Cholesterol/Cardiovascular System
The risk of heart disease is related to the level of blood lipids in your body in addition to several other indicators. These markers are related to blood clotting and inflammation. A traditional cholesterol test usually checks for the levels of triglycerides, HDL, LDL and total cholesterol. LDL levels can be somewhat misleading as the amount of VLDL is more important. Even though the LDL level can be 100 if 80% of that is constituted of VLDL the risk for cardiovasuclar disease remains elevated.
Interpretive Notes for Profile Elements
ATP III Guidelines for LDL, Total Cholesterol, HDL Cholesterol, and Triglycerides (in mg/dL)*
LDL Cholesterol Triglycerides
<100 Optimal <150 Normal
100 - 129 Near optimal/above optimal 150 - 199 Borderline high
130 - 159 Borderline high 200 - 499 High
160 - 189 High >500 Very high
>190 Very high
Total Cholesterol HDL Cholesterol
<200 Desirable <40 Low
200 - 239 Borderline high >60 High (Desirable)
>240 High
*National Cholesterol Education Program, ATP III Guidelines, May, 2001
Total cholesterol = HDL + LDL + (triglycerides/5)
Cholesterol
Cholesterol is a sterol that is essential for the proper functioning of the body. It is a component of cell membranes and is necessary for the production of steroid hormones. It also plays a significant role in the occurrence of atherosclerosis (thickening or hardening of arteries). There are several types of cholesterol including HDL, LDL and VLDL.
HDL
High density lipoprotein is often referred to as "good choelsterol". It acts as a scavenger transporting cholesterol from peripheral tissue to the liver. This prevents excess accumulation and deposition of cholesterol in blood vessels. Persons with high levels of HDL were less likely to develop atherosclerosis, and subsequent cardiovascular disease.
LDL
Low density lipoprotein is often referred to as "bad cholesterol". Oxidized LDL forms foam cells which are associated with the formation of atherosclerotic plaques.
VLDL
Very low-density lipoproteins produced by the liver contain triglyceride rich lipoproteins. Also an indicator of one's risk of atherosclerosis or clogged arteries.
Triglycerides
A family of complex lipids and make up 95% of all tissue-stored fat within the body. They are carried throughout the body by very-low-density lipoprotein (VLDL) molecules. Elevated triglycerides can contribute to coronary artery disease. Serum triglyceride levels can vary dramatically after meals, with high carbohydrate meals causing high triglyceride levels.
OTHER CARDIOVASCULAR RISK FACTORS
These "other" proatherogenic factors have been identified to contribute to the development of atherosclerosis. A more extensive lipid profile test should be conducted measuring the levels of these factors.
Apolipoprotein A-1 (ApoA1) is the major protein constituent of HDL (the "good" cholesterol). This molecule is responsible for the activation of two enzymes that are necessary for the formation of HDL, and this process may be a key factor in the relationship between HDL levels and the incidence of atherosclerosis.
Apolipoprotein B (ApoB) is the primary protein found in LDL (the "bad" cholesterol). Studies suggest that ApoB plays a major role in targeting the selective uptake of LDL by the liver, and has been identified as one component of the syndrome known as atherogenic lipoprotein phenotype which is a common disorder in persons at risk for atherosclerosis.
C-Reactive Protein(CRP) is a non-specific indicator of systemic inflammation and infection. Its level rises rapidly in response to tissue injury and inflammation, and is a risk factor for cardiovascular disease.
Fibrinogen is an important coagulation protein that is involved in the mesh-like network of the common blood clot. Studies have shown that elevated fibrinogen status is associated with subclinical cardiovascular disease. Small amounts of fibrinogen are needed in times of injury, but high levels of fibrinogen are a risk factor for heart disease. High levels can also increase the risk of re-occlusion of the arteries after a treatment such as angioplasty or the placement of a stent in the vascular system.
Homocysteine is a sulfur-containing amino acid and when it becomes elevated, it can damage coronary arteries, cell structures, blood lipids and artery walls eventually leading to the development of atherosclerosis and other forms of heart disease. Vitamins B6, B12 and folate, involved in homocysteine metabolism, act to regulate and reduce homocysteine. It is also thought that high levels may promote the formation of blood clots.
Lipoprotein(a) is a complex of ApoA and LDL, and an elevated status is associated with an increased risk for atherosclerosis and cardiovascular disease. The pathogenic role of lipoprotein(a) is similar to that of LDL in the development of atherosclerosis; it is localized in the blood vessel walls, then oxidized. Once oxidized, it forms the foam cells associated with atherosclerotic plaques. Lp (a) may inhibit the body's ability to destroy or dissolve blood clots.
In summary one wants to avoid a situation where the following levels are elevated or depressed.
Elevated
· c-reactive protein
· apolipoprotein B
· fibrinogen
· homocysteine
· LDL cholesterol
· lipoprotein(a)
· triglycerides
· VLDL cholesterol
Depressed
· apolipoprotein A-1
· apolipoprotein B
· HDL cholesterol
Supplementation to improve lipid profiles
There are a number of OTC supps that collectively and some even singularly are just as effective as prescription drugs. These supps affect lipid profiles in various manners allowing one to select a combination that suits their personal needs.
Beta sitosterol
Beta-sitosterol is a plant sterol(phytosterol) similar in structure to cholesterol, found naturally in fruits, vegetables, beans (especially soy), nuts, and seeds. Beta-sitosterol actually inhibits intestinal absorption of dietary cholesterol by competing for the limited space for cholesterol during intestinal uptake. It also affects an enzyme that results in the reduction of cholesterol rich lipoprotein, LDL. This results in lower total cholesterol and LDL levels, though there doesn't seem to be any effect on HDL. It is also used to improve symptoms related to benign prostatic hyperplasia (BPH). Beta-sitosterol should be consumed 30 minutes prior to meals. (1)
Fish Oil-
Niacin/inositol hexaniacinate
Niacin has been shown to lower LDL cholesterol, Lp(a) lipoprotein, triglyceride, and fibrinogen levels while simultaneously raising HDL cholesterol levels.
Niacin has been shown to reduce LDL by 5% at week 10, 16% at week 18, and 23% at week 26, reduce Lp(a) by 35% at week 26, and increasing HDL by 20% at week 10, 29% at week 18, and 33% at week 26. Weeks 1-10 were dosed at 1.5g/day and at 3-4.5g/day thereafter.(13) Niacin unfortunately has sides such as flushing and at higher dosages (>3g/day) can impair glucose tolerance. Inositol hexaniacinate does not cause flushing but still has the benefits on lipid profile. With Inositol hexaniacinate start with a dose of 500 mg at night before bed for one week. Increase the dosage to 1,000 mg the next week and 1,500 mg the following week and for several months. Given the slow nature of the product in improving lipid profiles either one of these compounds should be ran year-round.
Policosanol
Policosanol is a mixture of higher primary aliphatic alcohols isolated from sugar cane wax, whose main component is octacosanol. Policosanols are thought to improve lipid profiles by reducing hepatic cholesterol biosynthesis while enhancing LDL clearance. At doses of 10 to 20 mg per day, policosanol lowers total cholesterol by 17% to 21% and low-density lipoprotein (LDL) cholesterol by 21% to 29% and raises high-density lipoprotein cholesterol by 8% to 15% respectively.(3) After 20 weeks at 10mg per day, total cholesterol and LDL were lowered by 17.5% and 31.0%. Meanwhile HDL by 31.5%. (4) Policosanol has additional beneficial properties such as effects on smooth muscle cell proliferation, LDL peroxidation, reducing platelet aggregation, foam cell formation, and fibrinogen levels. Dosages of 40mg showed no substantial benefits over 20mg day.(5)
Dosage: 10 -20 mg/day
Red Yeast Rice (RYR)
Red yeast rice is the fermented product of rice on which red yeast (Monascus purpureus) has been grown. Research revealed the red yeast rice forms naturally occurring hydroxymethylglutaryl-CoA reductase (HMG-CoA) inhibitors. Xuezhikang, an extract of cholestincontains a family of naturally occurring statins (monacolins), one of which is lovastatin(Monacolin K). 1200 mg Xuezhikang contains roughly 10 mg lovastatin.The HMG-CoA reductase inhibiting activity of red yeast rice comes from a family of naturally occurring substances named monacolins. Red yeast rice has been found to contain sterols (ß-sitosterol, campesterol, stigmasterol, and sapogenin), isoflavones and isoflavone glycosides, and monounsaturated fatty acids
Xuezhikang significantly reduced fasting serum total cholesterol (TC) (-20%), low-density lipoprotein cholesterol (LDL-C, -34%), TG (-32%) and apoB (-27%) levels, and raised fasting high-density lipoprotein cholesterol (HDL-C, 18%) and apoA-I (13%) levels at 6 weeks, 1200 mg/day.(9) In 324 hypercholesterolemic subjects treated with Xuezhikang (1.2 g/d containing 13.5 mg total monacolins) for 8 wk, serum cholesterol concentrations decreased by 23%, triacylglycerols decreased by 36.5%, and HDL-cholesterol concentrations increased by 19.6%. Two to 4 wk before the initiation of this study, subjects were instructed to cease taking all medications and were provided with dietary counseling (10). In a second study, an earlier version of the red-yeast-rice supplement containing 10-13 mg total monacolins was given to 101 hypercholesterolemic subjects. Total cholesterol decreased by 19.5% and triacylglycerol decreased by 36.1% in the treated group. HDL-cholesterol concentrations increased by 16.7% in this study (11) Other studies have shown that HDL-cholesterol concentrations did not differ significantly within or between groups at baseline, 8 wk, or 12 wk at a dosage of 2.4g/day. (8)
RYR supplementation has been shown to deplete CoQ10 in heart and liver tissue(12) and therefore requires cosupplemnation of either coQ10 or Idebenone at 300 and 100 mg/day repsectively..
Dosage: 1200 - 2400 mg/day taken with meals
Theastatins from green tea
Lecithin
Omega 3s like Fish oil- lowers triglycerides and cholesterol
Resveratrol
(1)Plant sterols and endurance training combine to favorably alter plasma lipid profiles in previously sedentary hypercholesterolemic adults after 8 wk.
Varady KA, Ebine N, Vanstone CA, Parsons WE, Jones PJ.
(2)Role of policosanols in the prevention and treatment of cardiovascular disease.
Varady KA, Wang Y, Jones PJ.
School of Dietetics and Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada.
(3) Policosanol: clinical pharmacology and therapeutic significance of a new lipid-lowering agent.
Gouni-Berthold I, Berthold HK.
Medical Policlinic, University of Bonn, Bonn, Germany.
[email protected] <mailto:
[email protected]>
Am Heart J. 2002 Feb;143(2):356-65.
(4)Effects of policosanol and lovastatin in patients with intermittent claudication: a double-blind comparative pilot study.
Castano G, Mas R, Fernandez L, Gamez R, Illnait J.
Medical Surgical Research Center, Havana City, Cuba.
(5)Antiplatelet effects of policosanol (20 and 40 mg/day) in healthy volunteers and dyslipidaemic patients.
Arruzazabala ML, Molina V, Mas R, Fernandez L, Carbajal D, Valdes S, Castano G.
Center of Natural Products, National Center for Scientific Research Cubanacan, Havana City, Cuba.
(6)Effects of Xuezhikang, an extract of cholestin, on lipid profile and C-reactive protein: a short-term time course study in patients with stable angina
Jian-Jun Li,Sheng-Shou Hu, Chun-Hong Fang, Rui-Tai Hui, Li-Fu Miao, Yue-Jin Yang and Run-Lin Gao
Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, PR China
Renmin Hospital, Wuhan University School of Medicine, Wuhan 430060, PR China
Heart Center, First Affiliated Hospital, Tsinghua University School of Medicine, Beijing 100016, PR China
(7)Effect of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease
Shui-Ping Zhaoa, Ling Liu, a, Yan-Chun Chenga and Yu-Ling Lib
a Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan, China
b Department of Nutrition, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan, China
(8)Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement
David Heber, Ian Yip, Judith M Ashley, David A Elashoff, Robert M Elashoff and Vay Liang W Go
(9)Effect of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease.
Zhao SP, Liu L, Cheng YC, Li YL.
Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan, China.
(10)Clinical trial of extract of Monascus purpureus (red yeast) in the treatment of hyperlipidemia.
Wang J, Su M, Lu Z, et al.
Chin J Exp Ther Prep Chin Med
(11) A prospective study on Zhitai capsule in the treatment of primary hyperlipidemia.
Shen Z, Yu P, Su M, et al
Nat Med J China 1996;76: 156-7.
(12)Acute administration of red yeast rice (Monascus purpureus) depletes tissue coenzyme Q(10) levels in ICR mice.
Yang HT, Lin SH, Huang SY, Chou HJ.
School of Pharmaceutical Science, Taipei Medical University, Taipei, Taiwan.
(13)Comparative effects of lovastatin and niacin in primary hypercholesterolemia. A prospective trial
D. R. Illingworth, E. A. Stein, Y. B. Mitchel, C. A. Dujovne, P. H. Frost, R. H. Knopp, P. Tun, R. V. Zupkis and R. A. Greguski
Department of Medicine, Oregon Health Sciences University, Portland.
That's funny.. 
