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.

We're in flu season, and with all the media attention that the flu has been getting lately, everyone is either running towards their healthcare provider's office for their flu shot - or running away from anyone with even a slight sign of having the flu. But if you're taking a statin to lower your cholesterol, there's a new study that suggests that your statin may protect you from more than heart disease - it may help protect you from the devastating effects of the flu.

This new study, which was sponsored by the Centers of Disease Control, looked at roughly 2800 individuals hospitalized and diagnosed with an influenza infection through laboratory confirmation. Of those individuals, about 800 of them took a statin while in the hospital. At the conclusion of the study, the researchers found that 3.2% of individuals not taking a statin died from flu complications, compared to 2.1% of individuals taking statins. Statins are known to have healthy effects on the body - other than lowering cholesterol. Statins can reduce inflammation, which could contribute to heart disease if the inflammation is located within blood vessels.

While we need more proof before statins are administered to everyone with the flu, this information looks promising. The flu can be damaging to the body, and this is mostly due to inflammation induced by the virus and your immune system.

• What Are Statins?
• Other Statin Effects...Besides Lowering Cholesterol

With Halloween just around the corner, some of us may have candy on our minds. But if you're following any type of heart-healthy, cholesterol-lowering diet, candy may be on your list of "forbidden foods." Well, there's good news that comes out of all of this - especially for all of those chocolate lovers out there. A new study has found that the cocoa found in chocolate may be heart-healthy.

This isn't actually new to us, but this most recent study comes at the most candy-entrenched holiday of the year. The study, which was published today in the American Journal of Clinical Nutrition, examined 42 individuals ingesting skim milk or plain mild mixed with 40 grams of unsweetened cocoa powder daily. They found that individuals ingesting the cocoa and milk mixture had reduced inflammatory markers, and an increase in their HDL. Inflammation has been linked to contributing to the formation of atherosclerosis, which can eventually limit - or completely obstruct - blood flow to vital organs of the body.

But if you're going to use this study as an excuse to indulge in chocolate -beware! This could add extra calories to your daily intake, and the individuals participating in this study also saw a little weight gain by ingesting this mixture. Additionally, remember that moderation is also important when following any type of diet - including cholesterol-lowering diets.

AstraZeneca released a statement today that the Food and Drug Administration (FDA) has approved the use of Crestor (rosuvastatin) in children and teenagers aged 10-17 years with familial hypercholesterolemia. This inherited condition causes dangerously high LDL, or "bad", cholesterol levels and increases the risk of developing heart disease. The FDA approved the new indication based upon the PLUTO study (Pediatric Lipid-Reduction Trial of Rosuvastatin), which examined the effectiveness and safety of Crestor in children with this condition. Crestor is a statin that has already been approved for use in adults to lower cholesterol levels. According to AstraZeneca, the drug will only be indicated in children trying to lower LDL cholesterol when diet does not work.

• What Is Familial Hypercholesterolemia?
• Crestor: Basic Information

Foods containing soy are derived from the soybean plant. Besides offering protein to your diet, soy products may also contain isoflavones, which are estrogen-like components found in many plants. Soy products, such as tofu, soy beverages, soybean burgers, and soy nuts, already have an established reputation of being healthy, since they offer a healthy alternative to animal protein. Soy also has gained a reputation over the years for lowering cholesterol levels, but does it really work?

While it is well-known that more rigorous exercises, such as jogging, running, or cycling, can help lower cholesterol, not much is usually said about low-impact exercises. Low impact exercises can be an excellent alternative to those of us who cannot participate in high activity exercises -- whether it is due to a medical condition or a strong dislike for aerobic exercise. While studies are showing that low impact exercises are important in keeping your figure trim and improving well-being, there is evidence to suggest that these exercises may help keep your cholesterol levels low, too. Low impact exercises range from yoga to pilates. Find out which of your favorite low impact exercises will help you lower your cholesterol, as well as keep your heart healthy.

A new study published in Circulation Research has further established the role of a well-known protein in promoting atherosclerosis. Referred to as matrix metalloproteinase-8 (MMP-8), this enzyme normally functions in breaking down certain proteins in the body and is usually found at the site of atherosclerotic lesions. Atherosclerotic lesions, or plaques, can be caused by persistently high cholesterol levels. These plaques can continue to build up over time, reducing blood flow to affected organs.

Researchers in this study fed mice a diet high in cholesterol and fat (or Western diet) and blocked the production of MMP-8 in some of these mice. They found that mice having very low levels of MMP-8 were less likely to develop atherosclerotic plaques in the vessels of their hearts. On the other hand, the mice still producing this protein had an increased risk of developing atherosclerosis.

Although this wasn't studied in humans, this new finding provides us with more information about how atherosclerosis occurs. High cholesterol is an important contributor to the formation of atherosclerosis, but there are other factors in the body contibuting to this that are not fully understood. This finding may provide more information about other factors contributing to atherosclerosis, or possibly a future treatment to prevent it.

More About Atherosclerosis:

• What Is Atherosclerosis?
• Why Worry About Atherosclerosis?
• Ways You Can Prevent Atherosclerosis