For decades, doctors have been prescribing statins to lower "bad cholesterol" levels in the blood and boost "good cholesterol", believing this would protect against coronary heart disease by reducing the formation of plaques that block our blood vessels.
Doctors also traditionally tried to predict coronary heart disease by testing for the level of a specific component of "good cholesterol", high-density lipoprotein cholesterol (HDL-C). They now suspect this test is not predictive.
And we need predictive. The heart will continue to function as long as the plaque blockage in our arteries isn't too severe. But that can happen not only if the plaque builds up, but if a big chunk of plaque breaks off and, getting stuck somewhere, creates severe blockage.
Since a functional heart may be sick but asymptomatic, the ability to predict the likelihood of coronary disease based on blood biochemistry can save lives.
It turns out that size matters when it comes to the "good cholesterol" particles in our bloodstream, researchers at the Hebrew University of Jerusalem have discovered.
They also say they have found a more accurate way to predict coronary heart disease than the traditional method of "good cholesterol" testing.
When small is better
The bottom line is that certain small, dense, protein-rich particles making up "good cholesterol" may be more protective of our blood vessels than large, buoyant cholesterol-rich particles, they suggest.
The doctors used state-of-the-art scanning to identify calcification (i.e., crud) in the testee's coronary arteries, and advanced spectroscopy to identify the numbers and sizes of "good cholesterol" particles in the blood. Armed with the data, they then set out to find associations between the concentrations and sizes of different "good cholesterol" particles and coronary artery calcification.
What they found was that the more small and medium "good cholesterol" particles there were, the less arterial calcification there was. They did not find association between big "good cholesterol" particles and coronary artery calcification.
The findings were published in the prestigious journal Atherosclerosis.
The study was done on 274 Arabs and 230 Jews living in Jerusalem and was led by Prof. Jeremy Kark of the Hebrew University-Hadassah Braun School of Public Health and Community Medicine and Dr. Chobufo Ditah, a physician from Cameroon, as his thesis for International Masters of Public Health program at the Hebrew University.
"These findings support previous reports, based on studies in other population groups, suggesting that small dense HDL particles are protectively associated with risk of coronary heart disease. The consistency of this finding in a new population of urban Arabs and Jews, using different disease outcomes and different separation methods, add more strength to those findings," stated Dr Ditah.
Does all this means statins are sort of useless? Not at all.
While the role of statins in preventing plaque formation is unclear, Dr. M. Muz Zviman, a researcher with the Children's Hospital of Philadelphia, division of cardiology (not related to this study) points out that they may play another key role in preventing fatal heart disease.
"Statins given to reduce cholesterol, virtually all reduce the level of the bad cholesterol," Zviman explains to Haaretz. "Some also increase somewhat the levels of so-called good cholesterol in the bloodstream – but now some suspect that may not actually decrease the risk of plaque formation. But statins also reduce inflammation. Some think their anti-inflammatory effect may be what lies at the root of their effectiveness."
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