THE NEW CHOLESTEROL PHOBIA-WHY THIS AGRESSIVENESS?

The multi billion dollar Statin industry must be elated by the latest recommendations from an expert panel in the US regarding compulsory screening of children for high triglycerides and cholesterol in their blood to detect early signals for development of obesity.  It is true that in the US the single most critical health issue today is the wide scale prevalence of obesity with one third of the population obese and another one third over weight based on the yardstick of Body Mass Index ( BMI). If Statin industry has reached where it is now generating billions of dollars of business, thanks are due to the aggressive program of lipid profiling of the adult population pursued as an annual health check up effort. The present attempt to expand the lipid screening to young kids is a logical extension of the efforts of the industry to ramp up its financial health at the expense of the citizen! The fact that some of the members of the medical panel that made the above recommendations have had financial connection with drug industry raises the needle of suspicion regarding the intent of this exercise. Here is an analysis of this latest development vis-a-vis cholesterol screening in the US.    

"Moreover, the recommendations are based on expert opinion, rather than solid evidence, the researchers said, which is especially problematic since the guidelines' authors disclosed extensive potential conflicts of interest. The guidelines were written by a panel assembled by the National Heart, Lung and Blood Institute ( NHLBI) and published in Pediatrics, in November 2011. They also were endorsed by the American Academy of Pediatrics. The guidelines call for universal screening of all 9 to 11-year-old children with a non-fasting lipid panel, and targeted screening of 30 to 40 percent of 2 to 8-year-old and 12 to 16-year old children with two fasting lipid profiles. Previous recommendations called only for children considered at high risk of elevated levels to be screened with a simple non-fasting total cholesterol test. The call for a dramatic increase in lipid screening has the potential to transform millions of healthy children into patients labeled with so-called dyslipidemia, or bad lipid levels in the blood, according to the commentary by Thomas Newman, MD, MPH, Mark Pletcher, MD, MPH and Stephen Hulley, MD, MPH, of the UCSF Department of Epidemiology and Biostatistics and e-published on July 23 in Pediatrics. "The panel made no attempt to estimate the magnitude of the health benefits or harms of attaching this diagnosis at this young age," said Newman. "They acknowledged that costs are important, but then went ahead and made their recommendations without estimating what the cost would be. And it could be billions of dollars." Some of the push to do more screening comes from concern about the obesity epidemic in U.S. children. But this concern should not lead to more laboratory testing, said Newman. "You don't need a blood test to tell who needs to lose weight. And recommending a healthier diet and exercise is something doctors can do for everybody, not just overweight kids," he said. The requirement of two fasting lipid panels in 30 to 40 percent of all 2 to 8-year olds and 12 to 16 -year- olds represents a particular burden to families, he said."

Cholesterol is considered a villain in most heart disease and build up of this chemical in the arteries leading to atherosclerosis is considered a direct consequence of reckless eating habits evolved in wealthy countries like the US. Vast agriculture subsidies and skewed government food policies have spawned a whole generation of cheap but highly unhealthy foods to which the citizens have ready access while healthy foods like fluid milk and fruits and vegetables are priced out of the reach of the common man. Over eating of meat and related products rich in cholesterol practically every day makes the cholesterol induced "crisis" a formidable one to manage. Recent attempts by the government, though belatedly and half-heartedly to make one day a weak meat free was sabotaged by the meat industry fearing a slide down of its fortunes. The obsession with pre-empting possible diseases during early childhood which is characteristic of the American system seems to have driven the latest proposal of lipid screening for children. But the over weight does not develop over night and those with a tendency with increased BMI only need to be tested sparing most kids the trauma of lipid profiling process unnecessarily. One can only hope that better sense will prevail with the US government eventually after considering the pros and cons of implementing the latest recommendations.

V.H.POTTY
http://vhpotty.blogspot.com/
http://foodtechupdates.blogspot.com

HDL CHOLESTEROL BENEFITS UNDER THE SCANNER-A PERPLEXING SCENARIO

Cholesterol is a dreaded word for many people because of its perceived association with atherosclerosis and heart attack.  Some people are aware of the differentiation between High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL). Lay man recognizes HDL as good cholesterol and LDL as its bad cousin, with the latter causing heart disease. Even many physicians advise their clients to work for increasing the HDL level as high as possible imagining that it can protect the heart. There are millions of dollars of investment riding on the above hypothesis to develop drugs that can boost HDL levels in the blood though no appreciable success has yet been achieved. Against such a background comes an earth shaking finding that a high HDL level need not be a guarantee against heart disease and those with high HDL inherited genetically cannot be considered as less prone to heart attack. Here is a take on this new revelation which seems to have turned the clock back regarding the current knowledge about the role of lipo proteins on human health.   

"Now, a new study that makes use of powerful databases of genetic information has found that raising HDL levels may not make any difference to heart disease risk. People who inherit genes that give them naturally higher HDL levels throughout life have no less heart disease than those who inherit genes that give them slightly lower levels. If HDL were protective, those with genes causing higher levels should have had less heart disease. Researchers not associated with the study, published online Wednesday in The Lancet, found the results compelling and disturbing. Companies are actively developing and testing drugs that raise HDL, although three recent studies of such treatments have failed. And patients with low HDL levels are often told to try to raise them by exercising or dieting or even by taking niacin, which raised HDL but failed to lower heart disease risk in a recent clinical trial. "I'd say the HDL hypothesis is on the ropes right now," said Dr. James A. de Lemos, a professor at the University of Texas Southwestern Medical Center, who was not involved in the study. Dr. Michael Lauer, director of the division of cardiovascular sciences at the National Heart, Lung and Blood Institute, agreed. "The current study tells us that when it comes to HDL we should seriously consider going back to the drawing board, in this case meaning back to the laboratory," said Dr. Lauer, who also was not connected to the research. "We need to encourage basic laboratory scientists to figure out where HDL fits in the puzzle — just what exactly is it a marker for." But Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, who is helping conduct studies of HDL-raising drugs, said he remained hopeful. HDL is complex, he said, and it is possible that some types of HDL molecules might in fact protect against heart disease".

The million dollar question is whether high HDL level in blood is maintained due to good health or lower level of HDL heralds changes that lead to heart associated problems. It looks like HDL may not be a sure marker any more for insurance against heart disease while LDL certainly is a marker for bad health. Probably the present approach to cholesterol management will undergo dramatic changes if the above findings are confirmed by future studies. One question that naturally arises out of this development is whether the multi billion dollar Statin drug industry is going to be adversely affected. According to the authors of the above study, it is always healthy if LDL levels are controlled and those who cannot reduce the same will have to resort to drug intervention using Statins.

V.H.POTTY
http://vhpotty.blogspot.com/
http://foodtechupdates.blogspot.com