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Health News Archive 33 - Atherosclerosis and Cholesterol
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Magnesium may Reduce Cholesterol Better than Statins

A review published in the October 2004 issue of the Journal of the American College of Nutrition has found that the beneficial effects of magnesium could outweigh those of statin drugs. Statins are a class of drugs commonly prescribed for individuals with elevated cholesterol levels, a risk factor for cardiovascular disease. Because the drugs have side effects, some people are seeking alternative ways to improve their cardiovascular disease risk.

Andrea Rosanoff, PhD, and Mildred S Seelig, MD of State University of New York Downstate Medical Center in Brooklyn discuss the fact that statin drugs as well as magnesium inactivate the enzyme 5-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). HMG CoA reductase converts HMG-CoA into a substance called mevalonate, which is the first step in cholesterol formation. Reducing mevalonate improves endothelial function, reduces inflammation, and provides other cardiovascular benefits. Magnesium, however, is also involved in the activity of another enzyme known as lecithin cholesterol acyl transferase (LCAT), which helps elevate high density lipoprotein (HDL) cholesterol levels and reduces low density lipoprotein (LDL) cholesterol and triglycerides. In addition, another enzyme known as desaturase, which helps convert linoleic acid and linolenic acid into prostaglandins, is dependent upon magnesium. Furthermore, optimal levels of magnesium within the cell are a natural calcium channel blocker, which helps dilate the blood vessels.

Drs Rosanoff and Seelig note that while statin drugs help to prevent blood clots, lower inflammation and protect against atherosclerosis, they can elevate liver enzymes and cause myopathy as well as other side effects, whereas diarrhea or mild gastrointestinal distress are the only side effects that have been caused by magnesium supplements. Statins cost at least $100.00 per month compared to no more than $20.00 for a month’s supply of magnesium. These factors combined suggest that increasing magnesium could be a viable alternative to taking statin drugs.

Note: be sure to take magnesium with calcium, as magnesium can displace calcium when taken alone. 

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Policosanol Lowers "Bad" Cholesterol in Obese Patients

Policosanol, a natural substance purified from sugar cane wax, lowers levels of LDL (the "bad" cholesterol) and raises levels of HDL (the "good" cholesterol) in obese patients who have high cholesterol levels, according to a recent study.

In the randomized, double-blind, placebo-controlled study, researchers put 129 patients with body mass index of at least 30 on a cholesterol-lowering diet for five weeks. They then randomly divided the subjects into a group that received 5 mg of policosanol or a placebo once per day with the evening meal for three years. Thirty patients (18 placebo, 12 policosanol) discontinued the study.

After one year on treatment, policosanol significantly lowered serum LDL cholesterol by 24.3 % and total cholesterol by 15.8 %. It also increased levels of the "good" cholesterol, HDL, by 21.9 %. The changes that occurred in patients taking the placebo, on the other hand, were insignificant. At study completion, policosanol had lowered LDL cholesterol by 31.8 % and total cholesterol by 20.1 %, while raising HDL cholesterol by 24.6 %. Policosanol was safe and well tolerated.

In a similar study by the same researchers, policosanol was equally effective at lowering LDL and raising HDL as well as lowering triglyceride levels in type-2 diabetic subjects.

References:

Asia Pac J Clin Nutr. 2004;13(Suppl):S102. Long-term effects of policosanol on obese patients with Type II Hypercholesterolemia. Mas R, Castano G, Fernandez J, Gamez R, Illnait J, Fernandez L, Lopez E, Mesa M, Alvarez E, Mendoza S.

Asia Pac J Clin Nutr. 2004;13(Suppl):S101. Long- term effects of policosanol on older patients with Type 2 diabetes. Mas R, Castano G, Fernandez J, Gamez RR, Illnait J, Fernandez L, Lopez E, Mesa M, Alvarez E, Mendoza S.

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Fiber May Combat Atherosclerosis

Fiber has the ability to help combat atherosclerosis, reported researchers on the Los Angeles Atherosclerosis Study, a prospective study which is investigating factors involved in atherosclerosis progression. The study was published in the December 2003 issue of the American Journal of Clinical Nutrition.

In the Los Angeles Atherosclerosis Study, five hundred men and women between the ages of 40 and 60 with no history of cardiovascular events, received baseline examinations and were followed for three years. Dietary information was obtained through interviews at the beginning of the study and at the first follow up at eighteen months. Intima -media thickness of the common carotid arteries (a measure of atherosclerosis) was determined by ultrasound examination at the study's onset, at eighteen months and at three years. Blood samples taken at all three examinations provided data on serum lipids.

The median total fiber intake in the highest fifth of the study population was found to be twice that of the lowest fifth. Intima -media thickness progression declined with an increase in fiber intake. The trend was significant for soluble fiber found particularly in fruit and vegetables, and pectin. Adjusting for the intake of fruit and vegetables, which have other antiatherogenic constituents, did not alter the findings.

IncѲeased high density lipoprotein levels were correlated with an increase in total fiber, soluble fiber and pectin. Additionally, the ratio of total to HDL cholesterol was inversely related to total fiber, soluble fiber and pectin intake. These findings support the hypothesis that fiber retards the progression of cardiovascular disease through its effect on lipids.

The authors conclude that “The present study suggests that increased dietary fiber intake has significant cardiovascular benefit and that the regulation of serum lipids by dietary fiber may be partially involved in the process of slowing the progression of atherosclerosis.” 

Source: Wu H et al, “Dietary fiber and progression of atherosclerosis: the Los Angeles Atherosclerosis Study,” Am J Clin Nutr 2003; 78:1085-91.

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Lutein and Other Carotenoids Protect Against Atherosclerosis

Other published research from the Los Angeles Atherosclerosis Study indicates that lutein, zeaxanthin, alpha-carotene and beta-cryptoxanthin, four nutrients known as carotenoids, protect against the development of atherosclerosis.

In order to determine the progression of atherosclerosis, researchers measured the arterial thickness in 573 middle-aged women and men who were free of symptomatic cardiovascular disease at the study's start. The researchers performed an ultrasound examination of the common carotid arteries, determined the subjects' lipid levels, and assessed their risk factors at baseline and during an 18-month follow-up. The researchers also noted the plasma levels of antioxidants at the beginning of the study.

After 18 months, the thickening of the arteries was significantly related to the carotenoid levels. The higher the levels of lutein, beta-cryptoxanthin, alpha-carotene and zeaxanthin, the lower the rate of arterial thickening. Subjects with the lowest levels of the four carotenoids, on the other hand, had a higher rate of arterial thickening.

The researchers concluded that higher levels of these carotenoids may protect against atherosclerosis.

Source: Dwyer JH, Paul-Labrador MJ, Fan J, Shircore AM, Merz CN, Dwyer KM. Progression of Carotid Intima-Media Thickness and Plasma Antioxidants: The Los Angeles Atherosclerosis Study. Arterioscler Thromb Vasc Biol. 2003 Dec 1.

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Aged Garlic Extract (AGE) Combats Atherosclerosis in-vitro and in-vivo

Research conducted at Pennsylvania State University has found a mechanism of action for garlic's ability to lower lipids. Scientists tested aged garlic extract (AGE) and some of the sulfur containing compounds found in garlic (S-allyl cysteine, S-ethyl cysteine, S-propyl cysteine, and gamma-glutamyl S-alkyl cysteines) on a human liver cell line. They found that aged garlic and particularly aged garlic with the addition of S-allyl cysteine lowered cholesterol formation by reducing the production of the liver enzyme HMG-CoA, which is necessary for cholesterol synthesis. Since this is the same mechanism of action as statin drugs, aged garlic extract may be a promising therapy for cholesterol reduction without the side effects of statins.

Dr Yu-Yan Yeh, who is a professor of Nutritional Biochemistry of Penn State's Department of Nutritional Sciences, commented, “AGE can help people who are working to reduce their cholesterol levels in conjunction with drug treatments. Aged garlic extract can be useful for the general public to help achieve the desired cholesterol level of 200 or less.”

In a separate study currently under review for publication, researchers at UCLA conducted a double-blind randomized trial on 19 patients who consumed aged garlic extract or a placebo for one year. Participants underwent electron beam tomography to determine their atherosclerotic plaque burden at the study's onset and at twelve months. While the placebo group experienced an average progression in plaque of 22.2 percent, progression in the garlic supplemented group was 7.5 percent. Blood testing revealed an improvement in high density lipoprotein (HDL) and homocysteine status in the supplemented group. The researchers recommend larger studies to asses the impact of aged garlic on atherosclerosis and the prevention of coronary events.

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Tea Extract Lowers Cholesterol

A report published in the June 2003 issue of Archives of Internal Medicine provided the results of the first human study of its kind to reveal a cholesterol-lowering benefit for tea extracts.

Under the direction of Associate Professor of Medicine at Vanderbilt University Medical Center, Dr. David J. Maron, researchers in China enrolled 240 men and women with high cholesterol.  The participants were started on a low-fat diet.  Then participants were randomly provided with a placebo or a 375-milligram capsule containing 75 milligrams theaflavins from black tea, 150 milligrams catechins from green tea and 150 milligrams of tea polyphenols -- the equivalent of thirty-five cups black tea and seven cups green tea. The participants received the capsules for twelve weeks, during which time participants continued to consume the low-fat diets they had adopted prior to the study.

Subjects who received the tea extract capsule were found to have lower cholesterol than the placebo group at the end of twelve weeks. Previous studies involving tea-drinking and consumption of green tea extract had not found a cholesterol-lowering effect associated with tea.

Lead author Dr. Maron, stated, "Personally, I was very surprised. I expected, if anything, a very slight cholesterol-lowering effect. But what we saw was a 16-percent reduction in low density lipoprotein (LDL) cholesterol." He added, "The present study represents the first step in establishing the practicality, safety and LDL-lowering ability of this tea product. Although the results are exciting, we do not want people to take the extract in place of their medications. Unlike statins, this product has not been proven to prevent heart attacks or stroke, or to prolong life. The study shows that the tea extract is a useful adjunct to lowering LDL in people with high cholesterol already on a low-fat diet."

Dr Marron recommends further trials of the extract in combination with lipid-lowering medication, particularly statin drugs.

Source: Archives of Internal Medicine, June 23, 2003

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