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Update on Cholesterol

Scientists have known for many years that there are two types of cholesterol: a "good" type (HDL-C) that actually protects the heart, and a "bad" type (LDL-C) that clogs the arteries around the heart. High cholesterol usually refers to high LDL-C levels, which means a greater risk of heart and blood vessel disease.

Healthy eating habits can help lower LDL-C. A heart-smart diet includes less animal fat and more soluble fibre: lots of fruits, vegetables and complex carbohydrates (whole grains and pasta). Total fat intake should be no more than 30 per cent of daily calories, and saturated fat no more than 10 per cent. And exercise is part of a healthy lifestyle because it can increase your good cholesterol levels.

Medications commonly used to lower cholesterol include resins that bind up cholesterol building blocks (e.g., Questran, Colestid); the vitamin niacin and its derivatives (used at very different doses than the amount found in standard multivitamins); fibrates (e.g., Lopid, Bezalip, Lipidil); and HMG CoA reductase inhibitors (e.g., Mevacor, Pravachol, Zocor, Lescol). When deciding whether drug therapy is appropriate, physicians often consult guidelines published by American and Canadian expert groups.

However, several recently published studies may have the experts taking another look at cholesterol-lowering agents. These five-year studies , the 4S (Scandinavian Simvastin Survival Study) and the CARE (Cholesterol and Recurring Events Study), have drawn considerable media attention because of their dramatic lowering of cholesterol levels in patients taking medication.

The 4S study evaluated men and women with a history of heart disease and high blood cholesterol levels. The results showed that patients treated with simvastatin (Zocor) reduced their risk of dying from coronary heart disease by 42 per cent. Treatment also reduced the risk of needing invasive procedures to unclog arteries. First published in 1994, this study drew recent attention because new analyses for the data showed that women benefit as much if not more than men form taking simvastatin.

The CARE study looked at men and women with a previous heart attack and average cholesterol levels. The study found that patients who took pravastatin (Pravachol) to further reduce their cholesterol had a significantly lower risk of having another heart attack, of needing heart surgery, or of dying from heart disease compared to patients who took nothing to reduce cholesterol. Patients taking pravastatin also reduced their risk of stroke.

Although certain HMG CoA reductase inhibitors appear to be beneficial, especially in patients with heart disease, they do have some side effects and are relatively expensive. Ask your physicaian and/or your pharmacist if you might benefit form taking cholesterol-lowering drugs in addition to eating a healthy diet and increasing your exercise.