New way to treat cholesterol may be on the horizon

A breakthrough discovery by scientists at Houston Methodist could change the way we treat cholesterol. Researchers found new evidence that challenges a 40-year notion of how fast we eliminate it from our bodies.

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This accidental discovery, made by medical biochemist Henry Pownall, Ph.D., and his team at the Houston Methodist Research Institute, reveals a new pathway in the cholesterol-elimination chain that will be key to developing new drugs to lower cholesterol. Their findings are described in an article titled “ABCA1-Derived Nascent High-Density Lipoprotein-Apo AI, and Lipids Metabolically Segregate,” appearing online Oct. 26 and in print Nov. 21 in the American Heart Association’s Arteriosclerosis, Thrombosis, and Vascular Biology journal. Pownall, who is the corresponding author, said the initial purpose of their study was to prove the current model of cholesterol transport through the body was correct. It turns out, however, that the model was not quite right.

“The model people have been using for 40 years presumed that cholesterol was transported from the arteries with other lipids and proteins and entered a particle that stayed in the blood for several days before being cleared by the liver for disposal,” Pownall said. “What we discovered in the process was something different. We discovered the cholesterol skips all these steps and goes directly from this first particle to the liver in two minutes. This is a thousand times faster than what was formerly suspected.” Related image

While most studies look at HDL cholesterol in its mature form found in blood, Pownall and his colleagues studied cholesterol in nascent HDL, an early kind of HDL produced by cells. Cholesterol in the nascent HDL goes directly to the liver, mainly skipping conversion to the mature form of HDL. Pownall stresses that it’s not that current practices of treating “bad” LDL cholesterol are incorrect, but instead that physicians and researchers need to better understand how the “good” HDL cholesterol contributes to cardiovascular disease and how to raise it in a way that protects the heart, because some patients with very high HDL numbers, which were always thought to be beneficial, are actually at risk. “LDL cholesterol, the so-called ‘bad cholesterol’ is well controlled with the current statin therapies. The track record for these cholesterol-lowering drugs is indisputable, and they will continue to work,” Pownall said. “HDL, or the ‘good cholesterol,’ however, is a much trickier system. Not everything that raises it protects the heart and not everything that lowers it is terrible for you. We will need to redesign new drugs to lower plasma cholesterol in a way that takes into account this new mechanism. We will look for interventions, maybe dietary (why of course!), perhaps pharmacological, that raise HDL cholesterol in a way that helps protect the arteries and prevent cardiovascular disease.”

Adapted from: Bingqing Xu, Baiba K. Gillard, Antonio M. Gotto, Corina Rosales, Henry J. Pownall. ABCA1-Derived Nascent High-Density Lipoprotein–Apolipoprotein AI and Lipids Metabolically SegregateArteriosclerosis, Thrombosis, and Vascular Biology, 2017; ATVBAHA.117.310290 DOI: 10.1161/ATVBAHA.117.310290

Nutritional Nugget

Move to low-fat or fat-free milk or yogurt! Smoothies are a great way to enjoy dairy during the early morning rush. For a quick breakfast, blend yogurt with banana, peanut butter & ice.

WODal Nugget 

Timeous: In good time; sufficiently early

Inspirational Nugget

 

“There are three categories of suffering or pain to include: All-pervading pain, the pain of alternation and the pain of pain. All-pervading pain is the general pain of dissatisfaction, separation and loneliness. The sense of alternation between pain and its absence, again and again, is itself painful. And then there is the pain of pain. Resisting pain only increases its intensity.”

~Chogyam Trungpa Rinpoche

 

 

 

Weight loss after bariatric surgery can improve heart health

In overweight and obese people, fat often gets deposited into the midsection of the body. Large amounts of this belly fat can lead to unhealthy changes in a heart’s function and size. However, according to new findings presented at the American College of Surgeons Clinical Congress 2017, a bariatric surgical procedure, and the weight loss that follows it, actually may allow the heart to return to its natural shape and function.

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When a person lifts weights, pushing against resistance, their muscles eventually get bigger. The same is true for the heart muscle. When a person is overweight, the heart has to generate more force to pump even more blood throughout the body. This extra workload causes the heart muscle to grow bigger, but contrary to what some people think, a bigger heart muscle does not mean a stronger heart. In fact, the larger the heart, the less efficacious it is in fulfilling its functions.

“We know that obesity is the most prevalent disease in the United States. And that the cardiovascular system is significantly affected by this disease process,” said lead study author Raul J. Rosenthal, MD, FACS, chairman, Department of General Surgery at the Cleveland Clinic in Weston, Florida. “But we wanted to know to what degree the shape of the heart changes in someone who is obese, what the heart looks like in someone after having bariatric surgery and losing weight, and how that change in geometry affects heart functionality.” For this study, researchers at the Cleveland Clinic reviewed data on 51 obese men and women who underwent bariatric surgery between 2010 and 2015. The analysis included factors such as body mass index (BMI) and coexisting health problems. The average age of the patients was 61 years, and the average BMI was 40; approximately 100 pounds overweight.

To better understand the impact of a bariatric operation and weight loss on heart health, the researchers compared preoperative and postoperative echocardiography readings. An echocardiogram is an ultrasound of the heart that measures not only its size and geometry but also its function. An echocardiogram measures how much blood is in the heart, how much blood goes out of the heart, and how much blood remains in the heart. One year after bariatric surgery, the researchers found significant improvements in patients’ heart health. Nearly half of the patients had hearts that had gone back to their natural shape or geometry. They also found that there was a significant improvement in the size of the ventricles: On average these chambers of the heart decreased in size by 15.7 percent (left ventricle mass: 229 grams before surgery; 193 grams after surgery. Left ventricular wall diameter: 60.1 mm before surgery; 53.7 mm after surgery.)Related image

Larger chambers lose some of their pumping power. This loss means that more blood stays in the heart, and ultimately increases a person’s risk of heart failure. “When the size of the chambers gets bigger, and the walls of the heart get thicker, the blood flow to the heart is not as good, the functionality of the heart is not as good, and the heart itself doesn’t get enough blood,” Dr. Rosenthal said. “The whole body suffers because there is less blood going to your feet and to your toes and to your brain.” This study is the beginning of a series of studies that will be conducted by these researchers over the next few years. They will perform follow up studies to find out what the window is in which losing weight allows the heart to go back to its normal geometry.

“We don’t know if being obese for 20 years and having changes in your heart geometry is different from being obese for 10 years,” Dr. Rosenthal said. “The question is: Will the heart always come back to normal? It could be if you wait too long, the changes in your heart are irreversible.”

Adapted by: American College of Surgeons. “Weight loss after bariatric surgery can improve heart health: Significant improvements in heart shape and function can happen one year after an operation for weight loss.” ScienceDaily. ScienceDaily, 24 October 2017. <www.sciencedaily.com/releases/2017/10/171024232822.htm>

Nutritional Nugget

Take a walk instead! Replace a coffee break with a brisk 10-minute walk. Ask a friend or colleague to join you.

WOD Nugget

Relume: Relight or rekindle (a light, flame, etc.)

Inspirational Nugget

I smile because I have survived everything the world has thrown at me. I smile because when I was knocked down I got back up.

“Ego could be defined as whatever covers up basic goodness. From an experiential point of view, what is ego covering up? It’s covering up our experience of just being here, just fully being where we are so that we can relate with the immediacy of our experience. Egolessness is a state of mind that has complete confidence in the sacredness of the world. It is unconditional well-being, an unconditional joy that includes all the different qualities of our experience.”

~Pema ChÖdrÖn