TIME heart

High Cholesterol Can Be Dangerous Even If You’re Young

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High cholesterol levels in older age are a familiar risk factor for heart attacks, and doctors warn that the danger can start much sooner for many. But how soon should you start worrying?

Most of us know that too much cholesterol in the blood can bring on dangerous clots that lead to heart attacks and stroke. And recent studies show that the build up of these fats in the blood vessels doesn’t happen overnight — it takes years of gradual deposits to narrow a vessel. So in 2013, when heart experts expanded the criteria for who over the age of 60 should consider taking cholesterol-lowering statins, Michael Pencina, a professor of biostatistics at the Duke University Clinical Research Institute, began wondering about those, including himself, who were younger. How long should they wait before taking the drugs?

In the latest study of healthy people who were followed for about 15 years on average, researchers report Monday in the journal Circulation that having even mildly elevated cholesterol levels can increase risk of having later heart problems by as much as 40%.

The researchers argue that having high cholesterol for many years—even if it starts when you’re young—should be a new risk factor that doctors and patients consider when discussing their risk of heart disease.

Even people with moderately high levels of lipids, who might not qualify for treatment for high cholesterol levels, could be at higher risk of heart attacks later in life simply because they harbor these elevated lipid levels for a long period of time.

MORE: Should I Take a Statin? What You Need to Know About the New Cholesterol Guidelines

Among a group of 1,478 people aged 55 years old from the Framingham Heart Study’s Offspring Cohort, those who had higher cholesterol levels for 11 to 20 years (beginning when they were about 35 years old) had a 16.5% higher risk of having a heart attack about 15 years later, compared to a 4.4% risk for those whose cholesterol levels never veered beyond the normal range during middle age. That’s an almost fourfold greater risk, and one that Pencina and his colleagues argue might be reason enough to be more aggressive in discussing ways to lower cholesterol with these patients so they can reduce their risk of heart trouble later on.

MORE: New Cholesterol Guidelines May Put 13 Million More on Statin Drugs

“We identified a patient population whom the guidelines might miss,” he says. It’s another dimension of cardiovascular health that needs to be looked at, and yes, I would say that it should be considered a risk factor.” In the study, the researchers considered LDL levels above 130 mg/dL as elevated, which falls into line with previous professional heart organization criteria.

But he stresses that this factor won’t fall easily into a threshold below which patients won’t need to worry about their cholesterol and above which they will. “There are so many components like family history and other factors that go into the decision of what kind of intervention people may need, such as lifestyle, diet or pharmacologic,” says Pencina. “But if you are measuring your cholesterol, even if it’s fine at an early age, it lets you build that history.”

TIME health

Why Scientists Say Eating an Avocado a Day is a Major Health Benefit

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A recent study shows the avocado diet is a healthy diet

We probably don’t need to tell you how awesome avocados are. But if you’re looking for a reason to ramp up your consumption, here’s some news you will definitely enjoy. A recent study shows eating an avocado a day, every day, can help lower your cholesterol.

Researchers at Pennsylvania State University put 45 healthy but overweight adults between the ages of 21 and 70 on one of three diets designed to lower cholesterol. One was a lower-fat diet; the other two were moderate-fat diets. However, the two moderate-fat diets had one major difference: One included the daily consumption of one Hass avocado.

Here’s where the avocado really shined: All three diets lowered subjects’ cholesterol, but the avocado diet performed the best of the group. The avocado diet lowered LDL cholesterol by 13.5 milligrams per deciliter; the other moderate-fat diet caused a drop of only 8.3 milligrams per deciliter, and the low-fat diet resulted in a drop of 7.4 milligrams per deciliter.

One of the professors in charge of the study, however, did say: “This was a controlled feeding study, but that is not the real world—so it is more of a proof-of-concept investigation.” It’s enough proof for us. Time to grab some more guac.

This article originally appeared on FWx.com

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TIME diabetes

How Race Affects Diabetes Care—and Leads to Amputations

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Black diabetics are much more likely to face amputation

Black type-2 diabetes patients are three times more likely to lose a leg to amputation as non-black patients, finds a new report from the Dartmouth Atlas Project. That’s partly because they’re also far less likely to get preventative care like foot exams, cholesterol testing and blood sugar testing.

Researchers looked at Medicare claims from 2007-2011 from patients diagnosed with diabetes and peripheral arterial disease, a condition in which plaque builds up in the arteries and blocks blood flow, primarily in the legs. They found significant disparities, both racial and regional: black patients and the rural Southeast region of the U.S. both saw elevated amputation rates.

Diabetes-related amputation, a last resort, generally results from wounds on the feet and poor circulation. Foot exams and testing for blood sugar and cholesterol levels can help lower the risk of having to resort to extreme measures. But in 2010, 75% of diagnosed black diabetics received a a blood lipids test, while 82% of non-black patients had the test.

An average of 2.4 leg amputations for every 1,000 Medicare patients with diabetes and peripheral arterial disease happen nationally, but regionally, the situation is much more grim. Mississippi, which currently ties West Virginia for the most obese state, also has some of the highest amputation rates—6.2 per 1,000 patients in the city of Tupelo. It’s not just racial: For every 1,000 black Medicare beneficiaries with diabetes, 14.2 amputations occurred in the Mississippi city of Meridian, but only 2.1 occurred among black patients in San Diego.

“The resources needed to prevent amputation are currently severely misaligned,” says co-author Philip Goodney, MD, director of the Center for the Evaluation of Surgical Care at Dartmouth Hitchcock Medical Center. “While we must look for opportunities to expand education and preventive care for all patients at risk for amputation, it seems clear to us that we can make the greatest gains by focusing on African-American patients in the highest risk regions, typically in the poor rural regions of the Southern United States, where the highest amputation rates remain.”

TIME Research

Here’s Why You May Be Better Off Taking Generic Cholesterol Drugs

Patients with cheaper drugs tended to take their medicine more consistently

A new study in the Annals of Internal Medicine found that the cost difference between generic and brand-name drugs seems to be a big factor when it comes to sticking with a medication–especially when it comes to statins, one of the most-prescribed drugs in the country. People who got the generic versions of the cholesterol-lowering medication were more likely to consistently take it and avoid cardiovascular disorders than those who filled the brand-name kind.

“Initiating a generic versus a brand-name statin seems to be associated with lower out-of-pocket costs, improved adherence to therapy, and improved clinical outcomes,” the study said.

The study, which looked at more than 90,000 patients over age of 65, found that people taking generic drugs were more likely to stick to their medication regimen. Price played a role in this disparity, the study suggests. The average cost to fill a prescription for the consumer was $10 for generic statins versus $48 for brand names.

“Given this substantial cost difference, it is perhaps not surprising that adherence and cardiovascular outcomes were worse among patients receiving brand-name statins,” study authors wrote. Overall, people who took generic drugs had 8% fewer incidents than people who used brand-name drugs.

The study received grant support from drug manufacturer Teva Pharmaceutical (which makes both generic and brand-name drugs) and acknowledges that the results may not be generalizable for certain populations: particularly those with greater incomes or access to insurance plans that provide better coverage for brand-name drugs.

TIME Diet/Nutrition

How Instant Noodles Can Hurt Your Heart

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In the proverbial pantry of cheap, convenient eats, nothing beats ramen. You no longer even have to be a college student to indulge: the processed noodle has graduated from dorm room to restaurant, popping up on U.S. menus 18% more from 2013 to 2014, according to the food industry research firm Technomic.

But while the rise of ramen is good for noodle shops, a study published in The Journal of Nutrition found that it’s not great for your heart, particularly if you’re a woman.

The study looked at the reported diets of 10,711 adults using data from a two-year survey of South Koreans, who reportedly eat more ramen than anyone else in the world. Two diet tracks emerged: a “traditional diet,” which was full of rice, grains, fish, and produce, and a so-called “meat-and-fast-food pattern,” which replaced some of those staples with meat, soda, fast food, and instant noodles.

Neither of those diets on the whole were associated with an uptick in cardio-metabolic syndrome—which is a collection of risk factors for heart disease, type-2 diabetes and stroke including high blood pressure, blood sugar, and cholesterol. But the instant noodles were. Eating instant noodles at least twice a week was associated with 68% more cardiometabolic syndrome for women, regardless of what else their diet was made up of.

This effect was only seen in women. Study author Dr. Hyun Joon Shin, a clinical cardiology fellow at Baylor University Medical Center and a nutrition epidemiology doctoral student at Harvard School of Public Health, says that one likely reason is that women have different sex hormones and metabolism than men. Other culprits could include instant noodle packaging, which is often lined with the endocrine disruptor BPA and can mess with estrogen signaling, which may, in turn, lead to some of the risk factors for cardiometabolic syndrome.

Regardless, those noodle packs are hardly a healthy choice for anyone. Highly processed instant noodles differ from regular noodles because they’re often prepped in palm oil for fast cooking and loaded with salt, artificial flavors, and preservatives. “The noodle is very artificially made to make it more delicious, and it can be cooked very easily, within 5 minutes,” Shin told TIME. But cooking “slow” noodles—you know, the kind you dump in boiling water for just a few minutes longer than the instant ones—is well worth the wait for your heart.

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

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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

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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.”

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