The cholesterol conundrum pg. 2
“What starts with good intentions as a clean-up effort, ends up creating more of a mess,” Fazio explains. Atherosclerotic plaques are simply “big conglomerates of cells enriched with cholesterol.”
Diet and exercise can be very effective in lowering LDL levels, and can significantly reduce the risk of heart disease.
“We know what a healthy diet and lifestyle are,” says Linton, who has collaborated with Fazio since the early 1990s. “If you could wave a magic wand to get everyone in the country to live that way, you could eliminate—or at least dramatically reduce—the incidence of coronary disease and diabetes.
“The real problem,” he adds, “is it is hard to change people’s lifestyles.”
As a result, many patients and their doctors have turned to statins, a class of LDL-lowering drugs that have been shown to reduce the risk of heart attack and stroke by 30 percent to 40 percent.
Statins, however, are not without side effects, and many patients on the drugs still suffer adverse cardiovascular events—heart attack, stroke, and sudden cardiac death.
An attempt to “ramp up” this process, however, was halted last year when it appeared that an HDL-raising drug, torcetrapib, increased rather than decreased the incidence of heart-related deaths in a clinical trial.
The drug significantly increased HDL levels by blocking an enzyme that normally transfers cholesterol from HDL to LDL, but it failed to slow the progression of atherosclerosis as expected.
Fortunately, there are other ways to raise HDL levels.
One possibility is niacin, a vitamin supplement available at most health food stores. But niacin supplementation can cause facial flushing. An extended release from of niacin has gained widespread clinical use. Clinical trials are now investigating a novel “flush-free” form of the vitamin.