Now that National Cholesterol Education Month has ended, I thought this would be a good time to highlight some of the recent accomplishments in cholesterol treatment during this past year. But it's only fair to also highlight some of our recent failures as well. Looking at both our successes and failures helps us to gain a perspective on where we are today so that as we plan for the future, we are more aware of some of the challenges that lie ahead.
1. Dietary changes which include avoiding saturated fat and cholesterol are effective in lowering cholesterol not only in adults but also young children up to the age of 14. Regular family counseling and education has proven to be an effective means of preventing and treating high cholesterol in children and does not adversely affect childhood development. This is just another example of how effective simple lifestyle choices can be in the prevention and treatment of high cholesterol.
2. A relationship between high cholesterol and LDL and an increased risk of stroke in women was made this year prompting further calls to more aggressively screen and treat abnormal cholesterol levels in women. This information provides more evidence for women to be treated as aggressively as men.
3. In December 2006, New York City became the first city to pass a law banning all trans fats from foods served in restaurants with Philadelphia following suit shortly thereafter. Montgomery County, MD, became the first county to ban partially hydrogenated vegetable oils (the main contributor to trans fat in our diet) from not only restaurants but also grocery store bakeries and delis. Over the past year, 18 bills to ban or limit trans fat consumption have been presented in state legislatures. It seems that our government is finally taking some ownership in the dietary battle against high cholesterol.
1. A novel cholesterol medication called torcetrapib, a CTEP inhibitor, was able to reduce LDL and markedly raise HDL but proved to be more harmful than helpful. Recent studies show that torcetrapib raises blood pressure and may increase levels of non-protective HDL thereby contributing to an overall increase of heart attack, stroke and death. Whether these negative effects apply to all man made CTEP inhibitors waits to be seen.
2. Women are less likely to have their cholesterol levels controlled to target goal. Women are being screened just as often as their male counterparts, but less than half of women who had a recent heart event were reaching their LDL goal of < 100mg/dl compared to more than half for men. Minority women faired even worse with only 1/3 of African-American women reaching their LDL goals. This is just more evidence to support that gender and racial disparities still exist in healthcare.
3. Garlic, touted for all its potential health benefits such as lowering cancer and warding off vampires, was found in a randomized scientific study to have no significant effect on cholesterol levels. This flies in the face of decades of smaller studies and animal research. However, one fact remains - that garlic still tastes good.
1. Obesity: If we just take a look around when we are shopping or eating at a restaurant, it becomes quite apparent that obesity is a prevalent problem in our country. In fact, it has reached epidemic proportions with ~40 million Americans considered obese and 58 million overweight. That means 8 out of 10 Americans are overweight. Obesity is directly related to bad cholesterol levels, heart disease, and early death. One major challenge that lies ahead is trying to change our lifestyles and eating habits to combat this disease. Medications that can control some of the complications of obesity such as high cholesterol and diabetes are not treating the root problem: we eat too many calories and burn too few calories. Obesity is a multifactorial disease that is both physical and mental, and it is going to take a multidisciplinary approach to control it.
2. Noncompliance: Studies have shown that 1 out of 4 patients stop taking a prescribed statin for high cholesterol within 6 months of starting it. Up to half of patients will stop their medication within 2 years. 1 out of 3 patients stop because of lack of efficacy, 1 out of 3 stop because they aren't convinced about the need for continued treatment, and only 1 out 14 stop because of side effect of the medicine. Although we have volumes of scientific data to show what we need to do to control high cholesterol, translating this data into real life results is a huge challenge. The responsibility of noncompliance belongs to both patients and physicians.
3. Education: I know that this whole month was spent on cholesterol education, but there still remains so much more to be done. Educating ourselves about the risk of high cholesterol, gender and racial differences, appropriate evaluation, and treatment is such a fundamental part of combating high cholesterol or any other disease. The key is for us to have the desire to learn, the resources available to educate ourselves, and an adequate understanding of the information so that we can make good decisions. National Cholesterol Education Month and the Cholesterol Connection are just two such available resources.
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Published On: October 01, 2007