Good cholesterol may not be so good for heart disease

Amit V. Khera, M.D., Marina Cuchel, M.D., Ph.D., Margarita de la Llera-Moya, Ph.D., Amrith Rodrigues, M.S., Megan F. Burke, B.A., Kashif Jafri, B.A., Benjamin C. French, Ph.D., Julie A. Phillips, Ph.D., Megan L. Mucksavage, M.Sc., Robert L. Wilensky, M.D., Emile R. Mohler, M.D., George H. Rothblat, Ph.D., and Daniel J. Rader, M.D. conducted the research.
 
To do this they measured cholesterol efflux capacity in 203 healthy volunteers who underwent assessment of carotid artery intima–media thickness, 442 patients with angiographically confirmed coronary artery disease, and 351 patients without angiographically confirmed disease. 
 
They quantified efflux capacity by using a validated ex vivo system that involved incubation of macrophages with apolipoprotein B–depleted serum from the study participants.
 

The levels of HDL cholesterol and apolipoprotein A-I were significant determinants of cholesterol efflux capacity but accounted for less than 40 percent of the observed variation. 
 
An inverse relationship was noted between efflux capacity and carotid intima–media thickness both before and after adjustment for the HDL cholesterol level. Efflux capacity was a strong inverse predictor of coronary disease status.
 
Additional studies showed enhanced efflux capacity in patients with the metabolic syndrome and low HDL cholesterol levels who were treated with pioglitazone, but not in patients with hypercholesterolemia who were treated with statins.
 

The study was funded by the National Heart, Lung, and Blood Institute among others.
 
The American Heart Association says it's important for all people to know their cholesterol level.  Cholesterol is measured in milligrams per deciliter of blood (mg/dL).  The AHA endorses the National Cholesterol Education Program (NCEP) guidelines for detection of high cholesterol.  It recommends that everyone over 20 have a fasting "lipoprotein profile" every five  years.
 
Total cholesterol should be less than 200 mg/dl. HDL cholesterol should be less than 40mg/dl. LDL Cholesterol levels should be ideally less than 100mg/dl.
 
The American Heart Association says to keep cholesterol levels in the proper range Americans should reduce the amount of saturated fat, trans fat, cholesterol and total fat in their diet.  Control high blood pressure, avoid tobacco smoke,  get regular physical activity, maintain a healthy weight, control diabetes, and eat a healthy diet.
 
Cranberry juice has been shown to increase HDL levels. Fish and other foods containing omega-3 fatty acids can also increase HDL levels. In postmenopausal women (but not, apparently, in men or pre-menopausal women) calcium supplementation can increase HDL levels, according to About.com. 
 
If you'd like to monitor your own cholesterol at home, The Wall Street Journal reports the Food and Drug Administration, which has approved some home-use cholesterol tests, says on its website that they should be as accurate as those available at a doctor's office, if users follow the directions. The agency offers some information on how to interpret test results atfda.gov (find "in vitro diagnostics" in the alphabetical search, and on that page click "home use tests"). 
 
Also making news, Health News Daily reported on another study in which teens whose diets include lots of sugary drinks and foods show physical signs they are at increased risk for heart disease as adults.   Researchers from Emory University looked at 2,157 teens who took part in the National Health and Nutrition Examination Survey.  The average amount of added sugar eaten in a day was 119 grams (476 calories), which was 21.4 percent of all the calories these teens consumed daily, the researchers noted. This report is published in the Jan. 10 online edition of Circulation.