A new study brings a new blow to Zetia (ezetimibe). In a recent study published by the New England Journal of Medicine, it appears that taking the extended release form of a common supplement, niacin, works better in reducing atherosclerotic plaque thickness than Zetia, a newer cholesterol drug that is used to specifically lower LDL cholesterol.

High LDL levels, coupled with inflammation in the inner walls of arteries, lay down the foundation for developing heart disease. This process, known as atherosclerosis, can cause lipids within the vessel to build up into a thick plaque. Eventually, this plaque could limit - or even obstruct - blood and nutrients to vital organs.

The study examined 208 participants who had established heart disease or an equivalent to it. These individuals were already taking a statin, but were randomized to also take either extended-release niacin (Niaspan) or Zetia. The researchers measured carotid intima-media thickness in order to assess changes in plaque thickness from taking the drugs over a 14-month period.

The study found that niacin reduced plaque thickness in the carotid arteries. While Zetia also appeared to reduce plaque thickness, it was very slight and not a significantly different from the baseline measurement. Zetia also lowered LDL cholesterol slightly more than niacin, however niacin also raised HDL cholesterol.

While we need more studies to examine the effectiveness of Zetia and its role in preventing heart disease (heart attacks, strokes), studies like this cause us to question if Zetia really has a place.

More about the Zetia saga:

• Controversy Surrounding Zetia and Vytorin
• More About Niacin

_{Source: Taylor AJ et al. Extended-release niacin or ezetimibe and carotid intima-media thickness. NEJM 2009;361:1.} number, NCT00397657.)

A recent study published in the Journal of the American Medical Association suggests that statins may do more than just lower your cholesterol - it could also help prevent you from developing a gallstone.

If you've ever had a gallstone before -- or known someone who has had one -- you understand what they entail. Developing in the gallbladder, gallstones can move into the cystic duct, causing a great deal of pain. When this happens, the offending gallstone - and the gallbladder - is surgically removed. Over 80% of stones analyzed after surgery are completed of cholesterol. Since statins lower the amount of cholesterol made in and released from the liver, an investigation like this makes perfect sense.

The study examined over 27,000 participants who had previously undergone gallbladder surgery and were compared to over 100,000 healthy participants. The authors of the study found that individuals taking statins were slightly less likely to develop gallstones over time compared to those not taking a statin. However, this benefit appears to be noted only with taking statins long-term. In this study, the preventative benefit that statins exerted on gallstones was noted after a year or so of taking the drug. Although more studies are needed, the information appears promising -- especially for those of you at risk for developing gallbladder disease.

Information About Statins:
• What Are Statins?
• Additional Statin Benefits

_{Article: Bodmer M, Brauchli YB, Kraehenbuehl S et al. Statin use and risk of gallstone disease followed by cholestcystectomy. JAMA 2009;302:2001-2007.}

When you get your cholesterol checked, what are the first directions your healthcare provider gives you? Usually, they tell you to fast, or abstain from eating for at least 8 to 12 hours before your test. And you may have also heard the buzz about apolipoproteins being better predictors of heart disease. There's new information recently published in the Journal of the American Medical Association that suggests that HDL and LDL are still important in the prediction of heart disease risk. More importantly, this study also suggests that fasting may not be necessary to achieve accurate results for a cholesterol test.

The study analyzed 68 long-term studies looking at cholesterol, apolipoprotein, and triglyceride levels in over 300,000 participants. Some of these individuals, as the study progressed, suffered from a stroke or heart attack. The researchers of this study were looking at which lipid particles were most predictive of having heart disease, as well as whether or not fasting mattered when it came down to getting a cholesterol test.

This study found that examining HDL ("good" cholesterol) and LDL ("bad" cholesterol) was just as predictive of developing heart disease as testing for apolipoproteins A and B. Triglycerides measurements did not appear to be as good of an indicator when compared to HDL nad LDL. Additionally, the authors of this study found that, while not fasting for a cholesterol test did have a slight impact on lipid levels, it was not enough to place the individuals who didn't fast into a higher risk category for heart disease.

While this study isn't enough to completely discount fasting for a lipid test - especially for triglycerides, it does suggest that eating before this important test does not have as much of an impact as once thought. Additionally, reiterates the importance of LDL and HDL in predicting heart disease risk.

More About Your Lipids:

• Preparing for a Cholesterol Test
• Types of Lipids: The Major Players

_{Article: Danesh J, The Emerging Risk Factors Collaboration. Major lipids, apolipoproteins, and the risk of vascular disease. JAMA. 2009;302(18):1993-2000.}

Exercise plays an important role in lowering your cholesterol. But when you have heart disease, following an exercise program may be difficult to follow. If you are relatively stable, you may not have any problems with beginning a program. But if you have severe heart disease, this could present some problems with exercise. In any case, talk to your healthcare provider before you begin any type of exercise program. This article will provide you with some helpful tips in starting an exercise regimen, and what to look for when you might be overexerting yourself.