Quick, if I ask you, what is the best-selling pharmaceutical drug in the world, what would you guess (hint is in the title)? Yes, the #1 selling drug is Atorvastatin, commonly known as Lipitor. Its sales in 2010 was 11.7 
Billion dollars, followed closely by Plavix. It is interesting to note that, on the table listing the top selling drugs, it also mentions what condition it is for. Advair will be used to prevent Asthma, for example. When it comes to our top-selling drug, however, the condition listed is “cholesterol”. What are we really trying to prevent here? Cholesterol is NOT a disease, but fats necessary for cell building, brain development and hormone production.
We need not forget why we are concerned about cholesterol. Cholesterol was indicated in atherosclerotic plaque, essentially fatty deposits on the blood vessel walls, causing coronary heart disease (CHD), the top cause of death in the US. Decades ago, cholesterol was the sole cause of atherosclerosis. With time and further research, however, different fractions of cholesterol like LDL and HDL were discovered. LDL and HDL are transport vehicles for fats (cholesterol, triglyceride), with LDL as having more sticking potential in the arteries, and HDL being capable of transport cholesterol to liver for removal (hence the nickname “bad” and “good” fat, respectively). So, our focus changed from looking at cholesterol level alone to monitoring HDL and LDL.
Recent research goes into even more detail, indicating that watching LDL, HDL, and cholesterol for risk of CHD might not be that accurate. Potential of these fatty particles to stick depend on the amount and type of surface proteins attached to the LDL and HDL (named “apolipoprotein”). For example, apolipoprotein (a) is the surface protein that most likely results in coagulating and causing inflammation on the arteries, and is a predictor of coronary artery disease.
Another interesting recent discovery is that inflammation on the surface of the arteries can be the trigger in atherosclerosis. The integrity of arteries is compromised, and cholesterol is basically used as repair material (to prevent leaks). Recent research on Lipitor states that it prevents CAD not because of its cholesterol lowering power, but its effectiveness in reducing arterial inflammation. Essentially, people are admitting or finding that it is not an issue of just cholesterol.
So, equipped with all this information, are there any nutritional considerations that can aid in improving our cardiovascular health?
(Disclaimer: the following suggestions are not to treat any diseases, but general reference material aimed to improve health. Please always consult your physician and do not use the recommendations below to replace your medications).
• Vitamin C: if there are no weakened vessels in the heart, plaques will not need to form. Vitamin C was found a century ago exactly for this purpose: to stop scurvy, bleeding from weakened vessels. Collagen is the tissue cement that strengthens vessels, and Vitamin C is the necessary material to build collagen. Daily vitamin C intake can be guard against arterial inflammation and plaque buildup.
• Dietary fiber: studies have found two things about dietary fiber: 1) fiber can decrease the number of LDL (“bad fat”); and 2) fiber in some studies actually outperforms statin drugs (ie. Lipitor) in reducing LDL. Good sources of fiber include psyllium, oats and flax.
• Niacin – part of the Vitamin B family, it is found to reduce the surface proteins (apolipoprotein a mentioned above) that stick to arteries, and increase the level of apoliprotein A-1, another surface protein strictly found on HDLs (“good” fats), thus increasing the level of HDLs.
• Dietary Considerations: drug ads always say “when diet and exercise are not enough”. Actually, it should say “when diet and exercise are not adequate”. We should consider a low-fat, low glycemic-index lifestyle to adequately manage blood lipid levels. Low-fat lifestyle does not mean hating all fats, but rather limiting the man-made trans-fats that plaque our arteries and produced solely for the manufacturer’s profits. Also, a low glycemic diet promotes proper blood sugar balance, reducing storage of excessive blood sugars into triglycerides (a topic we talked about in last month’s issue).
• Omega-3 fats: we need not only to reduce the intake of bat fats (transfats), but also increase the amount of good Omega-3 fats, typically found in fish oils and flax seed oil. Omega-3 fats help produce anti-inflammatory proteins in the body, and are known to increase the level of HDLs.
There are many more beneficial nutrients to consider, but I’ll stop due to article size. Also note that since cholesterol is removed by the liver, a good liver detox program can assist in maintaining healthy blood lipid levels, a topic we will cover later.
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