Doctors advised to treat elderly carefully with cholesterol-lowering drugs (statins).

Dubai, United Arab Emirates. (Dr. Noorali Bharwani)
Dubai, United Arab Emirates. (Dr. Noorali Bharwani)

The College of Physicians and Surgeons of Alberta in their newsletter, The Messenger (Jan 11 2017) advised doctors to use statins carefully in the elderly.

If your blood cholesterol level is high then you should ask your doctor if treatment with statins is right for you.

High cholesterol level is a risk factor for heart disease. Statins are drugs that can lower cholesterol level in your blood. If your blood cholesterol level is high then plaques build up on the blood vessel walls. This causes partial or complete blockage of the blood vessels and reduces or blocks blood circulation. Why would you want that to happen?

Statin drugs are commonly used to reduce blood cholesterol level. Examples of statins include – atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

Statin is effective in lowering the cholesterol level. It may have other health benefits but we do not know everything about it. What is the effect of statin in the elderly is not very well known either. There is a variable quantity of data related to statin use in the elderly, according to the Canadian Cardiovascular Society Guidelines (2016).

The 2016 guidelines continue to recommend treatment for individuals at high risk for cardio-vascular events. This is with the caveat that for adults older than age 75 who are otherwise robust, a discussion should take place regarding the risks and benefits in the context of their individual situation. As I said earlier we do not have much information on the side effects of statin in individuals over the age of 75.

What are the side effects of statin use?

The most common adverse events (1.3 per cent) identified include musculoskeletal events (aches and pains in the muscles) and elevation in liver enzymes. Although not statistically significant, there may be new-onset diabetes and cataract formation. Doctors should monitor their patients for cognitive impairment as well, as it may be associated with statin use.

If you have been on statin prior to age 65, then you can continue to take it after that age if you have had no side effects. Make sure you discuss this with your doctor. You should try to keep total cholesterol level below 6.22 mmol/L. LDL or “bad” cholesterol should be below 3.37 mmol/L.

Taking a statin is one thing but you have to remember lifestyle changes are essential for reducing your risk of heart disease, whether you take a statin or not.

To reduce your risk: 1. Quit smoking and avoid second hand smoke. 2. Eat a healthy diet that’s low in saturated fat, trans fat, refined carbohydrates and salt, and rich in fruits, vegetables, fish, and whole grains. 3. Be physically active, sit less and exercise regularly. 4. Maintain a healthy waist girth: less than 40 inches in men and less than 35 inches in women.

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Scientific Evidence and the Role of Dietary Fats and Carbohydrates in Heart Disease

Dear Dr. B: In your Feb 1, 2011 article, you say that data indicate dietary cholesterol has little effect on blood serum cholesterol levels. I wonder if you could send me references for this. I’m having a debate with a friend and mentioned this, but he doesn’t believe it.

Answer: Finding a reference is not difficult these days. You just have to Google your question and you will find thousands of references. The difficult part is to know which reference is reliable. When I do my research, I generally look at several articles and find reliable scientific information from different sources.

You can find an excellent article on this subject in the American Journal of Clinical Nutrition (April 2011 vol. 93 no. 4 684-688) titled: The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?

The old hypothesis was that dietary fat raises blood cholesterol which eventually leads to atherosclerosis (hardening of the arteries) and coronary artery disease. This hypothesis was based on research done before we knew anything about the dangers of trans fats.

Now the research has confirmed that heart disease risk rises if there is a high concentration of bad cholesterol (LDL) in our blood and the risk is reduced if there is a high concentration of good cholesterol (HDL) in our blood. But what is poorly understood is the link between dietary fat and high blood cholesterol level.

What do we know about the role of dietary fats and carbohydrates?

-Eating saturated fats – SFs – (found in beef, pork, lamb, dairy products and tropical oils such as palm oil, palm kernel oil, and coconut oil) raises bad cholesterol (LDL) but also raises good cholesterol (HDL). One negative effect, one positive effect.

-Eating unsaturated fats – UFs – (MUFAs – monounsaturated fats – found in plant oils such as olive, canola, and peanut oil; PUFAs – polyunsaturated fats – found in plant oils such as safflower, sunflower, corn or soybean oil, fish with omega-3 fat) lowers the bad cholesterol (LDL) and lowers the good cholesterol (HDL). One positive effect, one negative effect.

-Eating industrially produced trans fats – TFs – (vegetables oils that have been chemically changed by a process called hydrogenation to make them solid at room temperature found in margarine, many fast foods, snack foods and fried or baked goods) is highly dangerous because it does two bad things – raises bad cholesterol (LDL) and lowers good cholesterol (HDL).

-Replacing saturated fats with carbohydrates (CHO) may actually increase cardiovascular risk unless carbohydrates come from whole-grain fibre-rich sources. Studies have shown that carbohydrates with high glycemic index –GI – (a measure of the effects of foods on blood-sugar levels) increase cardiovascular risk by 33 per cent.

Do you find all this confusing? You are not alone.

Next time you go to a grocery store, tell the helper (if you can find one) to give you some SFAs, PUFAs, MUFAs, no TFs, no LDL, lots of HDL, healthy CHOs and some low GI food. See what you get and surprise your family. Happy eating.

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Heart Disease and Your Enemy #3

Yesterday was Valentine’s Day. It must have been an evening of love and chocolates for you. That is good. Love and happiness are good for your heart. As they say, “Make love, not funeral plans.” And there is science behind that. It keeps your life active. People who have more sex live longer than those you don’t. Married people and people in healthy relationships live longer than lonely people.

Chocolates are good for your heart. But they are high in calories so if you are going to eat chocolates then you have to make adjustments to your calorie intake for that day. Evidence based recipe for a perfect meal (called polymeal) include wine, fish, dark chocolate, fruits, vegetables, garlic and almonds. Dark chocolates daily (100 grams) reduce blood pressure and cardiovascular diseases by 21 per cent.

Let us go back to our enemy No. 3 – inactivity.

Being a couch potato is hazardous to your health. Being active is good for your health. That is obvious, right? Am I insulting your intelligence by writing such simple and obvious facts?

We have couch potatoes in all age groups. They watch too much TV or spend too much time on the Internet. While they do that they eat junk food. Inactivity plus junk food equals bad news for your heart as you get older. Regular physical activity makes your heart strong.

In sedentary people or couch potatoes, the risk of heart attack was seven times higher in a German study and more than 100 times greater in a U.S. study during vigorous exertion than during lighter activity or no activity. If you compare this to among people who exercised regularly, there was almost no increased risk. Another beneficial effect of regular exercise is that it increases the blood level of HDL (good cholesterol). HDL is another line of defense against heart attack.

The type and amount of exercise required to be fit and healthy depends on your age, your health and your current state of physical fitness. There are three types of exercises: aerobic, weight lifting (resistance training) and stretching. A good exercise program should benefit all three aspects of fitness: stamina, flexibility and strength.

A study found that 150 minutes a week (two and a half hours) of a moderate exercise such as walking and 75 minutes per week (an hour and 15 minutes) of activity like easy jogging provides good health benefits.

It has been estimated that people who are physically active for approximately seven hours a week have a 40 percent lower risk of dying early than those who are active for less than 30 minutes a week.

Be active, do whatever you can and have fun. If it is not fun then don’t do it. Find a partner, join a group, get a dog and just go for a walk. You can celebrate Valentine’s Day every day. Who cares, as long as you are having fun…right?

Ok, get moving now.

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Heart Disease and Your Enemy’s Best Friend – Triglycerides

In the last column, we discussed about the harmful effects of bad cholesterol (LDL) on your cardiovascular system. I call LDL enemy number one. Today, we move on to our enemy number two – triglycerides.

Triglyceride is another type of lipoprotein which carries harmful fat-carrying particles. That means it is a bad one. It is the main constituent of vegetable oil and animal fats. It is a major component of chylomicrons and very-low-density lipoprotein (VLDL).

Chylomicron is one of the microscopic particles of fat occurring in a ‘milky’ fluid composed of fat and lymph formed in the intestine during digestion. Next, VLDL is produced in the liver and later becomes the bad LDL.

Triglycerides are the most common form of fat in the body. In fact, almost all the excess calories you consume, whether from fats or carbohydrates, are converted to triglycerides and stored in your fat cells. Once at capacity these cells divide. If you ‘lose weight’ these cells decrease in fat content but never in number. This makes it easier to get fat again.

High levels of triglycerides in the bloodstream have been linked to atherosclerosis (hardening of the arteries), and the risk of heart disease and stroke. High triglyceride levels can
cause pancreatitis, a painful and potentially dangerous inflammation of the pancreas.

What causes elevated triglycerides?

Elevated triglyceride levels can be related to your diet (high in bad fats, carbohydrates and alcohol) and your genetic makeup. In addition, high triglyceride levels can be produced by several medical conditions including: obesity, diabetes, metabolic syndrome and hypothyroidism (low thyroid).

How can we manage high triglyceride levels and reduce the risk of CAD, stroke and death?

It starts with lifestyle modification. Your diet has to change. The key is to replace bad fats with good fats in your diet.

Bad fats are: saturated fats (found in meat and dairy products, some plant foods such as coconut oil, palm oil and palm kernel oil) and trans fats (found in commercially packaged foods and fried foods).

Good fats are: monounsaturated fats (found in nuts, almonds, pistachios, avocado, canola and olive oil) and polyunsaturated fats (found in seafood, fish oil, omega-3, corn, soy, safflower and sunflower oils). Monounsaturated fats have also been found to help in weight loss, particularly in reducing body fat.

Eat plenty of fruits and vegetables. Avoid alcohol, lose weight, exercise, do not smoke, and control your blood sugar and blood pressure. Wow, sounds easy! Well, sort of. There is plenty of help around to achieve your goals. You and your doctor should work together. But you have to have the motivation to start the ball rolling.

This plan will help reduce LDL bad cholesterol, the bad triglycerides (friend of enemy number one) and increase HDL good cholesterol. Next week, look for more fodder for your healthy heart besides love and chocolates on Valentine’s Day. Who is your enemy number three?

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