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Cholesterol What Is It and Are You At Risk?

Sunday, June 22nd, 2008

Cholesterol is a fatty lipid, steroid and an alcohol found in the body tissues and blood plasma of vertebrates. It is the essential part of the outer membranes of human body cells, and it circulates in the blood.

Cholesterol in the human body comes from two major sources. About three-quarters of the body’s total cholesterol is produced within the body, while only one-quarter comes from cholesterol in food.

Higher concentrations of cholesterol are present in body tissues which have more densely packed membranes – i.e. the liver, spinal cord, brain, atheroma, adrenal glands and reproductive organs.

The liver is the most important site of cholesterol biosynthesis. It is secreted from the liver in the form of an acidic secretion known as ‘bile’.

Diets rich in animal fats, meat, poultry, fish, oils, egg yolks and dairy products are a rich source of dietary cholesterol. Organ meats, such as liver and kidney, are extremely rich in cholesterol content, but foods of plant origin contain no cholesterol.

High cholesterol levels in the bloodstream can influence the pathogenesis of certain conditions. Recent studies have revealed that the abundance of protein complexes called lipoproteins, are responsible for the cholesterol build-up in the blood vessels.

Cholesterol gets attached to these lipoproteins. The high-density lipoprotein (HDL) carries cholesterol out of the bloodstream for excretion, while the low-density lipoprotein (LDL) carries it back into the system for use by various body cells.

LDL cholesterol is called bad cholesterol, because elevated levels of it are associated with an increased risk of coronary heart disease. LDL deposits cholesterol on the artery walls which leads to the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis.

The levels of both HDL cholesterol and LDL cholesterol may also determine risk for heart disease; however current medical opinion is that the ratio of HDL cholesterol to LDL cholesterol is much more important than the level of cholesterol.

Methods to control your cholesterol levels:

Lower your consumption of foods containing saturated fats – fried fast foods, butter, cream, cheese, and fat on meat – to help reduce cholesterol. Add more plant foods to your diet – vegetable oils, nuts, legumes, breads, cereal grains, fruits and vegetables. A low cholesterol diet, combined with regular exercise is the best way to lower cholesterol levels.

Medications can also help lower cholesterol levels. HMG-CoA reductase inhibitors, ‘Statins’, such as lovastatin and atorvastatin (Lipitor) are the most effective and widely used medications to lower LDL cholesterol. Other medications include nicotinic acid, fibrates such as gemfibrozil, resins such as cholestyramine, and ezetimibe. These medications should be taken after consulting the experts.

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Pfizer Enlists a Labor Union (SEIU) to Promote Lipitor

Sunday, April 27th, 2008

A couple of weeks ago Dr. Alicia Fernandez, an associate professor of clinical medicine at UC San Francisco, received a very unusual letter from The International Association of EMTS and Paramedics, an affiliate of The National Association of Government Employees (IAEP/SEIU).

The letter began by noting that Fernandez is part of the union’s approved physician network, and then launched into what can only be described as a shameless sales pitch for Lipitor, Pfizer’s blockbuster cholesterol-lowering drug.

First, the alarming statistics presented in the letter:

* 1 in 3 adults has some form of CVD (cardio-vascular disease)
* About every 26 seconds, an American will suffer a coronary event
* Stroke is a leading cause of serious, long-term disability in the United States
* Every 45 seconds, someone will suffer a stroke.

Then, the endorsement: “Lipitor is available to our members through their prescription plan. IAEP leadership stands behind LIPITOR as the lipid-lowering agent of choice when it is prescribed by a physician. This confidence in LIPITOR is based on its proven efficacy and is supported by its vast clinical experience of more than 15 years…”

The letter went on, at length, to praise Lipitor’s benefits and to downplay the drug’s risks. In clinical trials, the letter states, “the most common adverse events were constipation, flatulence, dyspepsia and abdominal pain.” But while other risks may not be as “common” they are certainly worth mentioning. They include memory loss which can look like Alzheimer’s and severe muscle pain.

A few days ago, Fernandez received a second, identical letter. Never before in her professional experience had she received a drug ad from a union.

“I’ve never seen anything like this. I’ve never seen Labor endorse a drug product,” she told me. “This is incredible.” Unfortunately, Fernandez adds, this is not the first time that she has seen a drug company use a progressive organization to promote its product. …

Why would Pfizer need the union’s help in peddling its drug? Lipitor, after all, is the best-selling drug in the world, with sales of almost $13 billion in 2006.

But recently, Lipitor has been attracting some decidedly negative publicity.

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Attention to Heart Health Good for the Brain

Friday, April 25th, 2008

A recent survey found that two out of three African Americans worry about developing heart disease and two out of five are concerned about developing Alzheimer’s disease, yet only one in 20 are aware that heart health is linked to brain health.

February is Black History Month and American Heart Month, and the Alzheimer’s Association and the American Stroke Association, a division of the American Heart Association, are teaming up to educate African Americans on how to manage heart health to promote brain health.

“What’s good for your heart is good for your brain,” Dr. Jennifer Manly, spokesperson for the Alzheimer’s Association, said in a statement.

“African Americans should be aware that there is building evidence that older adults whose hearts are healthy tend to live longer with healthy brain function,” Manly added in comments to Reuters Health. Manly is with the G.H. Sergievsky Center and the Taub Institute for Research in Aging and Alzheimer’s Disease at Columbia University, New York.

Compared to the general public, African Americans have a higher risk of diabetes, high blood pressure, high cholesterol and other cardiovascular complications, which could lead to a higher risk of stroke and Alzheimer’s disease.

Manly said African Americans can help to improve their heart health and cognitive function by “partnering with their doctor and watching their numbers; keep blood pressure below 120/80 millimeters of mercury, fasting blood sugar less than 100 milligrams per deciliter, cholesterol below 200 milligrams per deciliter, and maintain a body weight in the recommended range.”

Healthy lifestyle choices will also help African Americans improve their heart and brain health. African Americans who are physically and mentally active, maintain their social connections, reduce fat and cholesterol in their diet, and don’t smoke may lower their risk for stroke and Alzheimer’s disease, the researcher emphasized.

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What You Must Know About Your Cholesterol

Friday, April 11th, 2008

Many of us are in the danger zone, and we don’t realize it. What to do right now?

How’s your cholesterol? Here’s a guess: If you’re healthy, you probably have no idea. New surveys show women tend to be clueless about their risks of heart disease, especially when it comes to managing their cholesterol.

But this kind of ignorance is anything but bliss. The reason: The artery clogging that makes heart disease the number-one killer of women late in life begins much earlier—in your 20s, 30s, and 40s—and that’s when your cholesterol numbers may be sounding alarms. So, are you ready to start paying attention? Here, the things all women need to know now.

1. High cholesterol is surprisingly common.

Researchers with the Framingham Heart Study recently delivered a nasty surprise: Nearly a quarter of women in the study who are in their early 30s have borderline-high levels of bad cholesterol, as do more than a third in their early 40s and more than half in their early 50s. A third of women in all three age groups have low levels of good cholesterol.

Bad cholesterol, also known as low-density lipoprotein (LDL), contributes to heart disease by laying down artery-clogging plaque; good cholesterol, or high-density lipoprotein (HDL), helps clear it away. “The double whammy of high LDL and low HDL is particularly dangerous,” says Framingham researcher Vasan Ramachandran, MD, of the Boston University School of Medicine.

2. Your doctor may miss the problem.

Though women are better than men about seeing a doctor regularly, the care they receive isn’t as good when it comes to preventing and treating cardiovascular disease, according to new studies. “Perhaps doctors still haven’t gotten the message that women need to control cholesterol,” says Chloe Bird, PhD, author of one of these studies and a senior sociologist at the nonprofit RAND Corporation. Bird found that doctors are less likely to monitor and control cholesterol in women than in men, even when the women are at superhigh risk of heart attack.

Part of the problem, she says, may be that many women see only a gynecologist. This isn’t to say that OB-GYNs can’t be good primary care doctors, but you have to make sure the doc is willing to monitor your heart health, especially if you already have diabetes or a heart issue. That means she should order cholesterol checks as part of your regular blood work and discuss the results with you.

3. Your numbers may trick you.

Many people misunderstand the roles of so-called good and bad cholesterols, according to cardiologist and lipidologist Pamela Morris, MD, of the Medical University of South Carolina in Charleston. “What we’ve learned is that HDL and LDL are independent predictors of a woman’s heart attack risk,” she explains. “We see women with high HDLs having heart attacks when their LDL is also high, and we also see heart attacks in women with very low LDL but also low HDL.”

What that means to you: It’s important to keep track of both. A woman wants to keep her HDL above 60 (the level at which HDL helps prevent disease) and her LDL below 100. If your HDL drops below 50 or LDL rises above 160, you need to take immediate action. That may include an LDL-lowering drug such as a statin, and it definitely includes a commitment to a heart-healthy diet and lifestyle.

4. You may need an “inflammation” test.

The math used to estimate your heart disease risk is a little misleading. If your LDL rises above the danger line of 160 or your HDL drops below 50, the math says you have an elevated risk of a heart attack within 10 years. But that warning may actually underestimate your risks beyond 10 years, Morris says. So when she has a female patient with cholesterol numbers in the intermediate range—LDL above 130 or HDL under 60—she often takes a close look at the woman’s whole-body inflammation level.

You can’t see this kind of inflammation, but it’s actually an independent measure of heart attack risk. You measure it by adding a test for high-sensitivity C-reactive protein (hs-CRP) to the usual cholesterol blood work. CRP, essentially a body chemical, usually rises anytime your body becomes inflamed. And since artery clogging is associated with inflammation, high CRP is viewed as a marker for clogged arteries. That means your C-reactive protein levels may help you and your doctor decide how aggressively you need to control borderline-high-cholesterol levels with drugs, diet, and exercise.

5. These foods are your best friends.

Certain classes of food chemicals can actively and powerfully lower a person’s bad cholesterol. Two—soluble fiber and phytosterols—have so much science behind them that they’ve become part of standard medical prescriptions for treating high cholesterol. But dietitian Janet Brill, PhD, RD, author of Cholesterol Down, also recommends regularly eating almonds, ground flaxseed, apples, soy protein, and olive oil. Preliminary research suggests they all have cholesterol-lowering powers. “Each one works in a slightly different way,” Brill says. “So together, you get a synergy that can dramatically lower cholesterol.”

Almonds and olive oil are high in monounsaturated fats, which are thought to blend with LDL molecules in a way that speeds LDL’s clearance from the blood by the liver. Flax is high in both soluble fiber, which lowers LDL by absorbing cholesterol from both food and bile inside the intestines, and omega-3 fatty acids, which studies show have anti-inflammatory effects. Other foods especially high in soluble fiber include oat bran, oatmeal, and apples. (Soluble fiber is different from insoluble fiber, the kind found in whole-grain bread and bran cereal. That’s good for you, too, but it won’t affect your cholesterol.) Soy may mimic natural estrogens in their LDL-clearing effects. Phytosterols are the plant version of animal sterols (a.k.a. cholesterol) and lower LDL by competing with it for absorption into the body. They’re found in supplements or phytosterol-enhanced margarine such as Benecol.

You don’t need any of these foods if your LDL is low, but experts still recommend them for everyone. What about steak, eggs, and cheese? They sure won’t help your cholesterol, because they all contain a lot of it. But it’s more important to focus on foods that lower your numbers rather than simply avoiding the bad stuff, experts say.

6. Good cholesterol may have a bad side.

The higher your HDL, the better, right? That’s been the current thinking, due to HDL’s protective effect. But here’s a surprise you may have read about in some news reports: Studies are showing that HDL may actually have harmful proteins capable of boosting heart disease risks. A test to determine if your HDL has the harmful proteins may be available in a few years. In the meantime, if your HDL is lower than 60, it’s still OK to raise it a little as long as you don’t go overboard. How? Try getting a lot of omega-3s from fish or fish oil, exercising regularly, controlling your weight, and avoiding smoking.

7. Your heart loves long walks.

Walking 10 miles a week brings lasting improvements in your heart health, according to researchers at Duke University Medical Center. The funny thing is, if you jog those 10 miles, you won’t get quite as much benefit. “Duration appears to be key,” says Duke’s Cris Slentz, PhD, an exercise physiologist. “Jogging or walking 10 miles both burned around 1,200 calories, but in our studies, one took about two hours and the other, three.”

Longer stints of exercise, even moderate exercise, may burn more belly fat—the little rolls of skin near your navel and the fat deep inside your abdomen. The latter is linked to metabolic syndrome, a condition associated with a host of cardiovascular risk factors including low HDL, high blood pressure, and high triglycerides (a kind of blood fat that contributes to heart disease).

Should you aim for weight loss as well as long walks? If you’re overweight, absolutely. But understand that shedding a few pounds will make only a small dent in your cholesterol. Canadian researchers recently found that overweight women who lost about 25 pounds—no easy task—saw their LDL drop about 10 percent and their HDL rise by the same amount.

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How to Lower Your Cholesterol

Wednesday, April 9th, 2008

Heart disease is the UK’s biggest cause of death – and having high cholesterol puts you at significant risk. But as there are no obvious symptoms, a heart attack is often the first warning sign of the condition.

Don’t let this happen to you. Take our quick cholesterol quiz to identify whether you may have the condition – and how to slash your risk…

1. How old are you?

a) Under 24 (-1)
b) 25-44 (0)
c) 45-65 (+1)
d) Over 65 (+2)

Why it matters: Cholesterol increases with age. Only 26 per cent of men and 31 per cent of women under 25 have high cholesterol, but by the age of 50 those figures shoot up to 81 per cent of men and 79 per cent of women. “We don’t exercise as much as we get older and we tend to eat more fat,” explains Ellen Mason, cardiac nurse at the British Heart Foundation.

Whatever your age simple lifestyle changes can turn things round fast. Just adding a handful of walnuts a day to your diet can slash levels of harmful LDL cholesterol by 10 per cent in up to six months, while eating 100g of beans daily can reduce it by 20 per cent in three weeks.

2. Do your relatives have high cholesterol? Or have any close male relatives had a heart attack before 50, or any female ones before the age of 55?

a) Yes (+2)
b) No (0)
c) I have no idea (+1)

Why it matters: “Family history is definitely a risk factor for cholesterol,” says Dr Robert Finnie, a trustee for the cholesterol charity Heart UK.

“If a sibling or parent has high cholesterol you have a 50 per cent greater chance of having it yourself.” The reason is that genes can determine how your body makes and processes cholesterol. If, for example, you inherit an under-performing version of a gene called APOE-4, you won’t transport cholesterol out of your body as well as other people.

Fortunately, gene behaviour can be changed. According to Dr Jack Challam, author of Feed Your Genes Right (Wiley Books), healthy levels of vitamin E in the diet help boost APOE-4 activity. Consider taking a supplement.

3. Which of these sounds most like your exercise regime?

a) I don’t do any (+2)
b) I do my 10,000 steps throughout the day (+1)
c) I exercise for 20 minutes at least three times a week (0)
d) I exercise for more than 20 minutes at least three times a week (-1)

Why it matters: “Exercise triggers the release of enzymes that break down the harmful LDL form of cholesterol that collects in your arteries,” says Dr Marie Murphy, head of the School of Exercise Sciences at the University of Ulster. Any movement triggers this enzyme release – in Dr Murphy’s trials simply walking up stairs for two minutes up to eight times a day slashed LDL levels by seven per cent in eight weeks. But longer sessions of formal exercise create a greater effect.

Aim to do a 40-minute workout three to four times a week.

4. Which of these do you eat more than three times a week?

a) Red or processed meats (+1)
b) Butter, cheese, full fat milk (+1)
c) Cakes, biscuits, chocolate, crisps (+1)
d) Deep-fried foods (+1)

Why it matters: All of these are high in saturated fat. “This is basically the raw material your body needs to make cholesterol,” says nutritionist Dale Pinnock (www.dalepinnock.com).

Cut your intake of saturated fat and cholesterol levels fall.

A us study has shown that every one per cent of saturated fat you drop from your diet cuts your cholesterol by one per cent, too.

To cut down, limit all of the above and opt for low-fat versions. Grill, bake or steam foods and use heart-healthy sunflower or olive oil for frying.

5. How stressful is your life?

a) Very, I get stressed easily and it happens a lot (+2)
b) Very, but I do lots of relaxation/ exercise to fight it (+1)
c) I usually cope well with stress (0)

Why it matters: Dr Andrew Steptoe, at University College London, found that levels of “bad cholesterol” are three times higher in people who are stressed than those who remain cool under pressure. “Blood fats, including cholesterol, are released during stress as, in past times, we needed them to fuel our ability to flee the thing causing us stress. Today we tend not to run away from stresses so the fats are not used up and remain in our blood,” he says. Controlling stress is therefore important for controlling cholesterol levels.

6. How many of these do you have more than four times a week – tea, wholegrains, oats, beans, soy, olives, seeds, Benecol, nuts, apples?

a) None (+2)
b) 1-2 (0)
c) Over 2 (-1)

Why it matters: “These foods can all actively lower levels of cholesterol in your body,” says Dale Pinnock. High-fibre foods such as oats, wholegrains and beans absorb cholesterol in the intestine helping you pass it out of the system. Healthy fats in nuts, seeds and olives speed up how fast your liver breaks it down. Try to include one to two servings of cholesterol lowering foods every day.

7. How much coffee do you drink a day

a) Fewer than four cups (0)
b) Over four cups of espresso or cafetiere coffee (+1)
c) Over four cups of any other type (0)

Why it matters: “Cafestol, an oil in coffee beans, activates an enzyme that inhibits cholesterol breakdown,” says Professor David Moore, of Baylor College of Medicine in Texas. Drinking five cups of high-cafestol coffee – espresso or that made in a cafetiere – can raise cholesterol by up to eight per cent in four weeks. Fortunately for coffee lovers a sensible intake of under four cups a day won’t cause major issues.

8. Measure the area around your tummy. Is it over 37ins (men) or 32ins (women?

a) Yes (+1)
b) No (0)

Why it matters: The more you weigh, the higher your cholesterol is likely to be.

Denise Armstrong, at Heart Research UK, says: “People who are overweight tend to eat higher fat diets and do less exercise.”

Changing these things will reduce weight – and cholesterol.

9. How much alcohol do you drink a day?

a) Nothing (+1)
b) Up to two units a day for women, up to three for men (0)
c) More than two units a day (women) or three for men (+1)

Why it matters: Moderate alcohol intake actually boosts levels of healthy HDL cholesterol. Excess alcohol doesn’t raise cholesterol, but it does increase the amount of harmful fats called triglycerides which damage the arteries.

10. Do you smoke?

a) No (0)
b) Yes (+1)

Why it matters: Smoking doesn’t increase cholesterol but it also raises triglycerides in your body.

WHAT THE SCORES MEANS

Under 3: You are living a low-cholesterol lifestyle so chances are your levels are within the normal range. Keep it up.

4-10: You may have health issues. Ask your GP for a cholesterol test, or try a home test (Superdrug’s Self-Check Test is £9.99).

More than 11: You are at high risk of high cholesterol. See your GP for a test rather than trying a home one. If levels are very high, you may need a course of cholesterol-lowering drugs – as well as making lifestyle changes.

I got a wake-up call before it was too late

Sarah Wade, 34, lives in East London. She’s single and works for a design agency. She says:

“I was registering with a new GP so I asked him to give me an MOT.”

“Although I’d lost an uncle to heart disease and my mum has high cholesterol, I was still shocked when he said my levels were high, bordering on very high. I thought cholesterol only affected overweight people and at 9st I certainly wasn’t that.”

My doctor explained some simple changes I could make to lower it. Now, one Sunday a month, I cook loads of pasta, lean meat and oily fish dishes (the omega 3 fats help lower cholesterol) and freeze them in batches. I work long hours and used to rely on ready-meals and takeaways, which are packed with saturated fats, but now I have my own healthy ready-meals.

“I eat more fruit and veg and have replaced squashes with fresh juice, especially pomegranate juice, which is good at lowering cholesterol. I eat more fibre and take psyllium husk supplements, a natural source of dietary fibre. I also run three times a week and have reduced my alcohol intake.”

“Thankfully my cholesterol is now normal. I’m just grateful I had a wake-up call before it was too late.”

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Listen to Your Heart

Friday, March 14th, 2008

When cardiovascular disease sneaked up on them, three women faced the challenges

Quick: What’s the No. 1 killer of women 20 and older?
If you answered anything other than heart disease, you’re wrong.

Each year, heart disease kills more than 6,000 women in the 35-to-44 age range, and 10,000 women between the ages of 29 and 44 have a heart attack, according to the American Heart Association.

In recent years, both men and women ages 20 to 44 have been the fastest-growing users of prescription drug medicines to treat heart disease, according to a recent study by Medco Health Solutions.

But among women, things aren’t improving. One recent study showed that in the past decade, the mortality rate from heart disease among women ages 35 to 44 has even been creeping up.

“It’s probably the age-old issues with women and heart disease,” says Cindy Adams, director of the Healthy Hearts Center at the Indiana Heart Hospital and a nurse practitioner. “The health-care system is more geared to pick up and treat men’s disease.”
But now a burgeoning field of research is focusing on the differences in heart disease between men and women. Stanford University, for instance, has just opened Women’s Heart Health, a new clinic just for women with cardiovascular disease.

Closer to home, researchers like Dr. Daniel Meldrum of Indiana University School of Medicine are exploring why women’s and men’s hearts are so different. While they look the same, the way they respond after a heart attack or surgery is not all similar, says Meldrum.

“In the past, we would attribute any differences in cardiovascular disease to the hormone estrogen, but we now know that is not even close to the whole story,” Meldrum wrote in an e-mail. “I think we are on the cusp of an explosion of information regarding how best to treat women following heart attacks and surgery.”

Such information can’t come too soon, experts say, given that women, especially young ones, often inexplicably do worse with common therapies and treatments.

Here are three women who discovered, to their shock, that they had heart disease.

Not one of these women had a known family history of heart disease. They all took their health seriously. And they all were shocked when they learned that they had heart disease before the age of 50. Here’s how they’ve fought back.

Cindy Springer, 50

Nothing about the pain in her arm signaled heart attack to Cindy Springer.
She had no risk factors, aside from elevated cholesterol, for which she was already taking medicine. She had normal blood pressure, had never smoked, exercised regularly and watched what she ate.

But the aching in her left arm persisted for a few weeks. One day while at work, Springer mentioned it to her husband on the phone.

Her husband didn’t think it was serious either, but, still, he told her, “Go to Methodist.” So the attorney enlisted her secretary to drive her to the Methodist emergency room that

April day nearly two years ago.

As the two women sat there, Springer felt better and got up to leave. Her secretary said, “Oh, you’re here already, why don’t we go get you checked out.” That’s the last thing she remembers. Soon after, she slumped down, unconscious.

Not only had she had a heart attack in which two of the three main arteries of her heart were completely blocked, but the lack of blood heading to that key organ had triggered the electrical system of the heart to go awry, causing a condition known as sudden cardiac arrest.

“It’s usually called sudden cardiac death,” Springer says now wryly. But because she was seconds from help, Springer survived.

Even today, “why me” remains a mystery.

After the heart attack, Springer became diligent about her workout, exercising daily. Her doctors placed her on an array of cholesterol medicines.

A complete lipid profile also revealed that Springer had abnormally high levels of a substance called lipoprotein(a), which has been implicated in heart disease.

Now her two daughters, who are in their 20s, are considered at risk. They’ve both had their cholesterol levels checked, and one of them has started taking medicine to bring down her cholesterol and protect against heart disease.

Gina Jones, 45

Seven years ago, when Gina Jones started feeling fatigued and having difficulty breathing, both she and her doctor chalked it up to a flu-like illness.

But then one day, she felt dizzy. She got herself to bed and “that’s when I felt someone was taking a rope and just trying to rip my heart out of my chest,” she recalls.

Nine hours later, she awoke, confused and scared, thinking she might have had an asthma attack. She called friends and family but couldn’t reach anyone, so she drove herself to the hospital.

A nurse there told Jones, then 39, she was having a heart attack.

Emergency angioplasty followed, and for a while Jones did all right. She remarried and stopped taking her cholesterol medicine, afraid it would prevent her from realizing her dream of having a child.

Then the artery that caused the problem in the first place “blocked like concrete,” she says.

This time the doctors recommended open-heart surgery.
Now, four years later, the Downtown resident has completely changed her lifestyle to accommodate her heart disease. She’s sought low-stress office jobs rather than more high-powered ones. She exercises regularly.

Most dramatic has been her approach to food.

“I used to go to the vending machine and eat any old thing,” she says. “It became huge to me to know that this is more than food; this is something that can really block the rest of your arteries.”

And she’s become an avid volunteer, helping to get out the word about heart disease, among other efforts.

“This experience has led me into wanting to be more productive with the life I have now because I saw how easily my life could end,” she says.

Melissa Oliver, 39

Like many women, Melissa Oliver had always figured heart disease was something she’d have to worry about when she got older.

Then she had a heart attack at age 35.

One day at work four years ago, Oliver felt an unusual pain in her chest.
When she went to her doctor, he downplayed her fears, but ordered a stress test just in case.

“I certainly didn’t think it was my heart, but what else could it be?,” says the Southside resident. “I didn’t have time to be sick. I’m busy, I’m a mother.”

She was shocked when her stress test revealed that she had had a heart attack. At first the cardiologist thought she might need open-heart surgery to repair her problems, which may have been congenital and exacerbated by her recent high blood pressure.

Instead, the doctor fixed her heart with four stents. After problems with the stents for eight months, Oliver’s heart stabilized, but her life would never be the same.
She takes six medicines, has stopped long-distance running, eats sensibly and tries to be less high-strung.

“I want to do everything I possibly can to make sure I live a long life,” she says.
The biggest challenge came as Oliver considered having a second child.

Her cardiologists didn’t say no, but they warned her that they did not have much experience with women of child-bearing years and heart medicine. Oliver was pondering her next step when a close friend offered to carry a pregnancy for her.

“My girlfriend was very afraid that I would go ahead and try it and put my life at risk,” Oliver recalls. “That was probably the best route for me to have another baby. . . . It was such an amazing miracle.” Eight months ago, Owen was born.

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The Definitive Guide to Cholesterol

Wednesday, February 20th, 2008

With all the talk of fighting, battling, combating and beating cholesterol into submission, you’d think it had a black plastic body suit and James Earl Jones’ voice. Big Pharma has, dutifully created quite an arsenal for our supposed defense, and the medical community has been a willing faction, delivering the rhetoric that would incite us all to pick up arms. Now if only we could put down the Big Macs. And the Ding Dongs, HoHos, Twinkies and…you get the point.

Preposterous.

But the insidious rogue, that menacing villain isn’t to be found at the helm of the Death Star. Turns out, there is an enemy within and it’s not even cholesterol. Before you fall to your knees, rip your shirt and gnash your teeth, you might want to consider news you don’t hear often enough: the much aligned compound in question is absolutely essential to your physical, psychological and cognitive functioning.

Yes, the message these days seems to be that no number is too low when it comes to cholesterol (except HDL but we’ll get to that later). I’d like to offer a deeper look into the issue, user-friendly enough but more complex and contentious than you’ll get from the commercial sound bytes telling you to talk to your doctor about blah, blah, blah. Consider it one of MDA’s definitive guides that we’re happy to serve up for our gregarious and always thoughtful community.

Excuse me, have you met cholesterol?

(10R,13R)-10,13-dimethyl-17-(6-methylheptan-2-yl)-2,3,4,7,8,9,11,12

,14,15,16,17-dodecahydro-1H-cyclopenta[a]phenanthren-3-ol

Cholesterol is a waxy, charming lipid gracing every cell’s membrane and our blood plasma. Its jobs, which are many, include insulating neurons, building and maintaining cellular walls, metabolizing fat soluble vitamins, producing bile, and kick-starting the body’s synthesis of many hormones, including the sex hormones. Cool stuff actually.

Given all the work cholesterol has to do, the liver is careful to ensure the body always has enough, producing some 1000-1400 milligrams of it each day. In comparison, the 300 milligram recommended limit for dietary cholesterol (your tax dollars at work in the USDA) is a drop in the bucket. And get this: our livers come with feedback mechanisms (at no additional cost) that regulate cholesterol production in response to our dietary intake. When we eat more, it makes less, and vice-versa. Imagine that!

(Interesting note: While animal products like meat, eggs and dairy, are far and away the primary source of dietary cholesterol, plants contain trace amounts of cholesterol and cholesterol-like substances called phytosterols, which may help lower blood or “serum” cholesterol. Not that that matters, as we shall soon see.

So, what’s with all the acronyms on my cholesterol profile, you ask. Let’s take a look. First, there are high density lipoproteins (HDL). (Lipoproteins are spherical fat particles with water-soluble proteins around their exterior. They transport cholesterol). HDL: everybody loves this guy. He has the popular job of transferring cholesterol from the body’s tissues back to the liver. It’s basically the end of the line with this route, and the liver then excretes it through bile. HDL is the one to naturally help get rid of excess cholesterol when the body’s done with it, hence his universal popularity. Some cholesterologists (just made that up) even refer to him as Nature’s garbage truck.

Next, there are low density lipoproteins, LDL. LDL is a lipoprotein and delivery man as well. He has the disgraced job of transporting cholesterol after production from the liver to the body’s tissues. Remember, this is an important job! That cholesterol has a honey-do list a mile long.

Ironically, it turns out that it’s not the cholesterol part of the LDL or HDL moiety that is dangerous, but the actual lipoprotein part. Unfortunately, once medicine had found a way to differentiate between the amount of HDL and LDL in a cost-effective blood test, it was the cholesterol part that got the short end of the deal.

The latest research into LDL shows that there are actually sub-categories of this cholesterol transporter and that some are more dangerous than others. The larger, more billowy LDL particles are now thought to have little or no significant role in heart disease. On the other hand, the smaller, dense LDL particles are the ones believed to be most involved in the process of inflammation that begins the atherosclerosis cascade. And wouldn’t you know it, but it’s a diet high in simple carbs that most readily promotes the formation of these small LDL particles! Unfortunately, this important distinction is probably something your doctor knows very little about, yet it’s the number of small particle LDL that might be the most important reading in any cholesterol test. So a total cholesterol of, say, 230 or even 250 might not be dangerous at all if your HDL is high and your small particle LDL is low.

Before we move on, let’s give brief mention to triglycerides. Triglycerides are essentially the form that fat takes as it travels to the body’s tissues through the bloodstream. The relationship between triglycerides and cholesterol is more of an association. A high triglyceride level, which is unequivocally fueled by a high carb diet, is very often a marker for other problems in the body, particularly insulin resistance (and accompanying risk of diabetes) as well as inflammation (with its risk of heart disease). High levels are often seen with low HDL cholesterol. Once again, the high carb diet wreaks havoc.

The Rise of Cholesterol Panic

Cholesterol free zone looks to have a mascot.

Heart disease took off in the early part of the twentieth century, and doctors frantically searched for the cause throughout the next several decades. Tests in the fifties initially showed an association between early death by heart disease and fat deposits and lesions along artery walls. Because cholesterol was found to be present in those deposits (of course it would!) and because researchers had previously associated familial hypercholesterolaemia (hereditary high blood cholesterol) with heart disease, they concluded that cholesterol must be the culprit. In fact, what happens is that in response to an inflammatory situation, the body uses cholesterol as a “band-aid” to temporarily cover any lesions in the arterial wall. In the event the inflammation is resolved, the band-aid goes away and repair takes place. No harm, no foul. Unfortunately, in most cases, the inflammation proceeds, the cholesterol plaque is eventually acted on by macrophages and is oxidized to a point at which it takes up more space in the artery, slows arterial flow and eventually can break loose to form a clot. And all this time the cholesterol was just trying to be the good guy! Blaming cholesterol for all this is like blaming a cut finger on all the band-aids you have lying around your house.

Death from heart disease, according to the CDC, has declined over 50% since its peak in the 1950s. The success is attributed to a number of factors, including a decrease in smoking and better diagnosis and treatment of high blood pressure. Included in the list of factors was the opportunity for public education regarding the scientific findings/theories related to cholesterol; however, measures (including CDC estimates) of dietary saturated fat intake show that intake has generally stayed the same or risen.

But the dietary cholesterol message stuck.

Early drugs that “battled” high cholesterol prevented its absorption in the digestive tract. The side effects on the digestive system were unpleasant enough and the results modest enough that the drugs never garnered much support from either side of the prescription pad. Enter statins. Statins inhibited the natural production of cholesterol. Side effects were not as immediately noticeable or uncomfortable, and the results were quite good (at least at lowering cholesterol). (The recently beleaguered Vytorin and Zetia combined statin actions with a substance that reduces absorption of dietary cholesterol, preventing your body from trying to compensate for the lower natural cholesterol production.)

But what about the body’s natural impetus to produce a given and necessary amount of cholesterol? What happens to the parts of the body that need the cholesterol? What about the liver’s regulating mechanism? What happens when you mess with evolution? Exactly. Those are the sorts of questions that get thrown aside when you’re riding Big Pharma’s cholesterol hobby horse.

What Are the Problems With This (”Lipid”) Model?

Million Dollar Question

Oh, boy. There’s the million dollar question. First off, let’s go back to the evolutionary question. As a naturally self-regulating system, the body will react if it doesn’t have enough cholesterol (yes, the body’s definition of enough and not Merck’s). If there’s not enough cholesterol, the alarm goes off, strobe lights flash and the body goes into crisis mode. Corticoid hormones coordinate a redistribution of cholesterol, a triage of sorts in which cholesterol is rationed among the many areas of the body that need it. Nonetheless, the body is now working under hardship conditions.

Adequate cholesterol isn’t available for the body’s repair system, for the uptake of serotonin, for the full initiation of Vitamin D and hormone production and their regulation of blood sugar and inflammation, etc., etc. What does your logic tell you here? Yup, nothing is running the way it should.

Let me also add that everyone’s cholesterol profile is going to be different, no matter what. And I acknowledge that a very small percentage of people out there genuinely have *true* hereditary high blood cholesterol, familial hypercholesterolemia, a metabolic condition with impaired or even lack of ability to metabolize cholesterol. This condition can have serious health consequences. By the way, this condition, in its heterozygous form affects at most 1 in 500 people. Total serum cholesterol in these folks is in the 400 mg/dl range (as opposed to the 200 recommended). The homozygous form affects about 1 in 250,000. You likely don’t know anyone in this category because their disorder almost always ends their lives at a very young age.

I mention familial hypercholesterolemia because I want to distinguish it from the claim made by Big Pharma ads that you may have higher cholesterol because people in your family did, and – can you believe it – their company is here to help. Duh! Everyone’s family influences cholesterol profiles. It’s, in small part, genetic. No big worry there. Just because you come from a family with “elevated” cholesterol doesn’t mean you have the familial hypercholesterolemia metabolic disorder. You can pretty much bet a whole lot o’ money on the likelihood that your cholesterol profile – good or bad – has more to do with learned behaviors like diet and exercise. “Elevated” cholesterol doesn’t equate with metabolic disorder.

Officer, You Got the Wrong Guy!

I’ve said it before, and I’ll say it again. Sound and reliable medical research hasn’t proven that lowering (or low) cholesterol in and of itself reduces risk of death from heart disease across a population. Yes, there is always that single isolated guy who throws off the curve, but he (or she) is a statistical anomaly and doesn’t negate the legitimacy of the model. For instance, the Japanese people of Okinawa are among the healthiest in the world. Their heart disease rate is extremely low, but they tend to have “elevated” cholesterol levels.

The fact is, half of all first time heart attack sufferers have a perfectly “normal” cholesterol profile. What does this tell you? There must be some other piece here behind the “other half” and, I would solidly argue, behind the first half. Cholesterol is a red herring.

It all boils down to inflammation. Inflammation is the number one factor in heart disease. This is an accepted fact now, but it still gets little attention and no real prevention or treatment. Think about it: you have your cholesterol levels checked every five years or more if your profile is “problematic.” When do you have biomarkers for inflammation checked? Unless you’ve had a heart attack or been diagnosed with a serious medical condition, probably never.

Fighting inflammation near and far…

Inflammation. What is it caused by? Not fat, but carbohydrates. Yes, sugars and processed carbs are highest on the list of perpetrators here, but grains and starches as a whole contribute to the problem. LDL rises directly not with the amount of saturated fat you eat but with rising levels of inflammation caused by carbs and trans fats.

Oxidation. Furthermore, nearly every study suggests that LDL is only a true threat when it’s oxidized. What oxidizes it? Free radicals. We’re talking trans fats primarily, that beast of an additive found in countless food products (as opposed to foods). What counteracts free radicals (because we all naturally have some in us)? Anti-oxidants: veggies and fruits, of course, as well as nuts, olive oil, etc. Consider also a broad-based multi-antioxidant supplement containing those nutrients shown to decrease oxidation.

Back to the red herring issue. Substantially “elevated” cholesterol, low HDL or high LDL might be reason to give you pause, but not for the reason you might think. The number can tell you that something is amiss, but they’re a symptom of the larger concern rather than the main issue itself. Cholesterol profile can be impacted by other conditions such as hypothyroidism, untreated diabetes or pre-diabetes, pregnancy (surprise!), lactation, stress, liver conditions, heart disease (symptom, not cause of), etc. Talk to you doctor about what your numbers mean in the grand scheme of your health. And see if you can get a read on other markers, like C-reactive protein (an inflammatory indicator) and those small particle LDL numbers.

How to Maintain True Heart Health

Better use two hands…

Now that we’ve conquered the cholesterol frenzy (because the frenzy itself is the real threat), let’s get to the genuine issue of maintaining heart health. Maintaining heart health is about keeping inflammation at bay. As we say here at MDA, that means an anti-inflammatory diet (with exercise), and primal nutrition fits the bill: copious amounts and variety of veggies, fruits, good quality meats, healthy fats and proteins.

Also, plenty of omega-3 fatty acids, particularly fish oil, will thin the blood and help prevent clotting, which along with atherosclerosis (inflammation related), is a serious set up for heart disease and stroke. Fish oil also happens to generally lower triglycerides and increase “good” HDL.

Read up in our MDA archives for additional info on inflammation and healthy living. Thanks for tuning in.

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Understanding Cholesterol

Monday, February 18th, 2008

* Elevated cholesterol levels are very common in Western society and are one of the most important risk factors for cardiovascular disease (i.e. heart attacks and strokes) together with smoking, high blood pressure, a family history of heart disease and diabetes.

* In the next few articles we will look at cholesterol metabolism and what foods have a harmful or helpful effect on cholesterol levels.

* Contrary to popular opinion cholesterol is an essential nutrient for good health – it is a vital component of cell membranes, bile acids, Vitamin D and sex hormones.

* Cholesterol is transported around the body bound to proteins:

i) HDL (high density lipoprotein or ‘good cholesterol’) – transports cholesterol from tissues back to the liver for disposal (equivalent to a vacuum cleaner). When LDL levels get too high, HDL cannot keep up and LDL levels rise to harmful levels.
ii) LDL (low density lipoprotein or ‘bad’ cholesterol) – transports cholesterol from the liver to the tissues.
iii) Other Types e.g. ‘ApoA’ and ‘ApoB’.

* Total Cholesterol = HDL + LDL + Other Types

* The harmful effects of cholesterol occur as the result of a process called oxidation. Whenever wood is burned, smoke is produced as a byproduct. Similarly whenever fuel is burned by our cells oxygen is utilized (hence the name ‘oxidation’) and toxic byproducts are formed e.g. free radicals. Free radicals are molecules of oxygen that are missing one electron and are highly unstable. It is estimated that every cell in your body (over 70 trillion) is subjected to 100,000 free radical hits per day – this causes cumulative damage to all cell structures, particularly cell membranes and DNA. If cholesterol (particularly LDL) becomes oxidized, it turns rancid – this sets up a chain of inflammation and damage ultimately resulting in a build-up of plaque within the walls of your blood vessels (a process known as atherosclerosis). This in turn predisposes to heart attacks and strokes. This is the main reason why elevated cholesterol levels are a risk factor for cardiovascular disease.

* Levels of cholesterol that are accepted as ‘normal’ in the Western world are much higher than levels found in healthy cultures (e.g. Asians).

* Every 1% reduction in total cholesterol levels results in a 2% reduction in risk for heart disease.

ANOTHER FAT – TRIGLYCERIDES

* Triglycerides are the main kind of body fat.
* Triglycerides make up 95% of the fats we eat.
* Most of the stored fat we carry in our bodies is composed of triglycerides.
* Triglycerides are also carried in the bloodstream – high blood triglyceride levels are a risk factor for cardiovascular disease (heart attacks and strokes) similar to high cholesterol levels.
* Triglycerides are the main type of fat found in animal products (e.g. meat, dairy and egg yolks).
* Depending on their chemical structure they are labeled saturated, monounsaturated or polyunsaturated. These have different effects on your health.

FOODS THAT HAVE A HARMFUL EFFECT ON CHOLESTEROL LEVELS

* 25% of your body’s cholesterol comes from dietary intake. All cholesterol comes from ANIMAL sources – the major dietary sources are meat, eggs (yolks) and  full-fat dairy products (milk, yoghurt, cream, ice-cream, butter and cheese). Other sources are seafood (e.g. shellfish, oyster, lobster, crab & shrimp) and organ foods (e.g. liver, kidney, heart and brain).

* The remaining 75% is produced in your liver. Because your body makes cholesterol on its own, limiting the amount of cholesterol in your diet is only part of the solution to managing elevated cholesterol levels.

* The component of food in your diet that has the biggest effect on blood cholesterol levels is SATURATED FAT – this is found in animal products e.g. meat, eggs (yolks) and full-fat dairy products (milk, yoghurt, cream, ice-cream, butter and cheese) and some plant products e.g. coconut and palm oils. Saturated fats increase the amount of LDL and the total amount of cholesterol in the bloodstream.

FOOD NUTRIENTS THAT HAVE A BENEFICIAL EFFECT ON CHOLESTEROL LEVELS:

FIBRE:

* Fibre is tough structural part of a plant that is not broken down during digestion – strictly speaking, fibre isn’t a nutrient because it isn’t absorbed into the body but is excreted largely unchanged. In spite of this, fibre is incredibly beneficial to our health.

* There are 2 types of fibre:

i) Soluble – as soluble fibre passes through the digestive tract it forms a gel-like material that traps cholesterol and prevents it from being absorbed into your body. Pectin is a particular type of soluble fibre that has other beneficial effects as well – it decreases cholesterol production in the liver. Studies have shown that increasing soluble fibre consumption from 4 grams a day to 7 grams a day can decrease your chances of dying from heart disease by 40%.

ii)Insoluble (‘roughage’) – insoluble fibre doesn’t break down in the body; it stays in the intestine and absorbs a lot of water thereby making stools bulkier and easier to pass. By speeding the transit time through the bowel it reduces the amount of cholesterol (and other harmful substances) that is absorbed.

Aim to consume 30 grams of fibre every day.

FATS:

i)Monounsaturated: 

Monounsaturated fats (e.g. found in avocadoes, olives and many nuts) can decrease LDL while leaving the beneficial HDL untouched.

Olive oil may also improve the liver’s ability to remove LDL from the bloodstream.

 ii)Poly-unsaturated (Omega-3):

Found in deep sea fish (tuna, trout, salmon and sardines) and flaxseeds.
Lowers triglyceride and raises HDL levels.

PROTEIN:

Certain types of protein can reduce cholesterol levels e.g. those found in buckwheat, soybeans or beans.

ANTI-OXIDANTS:

Anti-oxidants stop the destructive process of oxidation by donating an electron.

i) Carotenoids – these are the pigments that give fruits and vegetables their colour. They are found in all rich yellow, orange and red vegetables as well as deep green leafy vegetables. The most important classes of carotenoids are B-carotene, lutein, lycopene and zexanthin.
ii) Tocotrienols – these act as anti-oxidants as well as acting on the liver to decrease cholesterol production.
iii) Lignans – these are other compounds with anti-oxidant ability.
iv) Flavonoids (e.g. rutin and quercetin) – these are water-soluble anti-oxidants that also shrink the size of LDL particles.
v) Vitamin C – is a powerful water-soluble anti-oxidant.
vi) Vitamin E – is a powerful fat-soluble anti-oxidant.

PHYTO-OESTROGENS:

Soy products (e.g. tofu, miso & tempeh) contain phyto-oestrogens which help transport LDL cholesterol from the bloodstream to the liver where it is broken down and excreted.
Soy foods also increase the activity of LDL receptors on cells thereby trapping LDL molecules from the bloodstream.
2-3 servings a day can reduce cholesterol levels by 10-13%.

CAPSAICIN:

Some evidence suggests that capsaicin consumption my lower LDL levels.
This substance is found in chillies.

ALLICIN:

Garlic contains a compound called allicin that changes the way the body uses cholesterol.
Eating ½ – 1 clove of minced or crushed garlic a day can lower your cholesterol levels by 10%.

MILK:

Studies have shown that milk contains substances that reduce the liver’s production of cholesterol. Make sure you use choose low-fat varieties e.g. ‘trim’ or ‘supertrim’.

ERITADENINE:

This compound found in Shitake mushrooms can effectively lower cholesterol levels.

SAPONINS:

Saponins appear to bind cholesterol and bile acids and aid their removal from the body.
Saponins have a special ability to target the cholesterol found in cancer-cell membranes – saponins selectively bind to these cells and destroy them.

POLYPHENOLS:

Powerful antioxidants.
Olive oil is a rich source

LIGNANS:

Plant oestrogens that help keep levels of human oestrogen in check and also lower LDL levels.
Flaxseeds are a rich source.

ORYZANOL:

Found in the outer bran layer of brown rice.
Reduces the body’s production of cholesterol – this compound is chemically similar to cholesterol-lowering agents.

 SUMMARY: To raise HDL levels:

·        Exercise daily
·        Consider drinking 1 glass of red wine every 2nd day.

 To lower Total Cholesterol, LDL and Triglyceride levels:

* Eat less saturated fats and cholesterol i.e. meat, animal fats (e.g. lard), full-fat dairy products (milk, yoghurt, cream, butter, ice-cream), tropical fats (palm and coconut oil), processed foods (e.g. sausages and salami), takeaways (e.g. fried foods), snack foods (e.g. biscuits, cakes, pastries, potato or corn chips), organ foods and sea-foods (e.g. shellfish and shrimps).
* Eat a minimum of 30 grams of fibre per day.
* Eat a variety of fruits, vegetables and whole grains (see chart below for best choices).

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Gene Linked to Bad Cholesterol Found

Tuesday, February 12th, 2008

A study published in the American Journal of Human Genetics has found new genes that are believed to be linked to ‘bad’ cholesterol. Researchers believe the discovery can potentially create opportunities for development of new therapies for the treatment of heart disease.

Coronary heart disease is one of the biggest causes of deaths in developed and developing countries. In the UK alone, one-in-four male and one-in-six female deaths can be attributed to heart disease. The condition accounts for nearly 233,000 deaths in the UK and more than 16 million deaths worldwide each year.

Deposits of fatty substances inside the arteries are normally the starting point of heart disease. When low-density lipoprotein (LDL), also known as ‘bad’ cholesterol levels increase within the arteries, the latter get clogged and blood flow becomes restricted. When the deposits break off and accumulate, blood flow is blocked and the heart is strained to supply enough blood to all parts of the body.

The medical fraternity has long believed that heart disease is a combination of physical, environmental and genetic factors. While the physical and environmental factors are well known, genetic factors have remained something of a mystery.

Researchers at The Barts and the London, Queen Mary’s School of Medicine and Dentistry undertook a detailed study of the entire human DNA sequence to unravel this mystery and determine exactly which genes are involved in the development of heart disease. What they found was a new region on chromosome 1 that has potential links to LDL cholesterol. They found that this DNA causes blood LDL levels to increase by 6%.

Study author Professor Patricia Munroe said, “Our study found new genes for serum LDL, the cholesterol which furs arteries.” The researchers believe their discovery has the potential of saving many lives. “We believe our findings are of significant clinical importance as they are strongly associated with cardiovascular disease; they also represent excellent targets for new medicines,” Professor Munroe said.

Professor Jeremy Pearson of the British Heart Foundation said, “This finding has the potential to lead to the development of new drugs to help lower cholesterol levels which in turn could help thousands of heart patients across the UK.”

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Heart Disease Myths Busted

Friday, February 8th, 2008

Six Common Myths You Should Know To Protect Your Heart

February is National Heart Month, a time to raise awareness about heart disease, which remains the leading cause of death for American men and women.

Ask yourself if you’re taking care of your heart, and do not be fooled by these common myths.

Myth 1
If I exercise and maintain a healthy lifestyle, I will not get heart disease. — False

Eating healthy and exercising is a great start, but does not guarantee health.

Risk of heart disease increases with several uncontrollable factors: You are more at risk if you are a man, if you are older and if you have a genetic history of diabetes, high cholesterol or high blood pressure.

It is important to follow up with your doctor at least once a year to test your blood pressure and cholesterol levels, even in your 20s.

If you are predisposed to high blood pressure or high cholesterol, you may need to take medication to prevent heart disease.

Myth 2
I won’t have to worry about heart disease until I’m much older. — False

Coronary artery disease can start to develop in our teenage years, and many of the bad habits we develop as young adults persist as we get older.

Children who are obese, have high blood pressure and a family history of heart disease are at higher risk.

Although rare, some children (usually due to genetic differences) can have unusually high cholesterol and thus an increased risk for heart disease.

Myth 3
A little bit of alcohol is good for the heart. — True

Recent studies show a small amount of alcohol every day, such as one glass of wine or a little bit more, can actually be beneficial for the heart.

There is debate as to what type of alcohol is best. There are benefits associated with red wine, but other types may be beneficial as well.

Too much alcohol can pose problems though. Binge drinking on weekends, for example, can be very damaging to the heart. Alcohol in large amounts has a toxic effect on the heart muscle cells, and can lead to heart failure.

Myth 4
If I have two scrambled eggs for breakfast, I’ve already exceeded my daily recommended cholesterol intake. — True.

A typical egg yolk has about 200 to 250 milligrams of cholesterol (of course, there is no cholesterol in egg whites). The recommended daily cholesterol intake, according to the American Heart Association, is 300 milligrams a day.

If you eat two egg yolks for breakfast, you are likely exceeding your daily recommended intake by more than one-third.

Even after eating just one egg yolk in the morning, it’s likely you will need to restrict other animal fats from your diet for the rest of the day to keep within recommended levels.

Myth 5
My blood pressure can never be too low. — False

In general, high blood pressure — a risk factor for heart disease — is so persistent that just getting blood pressure to normal levels doesn’t happen very often.

For most people, low blood pressure is a healthy thing. However, in rare cases, when a person is ill or on blood-pressure-lowering medication, she can get truly low blood pressure, which can lead to fatigue, fainting and kidney dysfunction.

Myth 6
I’ll know I’m having a heart attack because my chest and arm(s) will hurt. — False

Although 60 percent to 90 percent of heart attacks have the common symptoms (chest pain, arm pain, etc.), 25 percent of heart attacks have either no signs or atypical signs associated with the incident. So-called “silent” heart attacks are more common in diabetics.

On average, about half of women will have traditional chest pain, and the other half show atypical symptoms such as headaches, nausea, fatigue and stomach upset.

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