the technique for stem-cell based therapies to treat heart disease. Says Musunuru, “I think I can confidently say that with this tool, this technology will work on live, breathing human beings, but we need to figure out the safety; that’s the barrier to overcome before we can test these therapies.”

MORE: Who Really Needs To Take a Statin?

Drug companies are also working on drug-based ways to interfere with PCSK9, and lower LDL levels, but those therapies are antibodies that bind to the protein that the gene makes and need to be injected, at a doctor’s office, regularly. The genome editing strategy would be a one-stop therapy that could permanently protect against excessively high cholesterol levels.

“The way I think about it, it’s about how to make the average person like that person who won the genetic lottery and is protected against heart disease,” says Musunuru. “We want to extend the benefits the fortunate few have to the entire population. That would be the dream.”

TIME

Single Gene Responsible for Group of Heart Disease Risk Factors

It’s rare, but a genetic mutation may explain the collection of heart-harming factors, including obesity, known as metabolic syndrome

Researchers have been pretty successful at identifying individual genes that can contribute to obesity, diabetes, high blood pressure or high cholesterol levels. Having any—or a combination of these risk factors—can significantly increase the risk of heart disease and stroke.

But by studying three families whose members had higher than average rates of heart disease, diabetes and obesity, researchers zeroed in on a single gene, DYRK1B, that when mutated, can contribute to nearly all of these risk factors, which together are known as metabolic syndrome.

“Historically, there has been debate about the existence of metabolic syndrome. The question is, are the [risk factors] together coincidentally or are they here because the patient has a unifying [problem that explains them all],” says Dr. Ali Keramati, a resident in internal medicine at the Yale University School of Medicine. “This study shows that it’s possible for one patient to have all the risk factors that are all explained by one mutation.”

Normally, that gene is responsible for taking stem cells and turning them into fat or muscle, and for directing the liver to produce glucose to balance out insulin levels. In the aberrant form found among members of the three families, it became overactive, pushing the body to produce more fat cells, and driving the liver to pump out more glucose, raising blood sugar levels. The result is likely metabolic syndrome; family members with the mutated gene were more likely to be obese, have diabetes and early heart disease compared to those who did not.

For those who might think that their genes are to blame for their obesity, hypertension or diabetes, Keramati stresses that the mutation is rare, and likely only explains metabolic syndrome in a very small percentage of people. But for people who are affected, the good news is that a drug may help to control the hyperactivity of the gene. “It may be possible to develop a drug that knocks down the function of this gene,” he says.

And for the vast majority who don’t have the DYRK1B mutation, the finding may still lead to other drug treatments by improving doctors’ understanding of how various risk factors form the perfect storm of conditions for heart. In the meantime, the strongest ways to avoid metabolic syndrome are the most familiar – keeping weight, blood pressure, blood sugar and cholesterol levels under control with a healthy diet and plenty of exercise.

TIME Food

6 Facts About Saturated Fat That Will Astound You

Steak has saturated fat
Steak—it's not so bad for you OJO Images via Getty Images

It's nutrition dogma: saturated fat is bad for you. But a new book makes the case that our obsession with low-fat diets has made us sick

Back in 2000, the journalist Nina Teicholz got a gig reviewing restaurants in New York City for a small paper. It didn’t pay much, but it did come with free meals out, which is how Teicholz found herself eating the kind of rich, fatty food—choice cuts of beef, creamy soups, foie gras—that she’d avoided all of her life. She was breaking every nutritional dictate in the book and yet Teicholz lost 10 lbs. Her cholesterol, which should have been spiking since she was all but mainlining saturated fat, remained at healthy levels.

That experience launched her multi-year investigation into the science and politics of fat that has culminated with her new book The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. The book comes as new research has raised questions about the long-held connection between fat intake, cholesterol and cardiovascular disease. A meta-analysis published in March looked at dozens of past nutritional studies and found no evidence that eating saturated fat—chiefly found in meat, butter and cheese—increased heart attacks and other cardiac events, nor did it find evidence of less heart disease in people eating unsaturated fats like those found in olive oil or vegetable oil. In 2013, a prominent cardiologist argued in BMJ that the long-held advice to reduce saturated fats has actually increased the risk of obesity and heart disease.

It will take more than a few studies and this new book to sway the court of public-health opinion, but for now, here’s what Teicholz’s research reveals about saturated fat:

1. The war against fat was started by one man: Much of what we think we know about the supposed dangers of high fat intake comes from a single research project by a charismatic Minnesota pathologist named Ancel Keys. His Seven Countries Study compared the health and diet of nearly 13,000 middle-aged men in the U.S., Japan and Europe, and ostensibly found that populations that consumed large amounts of saturated fats in meat and dairy had high levels of heart disease, while those who eat more grains, fish, nuts and vegetables did not. The influential Keys relentlessly advocated the theory that fat caused heart disease, persuading the AHA in 1961 to issue the country’s first-ever guidelines targeting saturated fat—and he wasn’t shy about shouting down any researcher who questioned his data.

Yet it turns out there was a lot to question. Keys chose the countries most likely to confirm his hypothesis, while excluding nations like France—where the diet is rich in fat but heart disease is rare—that might have challenged it. “When researchers went back and analyzed some of the data from the Seven Countries study, they found that what best correlated with heart disease was no saturated fat intake but sugar,” says Teicholz.

2. Reducing fat has caused us to eat more carbs, which is not good: Nutrition science isn’t like the battle against smoking—you can’t simply tell people to stop eating fat and assume nothing will replace it. In the case of the U.S., saturated fat consumption has dropped by 11% since the early 1970s, while the consumption of carbohydrates—pasta, grains, fruit, starchy vegetables—has increased by 25%. To Teicholz, that’s been a bad trade. Carbs break down into glucose, which causes the body to release insulin, which happens to be very good at helping your body store fat.

3. That’s true even of supposedly “healthy” unrefined carbs: It’s not news that refined carbs like white bread and cookies are bad for you. But Teicholz says that even unrefined carbs—like whole-grain pasta and fruit—seem to be worse for your heart than fatty foods. “There have been rigorous clinical trials that have shown that a higher fat and lower carb diet is better for heart disease and obesity,” she says. “Even whole grains are less healthy than a diet that is higher in meat and cheese.”

4. Women have been particularly hurt by the demonization of fat: It wasn’t until the 1990s that women were studied as a separate group in heart disease and diet researcher, although they had been recommended to follow low-fat diets for decades. The major Women’s Health Initiative study, which looked at tens of thousands of women, found that a low-fat diet led to no significant reduction in the risk of cardiovascular disease, nor did it seem to reduce cancer risks. It turns out that when women follow low-fat diets—and they’ve done so more religiously than men—their levels of “good” HDL cholesterol drops even more dramatically than it does in men, which increases the risk of heart disease.

5. We shouldn’t be so quick to ban trans fats: If there’s one thing nutritionists can agree on, it’s that consumption of trans fats—artificially produced unsaturated fats that are now common in much processed and fast food—is bad for your heart. The Food and Drug Administration is moving to ban all artificially produced trans fats and while Teicholz doesn’t deny that trans fats can increase heart disease risk, she worries that in the rush to replace trans fats, the food industry will go back to using liquid vegetable oils—which when heated create oxidation products that have inflammatory effects linked to cancer and other illnesses. “We need to consider the alternative before we ban trans fats,” says Teicholz. “Some of the replacement oils have never been tested.”

6. We’ve been eating saturated fat for thousands of years: Death rates from heart disease have fallen rapidly since 1970, but much of that change can be attributed to reductions in smoking, cholesterol-reducing drugs like statins and better emergency medical care. And during the very decades when the case against saturated fat became nutrition gospel, Americans have gotten sicker and fatter. “It’s amazing to think that scientists believed that all these invented foods would restore us to a state of health,” says Teicholz.

TIME

New Cholesterol Guidelines May Put 13 Million More on Statin Drugs

Researchers estimate it could prevent nearly half a million heart events, but some patients may not even have a high risk of developing heart disease

When the American Heart Association and the American College of Cardiology revised its guidelines on risk factors for heart disease and stroke last November, heart experts were divided over the new advice. By loosening thresholds for treating heart disease risk with cholesterol-lowering medications called statins, the recommendations potentially made millions more Americans eligible for the drugs.

Now, led by a group at Duke University, researchers have calculated exactly how many more people might find themselves on a prescription under the new guidelines. According to the data, which was based on heart disease risk factors and heart disease rates among 3,773 people in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2010, 56 million Americans between the ages of 40 years and 75 years would be eligible for statins, compared to 43.2 million under the older recommendations – an increase of nearly 13 million. Most of the newly eligible – 10.4 million — would be those who have not had any history of heart disease, but would be advised to take the drugs to prevent a future heart attack.

MORE: Statins Have Few Side Effects, But Should More People Be Taking Them?

But because the new criteria are less specific to plaque buildup in the heart arteries that can lead to heart attacks, the group also includes people who may not be at significantly greater risk of developing heart problems at all, but end up getting overtreated.

Most of the new prescriptions, say the authors, came from older populations, between the ages of 60 years to 75 years. More than 77% of these people would be eligible for statins, even if they had no history of heart disease.

Reporting in the New England Journal of Medicine, the scientists even extrapolated their data to calculate how many lives the additional statin prescriptions might save, and figured that giving the cholesterol-lowering drugs to people without heart disease, but who might be at higher risk of the condition, could prevent 475,000 heart events.

MORE: Statin Drugs Linked to Lower Risk of Cognitive Decline

While the older recommendations relied heavily on the amount of cholesterol circulating in a person’s blood, as well as factors such as family history of heart problems, smoking, and hypertension, the new advice placed greater weight on factors such as age, weight, and smoking history to assess a healthy person’s risk of developing heart problems. Under the new guidelines, if a person’s risk of developing heart disease in the next 10 years was 7.5% or higher, then he might benefit from taking a statin. The threshold for starting statins in the previous guidelines was a more subjective assessment of heart disease risk in 10 years that included at least two of several major risk factors for heart disease, such as high cholesterol levels, hypertension, family history of heart problems, diabetes, and being overweight.

Whether the additional statin prescriptions do end up saving half a million lives won’t be clear for a few years yet, but researchers will be tracking how many more people are put on statins to prevent heart problems, and how effective that recommendation was in lowering disease and death rates.

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