Low Cholesterol Risks

Professionals only supplements resources that I rely on in my clinical work usually publish reports on studies of natural supplements that help health concerns.

While most hear about how high cholesterol is so bad and how many risky drugs you need, often you don't hear that low cholesterol can impair your immune function or defer review of other more risky markers. Triglycerides included.

I've educated on triglyceride issues for so long it seems funny to me that its just hitting headlines. Still its not prominent in the media to equal the risk to your health.

The real warning should be that yes, high triglycerides will kill you.

The Deadly Truth about Low Cholesterol
It’s a common misconception with fatal consequences: Many people still believe that low total cholesterol levels mean you’re not at risk for stroke, heart attack, or any of the other deadly risks that come with cardiovascular disease.

But in reality, nothing could be further from the truth—and unless you’re paying close attention to one particular group of fats called triglycerides, your heart could be a ticking time bomb, no matter how healthy your cholesterol might look.

Triglycerides are naturally manufactured and stored by both your liver and fat cells. At normal levels, they’re a crucial source of energy for your body—but start producing more than you can store, and those excess triglycerides will be dumped into your bloodstream, where they can wreak havoc on your arteries, heart, pancreas, and liver.1

Studies have shown that abnormally high triglyceride levels raise your risk of heart attack threefold—and when accompanied by low levels of high-density lipoproteins (HDL, or “good” cholesterol), your risk jumps a staggering 16 times higher. In fact, this ratio is one of the single strongest predictors of heart attack risk, even more accurate than the better-known LDL (low-density lipoprotein, or “bad” cholesterol) to HDL ratio.2 And it isn’t just your heart that suffers. Studies show that risk of stroke, obesity, diabetes, and liver disease are all linked to these dangerous fats.3-5

Keeping triglycerides in check is absolutely critical to your health—and a simple combination of omega-3 fatty acids, niacin and a supplement blend™ can make all the difference. One recent trial showed that supplementing with fish oil daily slashed triglyceride levels by 46 percent in as little as eight weeks.6 And niacin boasts nearly five decades of research demonstrating that it not only reduces triglycerides and LDL cholesterol, but also increases HDL levels by up to 29 percent.7-8

Finally, be wary of your blood sugar: Numerous clinical trials have shown that refined carbs and sugar can actually double triglyceride production.9-10 Tossing sugary sodas and boosting protein intake can help.11 So can supplementing with natural blood sugar managing agents like bitter melon, goat’s rue and quercetin.12-13A comprehensive formulas like some we use in our work contain these ingredients along with several others, including cinnamon. Clinical trials reveal that this popular spice can reduce triglycerides by 23 to 30 percent.14

References:

1. Webster’s New World Medical Dictionary, 3rd edition, William Schiel, Jr, MD, Author, 2008, Webster publishing.

2. Gaziano, JM., Hennekens, CH. Fasting triglycerides, high-density lipoprotein, and the risk of myocardial infarction. Circulation. 1997 Oct 21; 96(8):2520-5.

3. Grundy, SM., Cleeman, JI., Merz, CN., Brewer, HB, Jr., Clark, LT., Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004 Jul 13; 110(2):227-39. Review. Erratum in: Circulation. 2004 Aug 10; 110 6):763.

4. Tanne, D., Koren-Morag, N., Graff, E. Blood lipids and first-ever ischemic stroke/transient ischemic attack in the Bezafibrate Infarction Prevention (BIP) Registry: high triglycerides constitute an independent risk factor. Circulation. 2001 Dec 11; 104(24):2892-7.

5. Kadikoylu G, Yavasoglu I, Bolaman Z. Plasma exchange in severe hypertriglyceridemia, a clinical study. Transfus Apher Sci. 2006 Jun; (3):253-7.

6. Vega GL, Chandalia M, Szczepaniak LS, Grundy SM. Effects of N-3 fatty acids on hepatic triglyceride content in humans. J Investig Med. 2008 Jun; 56(5):780-5.

7. Crouse, JR. 3rd. new developments in the use of niacin for treatment of hyperlipidemia: new considerations for use of an old drug. Coron Artery Dis. 1996 Apr; 7 (4):321-6.

8. Drexel H. Nicotinic acid in the treatment of hyperlipidaemia. Fundam Clin Pharmacol. 2007 Nov;21 Suppl 2:5-6.

9. Teff, KL., Elliott, SS., Tschop, M., Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases in triglycerides in women. J Clin Endocrinol Metab. 2004 Jun;89(6):2963-72.

10. Furtado, JD., Campos, H., Appel, LJ., Miler, ER. Effects of protein, unsaturated fat, and carbohydrate intakes on plasma apolipoprotein B and VLDL and LDL containing apolipoprotein C-III: results from the OmniHeart Trial. Am J Clin Nutr. 2008 Jun;87 (6): 1623-30.

11. Parks, EJ., Skokan, LE. , Timlin., Dingfelder, CS. Dietary sugars stimulate fatty acid synthesis in adults. J. Nutr. 2008 Jun: 138 (6): 1039-46.

12. Sridhar MG, Vinayagamoorthi R, Arul Suyambunathan V, Bobby Z, Selvaraj N. Bitter gourd (Momordica charantia) improves insulin sensitivity by increasing skeletal muscle insulin-stimulated IRS-1 tyrosine phosphorylation in high-fat-fed rats. Br J Nutr. 2008 Apr;99(4):806-12.

13. Rivera L, Morón R, Sánchez M, Zarzuelo A, Galisteo M. Quercetin ameliorates metabolic syndrome and improves the inflammatory status in obese zucker rats. Obesity (Silver Spring). 2008 Sep;16(9):2081-7.

14. Anderson RA. Chromium and polyphenols from cinnamon improve insulin sensitivity. Proc Nutr Soc. 2008 Feb;67(1):48-53.

Pfizer hedging its bets? UPDATE

Today Pfizer agrees to pay out $894 million to settle lawsuits over Celebrex and Bextra. Other NSAIDS still show a link to heart disease but this is one of the most readily preventable health conditions we know of and other posts on this blog give you some of that data. For pain and inflammation there are many excellent natural remedies as well as one of the natural products I use from time to time that has been tested at Dana Farber.

$894 million deal ends pain of Pfizer's lawsuitsBy Linda A. Johnson, Ap Business Writer
17 October, 2008
TRENTON, N.J. – Drug giant Pfizer Inc. has reached an $894 million deal to end most of the lawsuits over its two prescription pain relievers, the popular Celebrex and a similar drug, Bextra, no longer on the market.

The world's biggest drugmaker said Friday it has agreements in principle to end more than 90 percent of personal injury lawsuits brought by people claiming the pills caused heart attacks, strokes or other harm.

The settlement includes roughly 7,000 personal injury cases, mainly plaintiffs who took since-withdrawn Bextra, said plaintiff attorney Perry Weitz. He represents nearly 2,000 claimants, about 10 percent of them relatives of people who died.

"It gives Pfizer closure and the claimants their money sooner, rather than later or never at all," Weitz said.

Pfizer hopes to finalize claims covered by the settlement, which now includes up to 92 percent of plaintiffs, by year's end. It also hopes to include many of the remaining claimants in the settlement and will fight any remaining personal injury suits with court motions or at trial, General Counsel Amy Schulman told The Associated Press.

"I don't think either side has an interest in protracting this," Schulman said in an interview.

Weitz said plaintiff lawyers will "have issues" with Pfizer "if their claimants aren't paid before the end of the year."

In early trading, Pfizer shares were down 47 cents, or 2.8 percent, at $16.50.

Schulman said the deal comes after two important court rulings — one by a New York state judge overseeing many of the state-level personal injury cases and the other by a federal judge in San Francisco coordinating pretrial steps in federal lawsuits over the drugs.

"We teed up some pretrial motions for a court ruling on whether there was significantly reliable evidence that would allow an expert to testify as to whether there was an increased risk of heart attack and stroke at the most common dose," 200 milligrams, Schulman said. Both judges ruled that was not the case, she said.

The proposed deal also would end suits by insurers and patients seeking to recover what they spent on Bextra and Celebrex, as well as claims by 33 states and the District of Columbia that Pfizer improperly promoted Bextra.

Out of the total settlement, $745 million will go to settle personal injury cases, $60 million will cover settlements with attorneys general in the 33 states and the District of Columbia, and $89 million will cover consumer fraud class action cases over reimbursement for money spent on the two drugs. Two additional states, Louisiana and Mississippi, still have pending cases regarding Pfizer's promotion of the drugs.

New York-based Pfizer withdrew Bextra from the market in 2005, a year after Merck & Co. withdrew its Vioxx, a similar drug.

The Vioxx withdrawal, which triggered an avalanche of lawsuits against Merck, also raised concerns about the safety of other medicines in the same class, called Cox-2 inhibitors. They were heavily touted by their makers as superior to traditional nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen, because they block an enzyme involved in promoting inflammation but — unlike NSAIDs — don't block an enzyme that protects the stomach from bleeding and other side effects.

Other NSAIDs, such as ibuprofen and naproxen, have also been linked to increased heart risks.

Celebrex is the only Cox-2 inhibitor that the Food and Drug Administration has allowed to remain on the U.S. market.

Attorney Christopher Seeger, a member of the plaintiffs steering committee, said he'll "have no problem recommending" the settlement to the roughly 400 clients he represents.

"We're very satisfied with the deal," Seeger said.

Schulman said the company's negotiations with opposing lawyers had been under way for some time but picked up in the late summer.

"Litigation can be distracting, and putting these matters behind us helps our shareholders and, most importantly, patients and doctors," Schulman said.

Weitz noted that it took four or five years to get through trials for less than 20 cases in the massive Vioxx litigation, because the court system can only handle a limited number of cases at a time.

Pfizer will take a pretax charge of $894 million to its third-quarter earnings, which it is scheduled to report on Tuesday.

Merck, based in Whitehouse Station, N.J., has begun paying a $4.85 billion settlement to end about 50,000 lawsuits brought by people claiming Vioxx cause heart attacks, ischemic strokes or death. It still faces other litigation over the former blockbuster arthritis treatment.

Copyright © 2008 The Associated Press.

Pfizer to Drop Development of Certain Drugs
by Shelley Wood, Heartwire 2008. © 2008 Medscape

October 3, 2008 (New York, NY) — Pfizer is getting out of the cholesterol-lowering game to focus on what it perceives to be more lucrative diseases, according to an internal memo obtained by Forbes [1]. And for the most part, the chosen "disease areas" don't include the heart.

In the memo, Martin Mackay, president of Pfizer Global Research & Development (R&D), informed his staff that the company plans to "exit" the fields of atherosclerosis/hyperlipidemia, heart failure, obesity, and peripheral arterial disease.

Instead, the company, whose cholesterol-lowering drug atorvastatin (Lipitor) is the world's top-selling drug, says it is turning its attention and R&D dollars to cancer, diabetes, Alzheimer's, pain remedies, and mental health as its "higher-priority areas."

The news comes in the wake of the flop of Pfizer's hoped-for new flagship, torcetrapib, a CETP inhibitor that was widely predicted to be the company's next blockbuster drug. While CV drugs have been the major moneymakers for Pfizer in recent years, those days are drawing to a close. In addition to Lipitor, which will lose patent protection in 2011, Pfizer's other major player in the CV drug arena is Norvasc (amlodipine), which came off patent in 2007.

Among the lower-priority "disease areas" where the company says it will continue working are thrombosis and transplant, the memo notes.

Contacted by heartwire, a handful of leaders for some of the major Pfizer-sponsored trials in cardiovascular disease over the past decade declined to comment on the company's announcement or speculate on what it might mean to the field of CV drug development--with one exception. Dr John Kastelein (Academic Medical Center, Amsterdam, the Netherlands), who was an investigator in the Pfizer-sponsored ASAP, TNT, and IDEAL trials, called Pfizer "a real powerhouse" in the CV drug arena.

"I kind of knew this was coming, but when you see it in print, it still hits hard," he told heartwire. "I think this is very, very significant both for the company itself and for the whole field of CV drug development. Pfizer had truly excellent people in the development arm of their company for CV and metabolic drugs, and they've contributed to this whole notion that you need more robust LDL lowering and that that's better than mild LDL lowering, which has become one of the axioms of CV prevention. And if they're stepping out now, that not only signifies their own problems, but it also signifies the problems in CV drug development, and how incredibly difficult and costly it has become to bring new drugs forward. And that's not good for patients."

Kastelein predicts that drug companies, having "lost faith" somewhat in HDL-raising therapies, will need to look more closely at anti-inflammatory drugs in the setting of coronary artery disease. "But there, the problem is, if you have no biomarkers whatsoever to do even dose-finding studies, you need to move from relatively small phase 2 trials to incredibly large, hard-outcome studies, which is taking quite a risk," he said. And that, at least for Pfizer, is too much risk.

"Everyone, not just Pfizer, is realizing that the days of the really big blockbuster drugs are over. And what is going to replace that are drugs in a class that are 10 times or 100 times more difficult to develop, so the risks are much higher. And these days, after Avandia and ezetimibe, everything is about safety. This means the FDA is forced, by public and colleague pressure, to demand even larger databases before drugs are going to market, which is of course making it more expensive. It's a cycle that's very hard to break."

Calls to Pfizer were not returned before this story was published.

Herper M. The Pfizer memo. Forbes, September 30, 2008. Available at: http://www.forbes.com/business/2008/09/30/pfizer-drug-agenda-biz-bizhealth-cx_mh_0930pfizermemo.html.

The complete contents of Heartwire, a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.