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Two out of three people with diabetes will die from heart disease or stroke. But those who are proactive with controlling cholesterol and blood pressure stand a much better chance of avoiding trouble.

In this week’s Dealing with Diabetes report, a local heart specialist considers diabetes to be more than just a risk factor.

As a diabetic, Las Vegas resident Irma Park knows the importance of controlling her cholesterol. And it’s a constant challenge. Park was able to quit smoking, but adjusting her diet is proving harder than she thought.

“I can’t pass up anything that looks good to me,” said Park.

Las Vegas cardiologist, James Mock says diabetics can do themselves a favor by trying their best to lead a healthy lifestyle. “One of the things that we’re going to really focus on with that diabetic patient is lifestyle modification. Lose weight as a beginning. Exercise, lose weight, attempt to lower the carbohydrate intake in your diet,” he said.

Poor circulation increases the prevalence of heart disease among diabetics to the point where some doctors automatically assume it’s going to be a problem.

“We treat the diabetic patient as we would treat a patient who’s already had a heart attack,” said Dr. Mock. And that means following strict guidelines for blood pressure and cholesterol.

“People with diabetes, our goals are changed. In terms of blood pressure lowering, we want them to have a much lower blood pressure than the non-diabetic patient. We want them to have a much lower bad cholesterol, or LDL cholesterol as compared to the non-diabetic patient. Why — because we assume they already have blocked arteries,” said Dr. Mock.

Dr. Mock says high blood pressure can also result in kidney failure and the need for dialysis — another reason to be compliant with doctor’s orders.

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Healthy Today - Sick Tomorrow

Unfortunately, high cholesterol (hypercholesterolemia) has become the dominating health concern of the 21st century. It is actually an invented disease that doesn’t show up as one. Even the healthiest people may have elevated serum cholesterol and yet their health remains perfect. But they are instantly turned into patients when a routine blood test reveals that they have a “cholesterol problem.”

Since feeling good is actually a symptom of high cholesterol, the cholesterol issue has confused millions of people. To be declared sick when you actually feel great is a hard nut to swallow. So it may take a lot of effort on behalf of a practicing physician to convince his patients that they are sick and need to take one or more expensive drugs for the rest of their lives. These healthy individuals may become depressed when they are being told they will need to take potentially harmful drugs to lower their cholesterol levels on a long-term, daily basis. When they also learn that they will require regular checkups and blood tests, their worry-free, good life is now over.

These doctors cannot be blamed for the blunder of converting healthy people into patients. Behind them stands the full force of the U.S. government, the media, the medical establishment, agencies, and of course, the pharmaceutical companies. All of them have collaborated to create relentless pressure in disseminating the cholesterol myth and convincing the population that high cholesterol is its number one enemy. We are told that we need to combat it by all means possible to keep us safe from the dreadful consequences of hypercholesterolemia.

The definition of a “healthy” level of cholesterol has been repeatedly adjusted during the past 30 years, which certainly does not give me much confidence in a system of medicine that professes to be founded on sound scientific principles. In the early days of measuring cholesterol levels, a person at risk was any middle-aged man whose cholesterol was over 240 and possessed other risk factors, such as smoking or being overweight.

After the adjustment of parameters during the Cholesterol Consensus Conference in 1984, the population was hit by a shock wave. Now, anyone (male or female) with overall cholesterol readings of 200 mg percent (200mg per 100 ml) could receive the dreaded diagnosis and a prescription for pills. The claim that 200 blood serum cholesterol is normal and everything above is dangerous was scientifically unfounded, though. At least, this was the consensus of all the major cholesterol studies. In fact, a report in a 1995 issue of the Journal of the American Medical Association showed no evidence linking high cholesterol levels in women with heart conditions later in life.

Although it is considered completely normal for a 55-year-old woman to have a cholesterol level of 260 mg percent, most women that age are not told about this. Also healthy employees are found to have an average of 250 mg percent with high fluctuations in both directions.

The lack of evidence linking elevated cholesterol with increased risk of heart disease, however, didn’t stop the brainwashing of the masses. In the U.S. 84 percent of all men and 93 percent of all women aged 50-59 with high cholesterol levels were suddenly told they needed treatment for heart disease. The totally unproved but aggressively promoted cholesterol theories turned most of us into patients for a disease that we probably will never develop. Fortunately, not everyone has followed the advice to have their cholesterol levels checked but, unfortunately, millions of people have fallen into the trap of misinformation.

To make matters worse, the official, acceptable cholesterol level has now been moved down to 180. If you have already had one heart attack, your cardiologist will tell you to take cholesterol-lowering statins even if your cholesterol is very low. From the viewpoint of conventional medicine, having a heart attack implies that your cholesterol must be too high. Hence you are being sentenced to a lifetime of statins and a boring low-fat diet. But even if you have not experienced any heart trouble yet, you are already being considered for possible treatment.

Since so many children now show signs of elevated cholesterol, we have a whole new generation of candidates for medical treatment. So yes, current edicts stipulate cholesterol testing and treatment for young adults and even children! The statin drugs that doctors use to push cholesterol levels down is LIPITOR (atorvastatin). If you decide to follow your doctor’s advice and take one of these drugs, make certain to read the list of side effects so that you know the risks you are taking.

If you want to obtain objective and untainted information on cholesterol, agencies like the National Institutes of Health and the American College of Cardiology are certainly not the places from which to obtain it. Until recently, they wanted you to keep your overall cholesterol level below 150. Then, in 2001, they finally admitted that measuring overall cholesterol levels makes no sense at all, so they began recommending an LDL level below 100. Now their aim is to keep LDL lower than 70. Every time they lower the target, the number of “patients” requiring treatment jumps dramatically, much to the benefit of the drug producers. Being officially backed by these agencies, doctors feel motivated, if not obliged, to prescribe these expensive drugs to their new patients.

The extensive promotional campaigns by the pharmaceutical giants have already brainwashed the masses to believe they need these drugs to be safe from sudden heart attack. Even if a doctor knows the truth about the cholesterol deception, these anxious patients will demand a prescription from him. This is not just affecting their health, but everyone’s economic future. The massive sales of these best-selling drugs of all time drive up health care costs to levels that undermine economic growth and make basic health care unaffordable to an ever-increasing number of people. The masses have been so brainwashed with misinformation that this lurking financial crisis doesn’t seem to be their immediate concern.

In 2004, there were already 36 million statin candidates in the U.S., with 16 million using LIPITOR alone. When the official LDL target level drops to 70, another 5 million people will be eligible for their use. At the consumer markup price of LIPITOR, you can understand the incentive that the pharmaceutical industry has to push their products and make them a mass commodity.

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But as INTERHEART and other studies have shown, cholesterol isn’t a serious risk factor for heart disease at all. An earlier study sponsored by the German Ministry of Research and Technology showed that no exact link exists between food cholesterol and blood cholesterol. Even more surprising, in Japan, the cholesterol levels have risen during recent years, yet the number of heart attacks has dropped. The largest health study ever conducted on the risks of heart disease took place in China. Like so many similar studies, the Chinese study found no connection between heart disease and the consumption of animal fats.

In an 8-year long heart study, researchers observed 10,000 people with high cholesterol levels. Half of them received a best-selling statin drug. The other half were simply told to eat a normal diet and get enough exercise. The results stunned the researchers. Although the statin drug did indeed lower serum cholesterol, this had no impact whatsoever on death rate, non-fatal heart attacks and fatal arterial disease. In other words, the statin-users had zero advantage over those who received no treatment at all. However, they had just spent eight years taking a costly drug with hideous side effects - risking liver failure, muscle wasting, even sudden death. Lowering cholesterol either through drugs or low fat diets does not lower the risk of developing heart disease.

All the major European long-term cholesterol studies have confirmed that a low-fat diet did not reduce cholesterol levels by more than 4 percent, in most cases merely 1-2 percent. Since measurement mistakes are usually higher than 4 percent and cholesterol levels naturally increase by 20 percent in autumn and drop again during the wintertime, the anti-cholesterol campaigns since the late 1980s have been very misleading, to say the least. A more recent study from Denmark involving 20,000 men and women, in fact, demonstrated that most heart disease patients have normal cholesterol levels. The bottom line is that cholesterol hasn’t been proved a risk factor for anything.

The current medical understanding of the cholesterol issue is more than incomplete. The argument that animal tests on rabbits have confirmed that fatty foods cause hardening of the arteries sounds convincing, but only when the following facts are omitted:

* Rabbits respond 3,000 times more sensitively to cholesterol than humans do.

* Rabbits, which are non-carnivorous animals by nature, are force-fed excessive quantities of egg yolk and brain for the sake of proving that cholesterol-containing foods are harmful.

* The DNA and enzyme systems of rabbits are not designed for consumption of fatty foods, and if given a choice, these animals would never eat eggs or brains.

It is obvious that the arteries of these animals have only an extremely limited ability to respond to the damage caused by such unsuitable diets. For over three and half decades, Western civilization assumed that animal fats were the main cause of dietary heart disease. This misinformation is highlighted by the fact that heart attacks began to rise when consumption of animal fats actually decreased. This was verified by British research, which revealed that those areas in the U.K. where people consumed more margarine and less butter had the highest numbers of heart attacks. Further studies revealed that heart attack patients had consumed the least amounts of animal fats.

In this context, it is important to differentiate between processed and unprocessed fats. It has been discovered that people who died from a heart attack were found to have many more of the harmful fatty acids derived from the partially hydrogenated vegetable oils in their fat tissue than those who survived. These so-called “faulty” fats (trans-fatty acids) envelop and congest the membranes of cells, including those that make up the heart and coronary arteries. This practically starves the cells of oxygen, nutrients, and water, and eventually kills them.

In another more comprehensive study, 85,000 nurses working in American hospitals observed a higher risk for heart disease in patients who consumed margarine, crisps, potato chips, biscuits, cookies, cakes, and white bread, all of which contain trans fats.

Eating margarine can increase heart disease in women by 53 percent over eating the same amount of butter, according to a recent Harvard Medical Study. While actually increasing LDL cholesterol, margarine lowers the beneficial HDL cholesterol. It also increases the risk of cancers up to five times. Margarine suppresses both the immune response and insulin response. This highly processed and artificial product is practically resistant to destruction, being one molecule away from plastic. Flies, bacteria, fungi, etc. won’t go near it because it has no nutritional value and cannot be broken down by them. It can last for years, not just outside the body, but inside as well.

It is very apparent that eating damaged, rancid fats or trans-fats can destroy any healthy organism and should be avoided by anyone. In 2007 New York City banned the use of trans fats in its restaurants; however, the trans fats are merely being replaced with new artificial fats that have the same or worse effects.

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Why has there never been a record of cholesterol having blocked a vein in the body! What is it about arteries that makes cholesterol attach itself to their walls, while leaving the veins alone? It is really the sticky nature of cholesterol that is behind the blockage of healthy blood vessel walls?

The answers to these questions may surprise you. The body actually uses the lipoprotein cholesterol as a kind of bandage to cover abrasions and tears in damaged arterial walls just as it does it for any other wound. Cholesterol is nothing less than a life-saver. However, for the past thirty-eight years, this lipoprotein has been stigmatized to be the number one cause of deaths in the rich nations - heart disease.

This is how the theory goes: For reasons not really known, a form of cholesterol that has earned the name “bad” somehow increases in the bloodstream of millions of people today; it sticks to the walls of arteries, and eventually, it will starve the heart muscle of oxygen and nutrients. Accordingly, the masses are urged to reduce or ban cholesterol-containing fats from their diet so that they can live without the fear of arterial occlusion and dying from a heart attack.

The tremendous concern of being attacked by this “vicious” lipoprotein has finally led to innovative technologies that can even extract cholesterol from cheese, eggs, and sausages, thus making these “deadly” foods “consumer-safe.” Products that claim to be low in cholesterol, such as margarine and light-foods, have become a popular choice of “healthy eating.”

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Patients in the intensive treatment group were given cholesterol-lowering statin drugs such as Lipitor and Merck’s Zocor, sold generically as simvastatin. For those who didn’t reach their goal, Zetia was added.

The group had a decrease in plaque buildup, a finding that clashes with the study, called Enhance, released earlier this month at a medical meeting. That trial showed Zetia, when added to Merck’s Zocor in Vytorin, the combination pill, failed to slow plaque build-up in the carotid arteries.

“It’s a direct conflict to Enhance,” Howard said.

Merck, based in Whitehouse Station, New Jersey, and Kenilworth, New Jersey-based Schering-Plough said the Enhance study was flawed, in part because it looked at patients with an inherited form of high cholesterol who had been aggressively treated for years with powerful drugs like Zetia.

The researchers now are comparing the patients who got Lipitor to those who didn’t, looking for differences in results. The findings will be published later, Howard said.

No Effect on Deaths

Aggressive treatment also led to better heart function, marked by a significantly greater drop in swelling of the left ventricle, the heart’s main pumping chamber, the study found. There were no differences in heart attacks, surgery to clear clogged arteries, chest pain or deaths between the two treatment groups, and the number was lower than anticipated in patients getting less aggressive treatment.

That finding suggests getting more patients to the currently recommended levels for cholesterol and hypertension could dramatically improve their health, Howard said. More than half of diabetic patients don’t get to the recommended targets now, she said.

The study can be used to support both sides of the argument about how low cholesterol and blood pressure levels should go, wrote Eric Peterson and Tracy Wang, from the Duke Clinical Research Institute in Durham, North Carolina, in an editorial that accompanied the study. Some doctors are convinced lower is always better, while “therapeutic nihilists” want clear proof before they accept the theory, Peterson and Wang wrote.

The results show aggressive treatment reduces early signs of disease and should generate better health with time, they said. On the other hand, three years of intense treatment in a high- risk group of patients documented no significant benefit in lowering heart attacks and complications, they said.

Blood Pressure

Until longer studies are completed, it makes sense to use proven drugs such as Pfizer’s Lipitor and AstraZeneca Plc’s Crestor to lower cholesterol as far as possible, Peterson and Wang wrote. More data are needed for blood pressure because those benefits aren’t as clear and the high drug doses led to side effects, such as dangerously low blood pressure, they said.

The larger studies are expensive. The current trial, dubbed Sands, cost about $12 million and followed 500 patients. A 10,000-patient study looking for specific results such as heart attacks, strokes and deaths could cost more than $200 million, they wrote.

Ultimately, there’s no choice except long-term trials, Howard said. When the researchers got high-risk patients to the currently recommended levels, heart attacks and other complications were similar in both groups. Teasing out a benefit from going lower with blood pressure and cholesterol will take time, she said.

“By getting the control group to standard targets and reducing their risks, you don’t have much room to show a difference” between the two treatment approaches, she said. “You have to go longer, with more people.”

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Oatmeal is the only whole grain food recognized by the FDA to help lower cholesterol to reduce the risk of heart disease. Oats contain a good variety of vitamins, minerals and antioxidants, and can also aid in maintaining a healthy weight as part of a diet rich in fiber.

When baking, quick or old fashioned oats can be substituted for up to one-third of the flour called for in recipes for muffins, biscuits, pancakes, coffee cakes and cookies. Oats can also be used in homemade granola, breads, pies, cakes, sticky buns, etc.

According to Quaker Consumer Relations, the only difference between old fashioned and quick oats is that the quick oats are cut into smaller pieces to shorten the cooking time. They also tend to absorb more into the other ingredients of a recipe, while the old fashioned (or rolled oats) hold their shape enough to make a noticeable difference in the recipe’s appearance.

Alongside the basic recipe for breakfast oatmeal, two of our favorite specialty recipes for oatmeal are homemade granola and baked oatmeal. I recently received a new recipe for baked oatmeal/granola, which was shared by David Alleman. David says this recipe can be varied considerably to suit your preference, and that he seldom makes it the same from one time to the next. He also mixes the dry ingredients the night before so he can quickly prepare it the next morning for a 6:45 study group. The original “All American” recipe calls for black walnuts and real maple syrup. However, English walnuts and honey may be substituted if desired. The cereal reheats well in the microwave, and David usually makes a double portion while the ingredients are out and the oven is hot, so he has extra for other meals. These recipes contain a variety of healthy ingredients, which help to get your day off to a good start nutritionally.

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Diabetics who lower their blood pressure and cholesterol below currently recommended levels may slow or reverse plaque buildup in arteries, a study found.

Patients were treated with a mix of drugs to reduce bad cholesterol to less than 70 milligrams per deciliter, compared with the recommended 100, and to cut systolic blood pressure to 115 millimeters of mercury, instead of the standard 130. One- third of the patients getting the intense treatment relied on Merck & Co.’s and Schering-Plough Corp.’s cholesterol pill Zetia to reach the goals, researchers said.

The amount of fatty plaque in arteries leading to the brain decreased among patients getting added treatment and increased slightly in those who followed the current guidelines. The findings conflict with a recently released study of Vytorin, a combination drug that includes Zetia, and may bolster arguments from Merck and Schering-Plough that the previous trial was flawed.

“More time is needed to see whether these improvements will result in long-term benefit,” said lead researcher Barbara Howard, senior scientist at the MedStar Research Institute in Hyattsville, Maryland, in an interview. “It’s likely they will, but it may be that you have to start patients at a young age and treat them for a long time.”

More Medicine

The researchers followed 499 American Indians with diabetes and no existing heart disease in Oklahoma, Arizona and South Dakota. Diabetics are particularly vulnerable to heart disease, which ultimately kills about 80 percent of them. In the study, there was no difference in rates of death, heart attack and other complications between the two groups.

Patients in the study’s intensive therapy arm got more medication, had higher costs and developed more side effects, mainly from blood pressure pills, the investigation found.

The study, funded by the National Heart, Lung and Blood Institute, appears in today’s edition of the Journal of the American Medical Association. Pfizer Inc. supplied Lipitor, while Merck provided the blood pressure drugs Cozaar and Hyzaar. The First Horizon Pharmacy donated Triglide for the trial.

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A relationship between low levels of cholesterol and Parkinson’s has been confirmed in a follow-up study. In 2006, University of North Carolina at Chapel Hill researchers published a study that found people with low levels of LDL cholesterol are more likely to have Parkinson’s disease than people with high LDL levels.

But that study could not answer the question of whether low LDL (low-density lipoprotein) levels were present in study participants before they were diagnosed with Parkinson’s, or if they developed low LDL levels after being diagnosed.

In the new study led by UNC researchers in collaboration with colleagues in Virginia, Hawaii and Japan low LDL levels were present in a group of men of Japanese ancestry long before these men were diagnosed with Parkinson’s.

“This finding gives us one more piece in the puzzle about the role of cholesterol in Parkinson’s disease,” said Dr. Xuemei Huang, the study’s principal investigator.

“What makes these results especially useful is the fact that most of the men in this study were not taking cholesterol-lowering drugs such as statins,” Huang said. “This suggests that the association between low LDL levels and Parkinson’s exists independently from statin use, which helps answer another important question raised by our earlier study.”

The new study was published online this week by the journal Movement Disorders.

Low levels of LDL cholesterol are clearly associated with good cardiovascular health. Huang’s research adds to a growing literature indicating that people with low LDL may be at greater risk for developing Parkinson’s.

“Our study again shows an association between low cholesterol and the risk of Parkinson’s disease, but we have not shown cause and effect,” Huang said. “People taking statins for valid medical reasons should not stop simply to avoid Parkinson’s.”

For this prospective study, fasting lipids were measured from 1991 to 1993 in a group of 3,233 men of Japanese ancestry who took part in a long-running study called the Honolulu-Asia Aging Study. These data were collected before statin therapy for lowering cholesterol was widely available. When followed for about ten years, the incidence of Parkinson’s disease increased with decreasing levels of LDL cholesterol.

After adjusting their statistical analysis for age, smoking, coffee intake and other factors, the researchers calculated that the relative odds of Parkinson’s for men with lower LDL levels (85 milligrams per deciliter) was about twice that of those with higher LDL levels (135 milligrams per deciliter). They concluded that this study supports the hypothesis that low LDL levels are associated with an increased future risk of Parkinson’s.

Huang said more research is needed to confirm these findings, with logical next steps including conducting studies with larger sample sizes and that include women and African-Americans.

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We know that cholesterol levels should be ideal to reduce the risk of heart attack and stroke.

Ideal Cholesterol Levels:

Total Cholesterol — less than 200
LDL Cholesterol — less than 100
HDL Cholesterol — greater than 60
Triglycerides — less than 150

But there’s more to it than just the numbers. How you get to goal is also important. Some drugs are better for your arteries than others. Of course diet and exercise are the first strategy to keep your arteries clear.

Statin drugs scored again as the best ones to control cholesterol levels. Also research was presented that showed that a “plain statin” specifically Zocor lowered cholesterol and reduced abnormally thickened arterial walls. The point of lowering cholesterol is to keep arteries open. Zetia , a drug that prevents absorption of cholesterol lowered cholesterol but did not reduce the arterial wall thickening. Zetia and Zocor make up the popular drug Vytorin.

So the message is the power is in the statin. They lower cholesterol and therefore help prevent heart attacks. Research was presented that showed that the stain Crestor has this benefit as does Zocor, Pravachol and Lipitor.

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We appreciate that your editorial included a critical aspect of the Enhance study that earlier news articles did not mention: that the study evaluated patients genetically predisposed to very high levels of cholesterol.

Most of the patients had been pretreated with lipid-lowering therapy, which potentially limited the amount that plaque buildup could have been reduced with further LDL cholesterol-lowering therapy. Investigators said this was one of the possible explanations of the results.

As to why it took as long as it did to complete the study, we want to point out that the Merck and Schering-Plough joint venture disclosed the primary results in a public news release just two weeks after the study data were first unblinded. The study itself took longer to complete than we had anticipated because of unexpected challenges in reading and analyzing the blinded data. We have made available on our Web sites a very detailed chronology of events related to this study.

While we are disappointed with the results, it is important to note that in this study and many others, these medicines did what the Food and Drug Administration has approved them to do: lower bad cholesterol. Vytorin and Zetia remain valuable treatment options.

We continue to study these medicines to add to the scientific knowledge about them and to determine whether they reduce cardiovascular disease, the country’s No. 1 killer.

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