Protecting Your Heart


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Protecting Your Heart








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The reason to lower cholesterol is primarily to provide protection from heart disease; some other things that can be done to protect from coronary heart disease include:

  1. Get regular cardiovascular exercise. This will protect your heart at any level of cholesterol - and may incidentally also help to raise your HDL cholesterol. (The point is not primarily the effect on cholesterol; but the effect on heart disease risk, which is the reason for caring about cholesterol.) Exercise protects against many things -- such as heart disease, diabetes, hypertension, cancer, stroke, peripheral arterial disease, osteoporosis, sleep disturbance, and depression. For this reason, if cholesterol lowering drugs are limiting your ability to get exercise, the potential impact on health and longevity should not be underestimated and must be considered in determining the risk-benefit balance. (The impact on well-being and quality of life, including ability to engage in activities of daily living, family life, social life, and work life are also not to be dismissed.)

  2. Eat lots of fresh fruits and vegetables. A number of quite different "phytonutrients" (substances in fruits and vegetables) have heart protective effects. Studies on fruits ranging from grapes to pomegranates to orange juice have shown benefits to the heart--and in the case of orange juice, benefits to HDL-cholesterol values (with sufficient consumption). A study from Duke University found much higher rates of nutrients in organic than commercially grown ones, so it may be prudent to include organic in your repertoire.

  3. Consider eating two fatty fish meals a week. This will have little affect on your cholesterol, but will likely reduce your risk of death from heart attack. One study (the Diet and Reinfarction Trial or DART) showed that in men with heart disease, advice to eat two fatty fish meals a week resulted in a 30% reduction in overall mortality in 2-years -- as big an effect as has been shown with use of statin drugs in men with heart disease (in the 4S study, which showed the biggest effect on cardiac deaths of the major statin studies). In contrast, a low-fat cholesterol-lowering diet in the DART study had no impact on survival. These data from this "randomized controlled trial" parallel data from the Framingham study, which showed a 30% reduction in coronary deaths in those who ate two fish meals a week.

  4. Completely avoid "trans hydrogenated fats."  This is anything with the words "margarine" or "shortening" in the ingredient list; and anything with the word "hydrogenated". Do not be fooled by phrasing such as "All vegetable shortening;" this may sound healthful, but evidence suggests it is more harmful than butter or lard. Trans fats raise harmful LDL, lower levels of protective HDL, and have the worst effect on the cholesterol-to-HDL ratio of any fats. They may also interfere with essential fatty acid utilization. In one study comparing several hundred men and women who had recently had a heart attack to control subjects, 2.5 pats of margarine or more a day was linked to a several-fold excess risk of heart attack, while butter consumption bore no relationship. In a very large study that followed nurses across time, being in the top 25% of margarine consumption in the population was associated with about a 50% increase in heart attack risk. Examine labels of packaged/ purchased baked goods carefully, since most will contain hydrogenated fats and you will need to identify brands with "healthy" fats or no fats.

  5. Other dietary suggestions: eat fresh nuts (evidence indicates cholesterol benefits, heart-protective effects and also benefit to “insulin resistance”); emphasize olive oil in cooking (monounsaturated fats raise HDL cholesterol and may lower LDL cholesterol, improving the cholesterol ratio); and consume garlic and perhaps onions in your diet, which may reduce cholesterol to some degree.  Chocolate (the kind made with cocoa butter, not trans-hydrogenated fats) contains primarily “stearic acid,” a fatty acid that raises HDL without raising LDL, so this need not necessarily be avoided from a cholesterol standpoint. Studies have also reported benefits of moderate chocolate consumption to heart disease.  By now you are probably familiar with the pros and cons of alcohol. If you do drink, the pattern that is most associated with benefit is small amounts of meal associated alcohol. Large amounts consumed in a non-meal associated pattern may be harmful to the heart, and increase “insulin resistance” (a diabetes-predisposing condition).



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Please email The UCSD Statin Study for any questions regarding this website. Last updated 05/08/07.