Giving Weight to the Other Cholesterol

During the past two decades, widespread use of cholesterol- lowering statin drugs has been a major success story in the battle against heart disease, helping to reduce risk of death, heart attacks and other serious cardiovascular problems.

But statins generally target just LDL cholesterol, one of three components of blood fats that play a critical role in affecting the health of coronary arteries. Now heart experts are growing increasingly concerned that the often-ignored other two components of blood cholesterol -- HDL, or good cholesterol, and triglycerides -- are threatening to undermine the gains of the statin revolution.

The reason: The markers are a tell-tale reflection of unhealthy diets and lack of exercise that are driving the epidemic of obesity and diabetes in the U.S. Abnormally high levels are now showing up with more prominence in the profile of heart patients. You don't want your HDL to go below 40 if you are a man and 50 if you are a woman. Triglycerides should be below 150.

Moreover, the markers are part of a larger cluster of risk factors -- others are a bulging waistline and elevated blood-sugar and blood-pressure levels -- that make up what doctors call the metabolic syndrome. That condition is a precursor to diabetes and heart disease and is associated with heart attacks at younger ages -- low 50s for men and low 60s for women -- and early death.

Heart disease "is not just affecting these people more, it's affecting them at a younger age," says Darren McGuire, a cardiologist at University of Texas Southwestern Medical Center, Dallas, who has an interest in the links between diabetes and cardiovascular disease. If these patients survive, he adds, that means the often-disabling consequences become "a long-term burden."

Statins, including Pfizer Inc.'s Lipitor, the drug industry's top-selling drug, and simvastatin, a generic version of Merck & Co.'s former blockbuster Zocor, are effective against LDL. But, except for AstraZeneca PLC's Crestor, which improves both HDL and triglycerides, statins' impact on those levels is modest. Other remedies, including niacin and drugs called fibrates, boost HDL, but they come with unpleasant side effects that limit their use.

The best option, cardiologists say, is to head to the gym, cut calories, and consume more fruits and vegetables -- relatively inexpensive interventions that could save both lives and health-care costs...more