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gt;gt;And that made a kind of intuitive sense—why wouldn't the fat you consume wind up as the fat you see on your butt and thighs? But "the low-fat diet backfired," says Frank Hu, MD, professor of nutrition and epidemiology at the Harvard School of Public Health. "America's obesity epidemic skyrocketed even while our fat intake went down." So experts are getting off the "fat is evil" bandwagon these days—and we should, too.gt;gt;gt;The upside of eating fatgt;gt;Like carbohydrates and protein, fat is an essential nutrient. This means that your body requires it for key functions, such as absorbing the fat-soluble vitamins A, D, E, and K. "Fat is also an important energy source and is vital for keeping your skin and hair healthy and smooth," says Bonnie Taub-Dix, RD, author of .gt;gt;Even more surprising: Research is revealing that eating the right fats can actually lower your risk of diabetes, heart disease, and obesity, and improve your cholesterol levels. That's because all fats are not created equal, Dr. Hu points out. It's not the total amount of fat in your diet that affects how much you weigh or whether you're at risk for heart disease, according to rigorous studies from the past decade. What matters is the type of fats you choose (and, when it comes to dropping pounds, the total number of calories you eat). Here's a breakdown.gt;gt;gt;gt;Good fatsgt;gt;gt;gt;gt;Monounsaturated fatty acids (MUFAs)gt;gt;gt;gt;MUFAs can actually lower cholesterol levels, and, in doing so, your risk of heart disease. In fact, a study showed that replacing a carb-rich diet with one high in monounsaturated fats can do both, and reduce blood pressure, too.gt;gt;gt;Polyunsaturated fatty acids (PUFAs)gt;gt;gt;gt;Like MUFAs, PUFAs have been shown to improve cholesterol levels and reduce heart disease risk. One type is the omega-3 fatty acid, which is plentiful in some kinds of fish—not to be confused with omega-6 fatty acids, found in meats, corn oil, and soybean oil. Some research finds that Americans eat about 20 times more omega-6 than omega-3; we should be aiming to get closer to four times as much. To do so, Dr. Hu says, sub in fish for meat when you can.gt;gt;gt;gt;Ok-in-moderation fatgt;gt;gt;gt;gt;Saturated fatgt;gt;gt;gt;We've been warned for decades to eat less saturated fat—after all, it raises "bad" (LDL) cholesterol levels, and thus, it was assumed, ups your risk of heart attack and stroke. Lately, though, research has begun to vindicate it. For instance, a 2010 review of 21 studies was unable to find a link between saturated fat consumption and heart disease or stroke. Some types have been entirely exonerated: "Stearic acid, found in dark chocolate, is clearly non-harmful," says David L. Katz, MD, director of the Yale University Prevention Research Center. The same may be true of lauric acid, a type of saturated fat abundant in coconut oil, but there's not enough evidence to say for sure, Dr. Katz says.gt;gt;While some experts, like Dr. Katz, say there's no downside to cutting out saturated fats, others believe keeping them in the mix helps us avoid getting too many bad-for-you refined carbohydrates instead. Bottom line: You don't need to ban them. Just make sure most of your fat intake is unsaturated, eat red meat only once or twice a week, and use olive oil instead of butter when possible.gt;gt;gt; gt;gt;Bad fatgt;gt;gt;gt;gt;Trans fatgt;gt;gt;gt;Trans fat gained notoriety several years ago when one state and a handful of cities banned the artificial kind—found in partially hydrogenated vegetable oil—from restaurants. (Trans fats also occur naturally in small amounts in some foods.) Research has found that artificial trans fats raise LDL cholesterol and lower HDL cholesterol—and a high LDL/low HDL combination can increase your risk of heart attack and stroke. Still, partially hydrogenated oil remains a fairly common ingredient in processed foods, in part because adding hydrogen to vegetable oil gives it a longer shelf life.gt;gt;Experts agree that you should cut out trans fat altogether—and thankfully, that's not so hard to do. "Limit your intake of processed foods, commercial snacks, and fast food, and you'll avoid trans fat," Dr. Katz says. Don't assume you're in the clear if your packaged snack says "0 trans fats" on the label. "Food manufacturers are allowed to put '0 trans fats' in the nutritional information if the item has up to 0.5 grams of trans fat per serving," says Taub-Dix. "Look at the ingredient list: If you see the word 'hydrogenated,' then the food has trans fat and you should skip it."gt;gt;gt;Eat fat, lose weightgt;gt;We know what you're thinking: How do you control calories if you're downing chocolate, olive oil, and nuts? After all, fat packs 9 calories per gram, compared to 4 cals per gram of carbs or protein. Well, for one thing, when you eat a food that contains some fat, you're likely to feel satisfied faster than when eating something fat free. That means you'll consume less of it and will likely be less tempted to snack later on. Some studies have also indicated that certain fats work to help you stay slim: For instance, Harvard researchers found that people who ate nuts regularly gained less weight over a four-year period than those who didn't. Plus, foods labeled "reduced fat" or "fat free" can actually contain more calories than their full-fat counterparts, because the fat has been replaced with sugar, starch, and other fillers with little to no nutritional value to add back flavor.gt;gt;As for dairy, we've all heard that drinking milk (and eating yogurt) can boost bone health and even lower blood pressure and promote weight loss. If you're getting the multiple servings of milk you should each day, consider making some of it low fat to keep saturated fat and calories down. When it comes to cheese, Dr. Hu recommends indulging in the full-fat stuff occasionally; it has more flavor than low-fat cheese, so a little goes a long way.gt;gt;So how much "good" fat you should get? The American Heart Association recommends that unsaturated fats make up 18 to 28 percent of the calories in our diets, with no more than 7 percent of our daily calories coming from saturated fat. But here's an easier rule of thumb: "I just make sure that the fats I eat come from healthy food sources—like vegetable oils, fish, legumes, nuts, and other plant-based foods," says Dr. Hu. "If you do that, then there's no need to count." ]]> Getty Images

gt;heart attacksgt;, gt;arrhythmiasgt;, and gt;heart failuregt;. And many of these so-called Merry Christmas coronaries will hit people who didn't even realize they were at risk when they unwrapped their gifts the day before. gt;gt;But the holiday season isn't good for heart health to begin with. A 2004 gt;studygt; by researchers at the University of California, San Diego and Tufts University found that heart-related deaths increase by nearly 5% during the holidays, perhaps because patients delay seeking treatment for heart problems or because hospital staffing patterns change. But anecdotally, doctors say that their ERs stay quiet on Christmas Day itself. Then, come December 26, they see a surge of cardiac traffic. A 2008 gt;studygt; found that daily visits to hospitals for heart failure increased by 33% during the four days after Christmas. gt;gt;"This time of year is notorious for heart attacks, heart failures, and arrhythmias," says Samin Sharma, MD, director of interventional cardiology at Mount Sinai Medical Center in New York. Here's how to steer clear of the hospital. gt;gt;gt;Keep your ticker tickinggt; gt; It's easy to knock back several glasses of wine when you're sitting around the holiday table for long stretches of time, especially if you tell yourself that wine is good for your heart. But more than one alcoholic drink can have consequences: Excessive drinking can trigger gt;atrial fibrillationgt;, a form of irregular heartbeat. If it persists, atrial fibrillation ups your odds of suffering a gt;strokegt;. "There are huge campaigns not to drink and drive during the holidays, but no one talks about the heart dangers," says Dr. Sharma. gt;gt;Extra money woes coupled with an already stressful holiday season can also be a setup for overindulgence. "People don't have as much money, but they still need to spend," says Gerald Fletcher, MD, a cardiologist at the Mayo Clinic in Rochester, Minn. "They're cutting back, but they're worried about the credit card bill on the way. With all this in mind, people might be drinking more than ever." gt;gt;Normally, a holiday heart arrhythmia isn't fatal, and in fact it usually fades on its own. Some of the symptoms are the same as a hangover—nausea, weakness, and a pale face—and your heart should be back to normal in 24 hours. But if it isn't, you may need to see a doctor for medication or electrical cardioversion, which will stabilize your heart beat. gt;gt;gt;gt;How to avoid a holiday heart attackgt; gt;Every year, gt;cardiologistsgt; see a spike in heart attacks once the weather starts to turn. When temperatures drop, blood vessels tend to constrict, raising blood pressure. You may want to think twice before you decide to shovel your stoop or take a postprandial hike in bitter weather, as strenuous physical activity can leave you clutching your chest. gt;gt;But cold weather isn't the only culprit. Come Christmas Day, many people confuse the signs of a heart attack—like shortness of breath or chest pains—with indigestion from a big dinner. And while you may be apt to play it safe on any other day, hauling yourself down to the hospital may seem like too much of a hassle on a big holiday. gt;gt;Instead, many people ignore the telltale signs of a heart attack until they wake up on the 26th, still feeling that discomfort. But by then it may be too late. "If you're having a heart attack, studies show that you can't wait longer than 12 hours to be treated," says Dr. Sharma. So if you wait until December 26, you may be playing with your fate. gt;gt;Listen to your body over the long holiday haul and don't dismiss any discomfort as a by-product of overindulgence. Keep an eye on any friends or family members who have had a heart attack in the past. gt;gt;gt;Breaking diet rules and heart failuregt; gt;Patients with heart failure who are following a low-sodium diet need to exercise extra caution this Christmas. Experts say that these people may choose not to live within their everyday rules, opting to partake in holiday overindulgences instead. Heavy meals, too much salt, and excess alcohol can all exacerbate heart failure. gt;gt;"Doctors need to make a point of telling their patients not to overindulge," says Dr. Sharma. "Ultimately, though, it's the patients who are going to decide what to do." gt;gt;But everyone, not just gt;heart patientsgt;, can benefit from watching what they eat. "We need to try to stay healthy through the holidays, not wait until January 1," says Dr. Fletcher. "You can't keep your resolution if you don't live through the holidays."]]> If you aren't careful, your holiday fun could quickly turn fatal. (ISTOCKPHOTO)

gt;gt; If the FDA adopts the panel's recommendation—the agency isn't required to do so, but typically does in such cases—it would mark the first time that a statin was approved for heart-disease-free people with healthy cholesterol levels but other risk factors, including high levels of C-reactive protein (CRP), a marker of inflammation.gt;gt;It would also mean that roughly 6 million new patients would be eligible to take a statin—in this case, Crestor (rosuvastatin).gt;gt; The recommendation “changes medical practice dramatically [and] will work its way into the guidelines," says Steven E. Nissen, MD, the chairman of cardiovascular medicine at the Cleveland Clinic.gt;gt; Cardiologists are divided over the expanded use of the drug. Some say it will help fight heart disease; others are concerned about the data used by the panel and the potential side effects of statins. Adding to the debate is a new study, published this week in , that calls into question the strength of the connection between CRP and heart disease.gt;gt; The panel's decision was based almost entirely on the Jupiter trial, a study funded by Crestor’s maker, AstraZeneca, that compared a daily dose of Crestor to placebo in nearly 18,000 people who fit the description used by the panel (and who would not be eligible for a statin under the current guidelines).gt;gt; “There was a 44% reduction in death, heart attack, and stroke among people taking Crestor,” says Dr. Nissen. “The benefit was very large and happened very quickly."gt;gt; “I don’t think the new labeling recommendation is really controversial," he adds. "The decision was very straightforward and among the people who treat lipids, this is a no-brainer."gt;gt;gt;Not all experts agree. Cholesterol is clearly not the only risk factor for cardiovascular disease—half of all heart attacks occur in people with normal levels of LDL, or bad cholesterol—but the accuracy of CRP as a predictor of cardiac risk has been disputed. And because statins, like many drugs, carry a risk of potentially serious side effects, the evidence for CRP may not be strong enough to justify prescribing these drugs to healthy people over the long term, they say.gt;gt; Stephen Kopecky, MD, a professor of medicine and cardiovascular disease at the Mayo Clinic, in Rochester, Minn., points out that elevated CRP levels don't necessarily indicate an increased risk of heart disease. “There are a lot of things that make CRP levels increase that are not due to heart disease,” he says. Because CRP is a generic marker of inflammation, it can rise due to any condition that causes inflammation, such as an infection, he says.gt;gt; In the study, the largest analysis of its kind to date, researchers analyzed the role of CRP in heart attack, stroke, and numerous other conditions (such as cancer) in more than 160,000 people. The study found that people whose CRP levels were three times higher than average had a 68% increased risk of heart attack and a 39% increased risk of stroke. But when more traditional risk factors for heart disease—such as cholesterol and blood pressure—were taken into account, the connection between CRP and heart disease was less apparent. Their findings, they write, "reduce the likelihood" that heart disease is directly caused by CRP.gt;gt;Maria Belalcazar, MD, an assistant professor of endocrinology at University of Texas Medical Branch, in Galveston, says that CRP “is one more indicator of risk that we need to evaluate carefully to decide if a person needs [statin] therapy."gt;gt; CRP, however, "needs to be evaluated in context of patients’ overall risk,” she says. “The whole risk profile needs to be taken into consideration for primary prevention because we are committing a person to taking the medication for more than 20 years.”gt;gt; Although statins are generally well tolerated, side effects can include muscle pain or weakness and liver damage (which is usually reversible). In the Jupiter trial, a greater percentage of participants taking Crestor developed diabetes during the study; there were also 13 deaths related to gastrointestinal disorders and 18 patients who reported "a confusional state."gt;gt; The advisory panel—as well as a separate FDA reviewer—decided that the benefits of Crestor outweighed these risks, however.gt;gt; This may indeed be true in people who need to lower their LDL cholesterol, but it isn't necessarily the case among people with normal cholesterol, says Dr. Kopecky.gt;gt; Dr. Nissen says that although liver enzymes rise in people who take statins, "there is no risk of liver failure," and "muscle weakness is real, but rare," he says.gt;gt; "These are among the safest drugs and I am glad we have them,” he says.gt;gt; For his part, Dr. Kopecky stresses that the emphasis on CRP, cholesterol, and statin therapy should not distract people—and physicians—from other important factors in heart disease, such as family history and lifestyle.gt;gt; Statin therapy is useful, Dr. Kopecky says, but it shouldn't take the place of healthy living. “Statins are a great drug for the right person, but we have to make sure that their lifestyle is healthy before jumping to a medication,” he says.gt;gt; "You just can’t jump to medical therapy,” he explains. “I ask [patients],‘Do you exercise and eat five servings of fruits and vegetables a day? Do you smoke? Is your weight in a reasonable range?’ Living a healthy lifestyle can cut your chance of heart attack or stroke by 90% in decades. That's better than any therapy.”]]>

gt;heart diseasegt; rises after gt;menopausegt;, but they weren't exactly sure why. It wasn't clear whether the increased risk is due to the hormonal changes associated with menopause, to gt;aginggt; itself, or to some combination of the two.gt;gt;Now, we have at least part of the answer: A new study shows beyond a doubt that menopause, not the natural aging process, is responsible for a sharp increase in gt;cholesterolgt; levels.gt;gt;This seems to be true of all women, regardless of ethnicity, according to the study, which will be published next week in the .gt;gt;“As they approach menopause, many, many women show a very striking increase in cholesterol levels, which in turn increases risk for later heart disease,” says the lead author of the study, Karen A. Matthews, PhD, a professor of psychiatry and epidemiology at the University of Pittsburgh.gt;gt;Over a 10-year period, Matthews and her colleagues followed 1,054 U.S. women as they went through menopause. Each year the researchers tested study participants for cholesterol, blood pressure, and other heart disease risk factors such as blood glucose and insulin.gt;gt;In nearly every woman, the study found, cholesterol levels jumped around the time of menopause. (Menopause usually occurs around age 50 but can happen naturally as early as 40 and as late as 60.)gt;gt;In the two-year window surrounding their final menstrual period, the women's average LDL, or bad cholesterol, rose by about 10.5 points, or about 9%. The average total cholesterol level also increased substantially, by about 6.5%.gt;gt;Other risk factors, such as insulin and systolic blood pressure (the top number in a blood pressure reading), also rose during the study, but they did so at a steady rate, suggesting that the increases—unlike those for cholesterol—were related to aging, not menopause. Of all the risk factors measured in the study, the changes in cholesterol were the most dramatic.gt;gt;The jumps in cholesterol reported in the study could definitely have an impact on a woman’s health, says Vera Bittner, MD, a professor of medicine at the University of Alabama at Birmingham, who wrote an editorial accompanying Matthews’s study.gt;gt; “The changes don't look large, but given that the typical woman lives several decades after menopause, any adverse change becomes cumulative over time,” says Dr. Bittner. “If somebody had cholesterol levels at the lower ranges of normal, the small change may not make a difference. But if somebody's gt;risk factorsgt; were already borderline in several categories, this increase may tip them over the edge and put them in a risk category where treatment may be beneficial.”gt;gt;In a first, the study did not find any measurable differences in the impact of menopause on cholesterol across ethnic groups.gt;gt;Experts have been unsure how ethnicity may affect the link between menopause and cardiovascular risk, because most research to date has been conducted in Caucasian women. Matthews and her colleagues were able to explore the role of ethnicity because their research is part of the larger Study of Women’s Health Across the Nation (SWAN), which includes substantial numbers of African-American, Hispanic, and Asian-American women.gt;gt;gt;More research on the connection between menopause and heart disease risk is needed, according to Mathews. The current study doesn't explain how the increases in cholesterol will affect the rate of gt;heart attacksgt; and mortality down the road, for instance.gt;gt; As the SWAN study continues, Matthews says, she and her colleagues hope to identify warning signs that will show which women are most at risk for heart disease. “The important thing is, ultimately, when we can figure out the characteristics of women who have early signs of cardiovascular risk that, if we don’t do anything about them, could later result in a heart attack.”gt;gt;Women should be aware of the changes in risk factors that occur around menopause, says Dr. Bittner, and they should talk to their doctors about whether they need to have their cholesterol checked more often or whether they should begin a cholesterol-lowering treatment, such as a gt;statingt;.gt;gt;Maintaining a healthy weight, not smoking, and getting plenty of exercise are essential to help keep cholesterol levels in check, Dr. Bittner adds, and she points out that menopause can be an especially difficult time for women to get enough physical activity. “It often falls by the wayside because women in this age range take care of kids, spouse, aging parents, and often work in addition,” she says.gt;gt;“Midlife is a great time to make these changes,” Matthews says. “If we can essentially reset the course to a more health-promoting direction in midlife, then that will have benefits for many years to come.”gt;gt;Wolf Ulian, PhD, the founder and executive director of the North American Menopause Society, a nonprofit organization that provides information on menopause to consumers and health-care professionals, says the findings underscore that menopause is a good time for women to adopt healthier lifestyles.gt;gt;“Menopause is a milestone," he says. "It’s a time to take stock and take control and try to enhance the quality of your second half of life."]]> Getty Images

gt;gt;In fact, low total cholesterol is associated with about 60% less risk of the most aggressive form of prostate cancer, and higher levels of good cholesterol (HDL) may protect against lung, liver, and other cancers, according to two studies published this week in the journal .gt;gt;That’s quite a reversal of fortune for low cholesterol, which has, in the past, been associated with a cancer risk. The new studies suggest that low cholesterol may not deserve its bad reputation, earned from a series of studies in the 1980s that said people with low cholesterol might be at risk of cancer.gt;gt; In fact, cholesterol may drop in people with undiagnosed cancer, meaning that low cholesterol may be a result—not a cause—of cancer.gt;gt;In the first study, men with HDL cholesterol above roughly 55 mg/dL had an 11% decrease in overall cancer risk, including lung and liver cancer. (HDL levels between 40 and 50 are average for men.) The study, conducted by National Cancer Institute (NCI) researchers who looked at about 29,000 male smokers in Finland over an 18-year period, is the largest to show a relationship between HDL and cancer.gt;gt;"Very few studies measured [HDL], and any relationship between HDL and overall cancer risk had therefore not been adequately evaluated," the NCI's Demetrius Albanes, MD, the lead author of the study, said at a press briefing.gt;gt;While the findings are new and intriguing, more research needs to be conducted to confirm a link between HDL and cancer risk reduction.gt;gt; “[It’s] a very new, exciting question, but we need to do a great deal more research before we have any clear answers," says Eric Jacobs, PhD, an epidemiologist with the American Cancer Society, who co-wrote an editorial accompanying the studies. For his part, Dr. Albanes stressed that the results need to be confirmed, especially in women and nonsmokers.gt;gt;gt;At first, Dr. Albanes and his colleagues found their results seemed to back up the studies from the 1980s; they discovered that men with low total cholesterol had a higher cancer risk. The trend all but disappeared when they excluded cases of cancer that were diagnosed during the first nine years of the study. (Such men may have already had cancer, but it hadn’t been diagnosed yet.)gt;gt;In the second study, researchers looked at about 5,500 men ages 55 and older. Men with total cholesterol under 200 mg/dL—the range the National Heart, Lung and Blood Institute deems "desirable"—had roughly a 60% lower risk of high-grade prostate cancer, an aggressive type.gt;gt;"It was a notable reduction, which is not that often seen in prostate cancer research," the lead researcher, Elizabeth Platz, ScD, a cancer epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told reporters.gt;gt;The decrease in risk was found only in high-grade tumors and not in less serious cases of prostate cancer—a pattern that Platz and her colleagues reported in a previous, similar study. According to Jacobs, this pattern is not uncommon in prostate-cancer studies. Obesity, for example, is associated with a higher risk of more dangerous tumors but not with prostate cancer overall, he said.gt;gt;This study was inspired in part by a growing body of evidence that suggests that statins, which are cholesterol-lowering drugs such as Lipitor, may protect against high-grade prostate cancer. In the current study, however, Platz and her colleagues did not measure statin use and therefore were not able to determine whether the lower risk of high-grade prostate cancer was influenced by statins or other cholesterol-lowering methods, rather than naturally low cholesterol.gt;gt;"Our next step…is to look not just at total cholesterol, but to also evaluate the relationship for high HDL cholesterol and low LDL cholesterol, and also to evaluate whether cholesterol-lowering—rather than low cholesterol as the usual state for these men—would also explain this relationship," Platz said.gt;gt;More studies, including randomized controlled trials, are necessary to explain the link between cholesterol and prostate cancer, according to Platz.gt;gt;Jacobs agreed, noting that the findings of the two studies raise important questions. The effect that HDL cholesterol and total cholesterol have on cancer risk are "likely to be very interesting areas for future research," he said.]]> Getty Images

gt;gt; Heart disease can occur when arteries become clogged, but in heart failure, the heart gets progressively weaker and larger.gt;gt;Still, since the study included a small number of patients and looked at only one point in time, it’s too early to say if the findings have implications for heart failure patients taking statins, according to lead author Lawrence P. Cahalin, PhD, of Northeastern University, in Boston. Cahalin presented his findings on Tuesday at the American College of Chest Physicians annual meeting in San Diego.gt;gt;Tamara Horwich, MD, an assistant professor of medicine at the University of California, Los Angeles, agrees that the results need to be interpreted with caution. “I just don’t think we can draw any conclusions about statins having benefits versus ill effects in some patients,” says Dr. Horwich, who wasn’t involved with Cahalin’s study.gt;gt;In heart failure, the enlarged heart struggles to pump a sufficient amount of blood, which can cause fluid to collect in the limbs and lungs, resulting in shortness of breath and fatigue. However, one type of heart failure, systolic, occurs when the lower chambers of the heart can’t contract with enough force to drive blood throughout the body.gt;gt; In the other type, diastolic heart failure, the heart muscle is so stiff that it can no longer relax enough to fill with blood between beats. About half of people with heart failure have systolic; the other half have diastolic, which becomes more common with age and is more likely to strike women.gt;gt;About 5 million Americans have heart failure.gt;gt;Currently, there are no guidelines on whether patients with heart failure should take statins. Some studies have shown that they can be helpful, while others have found no benefit. The decision of whether to prescribe these drugs is typically based on a patient’s cholesterol levels, his age, and whether he also has coronary artery disease, according to Dr. Horwich.gt;gt; “There’s not a consensus,” she says. “It’s up to the individual physician to make a decision.”gt;gt;gt;Since statins can cause muscle damage, they could theoretically also harm the heart—which is, essentially, a big muscle—although there is no evidence that this is the case. To investigate whether the drugs might affect the heart and other muscles in heart failure patients, Cahalin and his colleagues analyzed data on lung function and exercise tolerance in 136 patients, 61 of whom were taking statins.gt;gt; Overall, the patients taking statins had worse lung function and exercise tolerance than those who weren’t taking the drugs. But when Cahalin and his team analyzed patients with the two different types of heart failure—systolic and diastolic—separately, they found the drugs seemed to help those with the systolic version, and hurt those with diastolic heart failure.gt;gt;Cahalin says he and his colleagues are planning to follow patients with both types of heart failure over time to see how taking statins affects their symptoms. He speculated that the anti-inflammatory effect of the statins could be helping systolic heart failure patients, while their muscle-weakening effects might impair breathing in those with diastolic heart failure.gt;gt;A major problem with the study, notes Dr. Horwich, is that there were a number of factors that could have contributed to the findings; for example, it’s not clear from the study why doctors chose to put some patients, but not others, on statins. Systolic heart failure patients may have seen more benefits because they were more likely to have coronary artery disease, she adds.gt;gt;“I think it’s definitely possible that statins may not be helpful in diastolic heart failure,” Dr. Horwich says. She notes that the importance of diastolic heart failure has only become clear relatively recently. Although doctors have a good handle on how to help patients with systolic heart failure, she explains, there really aren’t any treatments that are known to help patients with diastolic heart failure.gt;gt; According to Cahalin, it could make sense to do a simple lung function test on heart failure patients before prescribing statins. That way, he says, it would be easy to tell if their lung function got worse while they were on the drugs.gt;gt;And if someone with diastolic heart failure is prescribed the drug and his or her heart failure symptoms—such as weakness, fatigue, and shortness of breath—get worse, he adds, “that should be investigated.”]]> Istockphoto

gt;gt;But just because your Uncle Jack says a supplement worked miracles on his cholesterol doesn’t mean it will work for you. In fact, his success may be due to a placebo effect or a diet overhaul he neglected to mention.gt;gt; Though not always perfect, scientific studies are the best way to determine if nonprescription remedies really work. Below, we break down what the research does—and doesn’t—say about the benefits of the most popular alternative remedies for lowering cholesterol.gt;gt; To see what these supplements look like, gt;view this slideshowgt;.gt;gt;gt;gt;Artichoke leaf extractgt;gt;gt;gt;• gt;What it is:gt; The dried extract of the artichoke leaf is also known as .gt;gt;• gt;The evidence:gt; In 2000, German researchers performed a randomized, double-blind, placebo-controlled trial using nearly 150 adults with total cholesterol over 280—well into what the American Heart Association (AHA) considers “high risk” territory. The participants who took an artichoke supplement for six weeks saw their levels of low-density lipoprotein (LDL), or bad cholesterol, fall by 23%, on average, compared to just 6% in the placebo group.gt;gt;These are promising numbers, but they haven’t been replicated. A more recent, three-month trial of similar design found that total cholesterol fell by an average of 4% among participants taking artichoke leaf extract, but the researchers found no measurable impact on either LDL or high-density lipoprotein (HDL), also known as good cholesterol. They suggested that differences in the health of the participants and the potency of the supplements—the patients in the second study received a dose about 30% smaller—could explain the discrepancy between the results of the two studies.gt;gt;• gt;The bottom line:gt; There have been very few quality studies conducted on artichoke leaf extract, and the mixed results suggest that more evidence is needed to confirm its effect on cholesterol. Don’t expect your LDL to plummet if you take artichoke supplements.gt;gt;gt;gt;Fenugreekgt;gt;gt;gt;• gt;What it is:gt; Fenugreek is a seed (often ground into a powder) that has been used since the days of ancient Egypt and is available in capsule form.gt;gt;• gt;The evidence:gt; Several studies from the 1990s have reported that, in high doses, various fenugreek seed preparations can lower total cholesterol and LDL, in some cases dramatically. (One study recorded an LDL drop of 38%.) Almost without exception, however, the studies have been small and of poor quality, which casts some doubt on the validity of the results.gt;gt; Fenugreek contains a significant amount of dietary fiber (anywhere from 20% to 50%, analyses have shown), and some experts speculate that the purported cholesterol-lowering effect of fenugreek may in fact be attributed largely to its fiber content.gt;gt;• gt;The bottom line:gt; Despite the studies frequently cited as proof of fenugreek’s ability to lower cholesterol, there is not enough evidence to support its use.gt;gt;gt;gt;Fibergt;gt;gt;gt;• gt;What it is:gt; Soluble fiber is a type of dietary fiber found in oats, barley, bran, peas, and citrus fruits, as well as in dietary supplements. (Though it is good for the heart in other ways, insoluble fiber does not affect blood cholesterol.)gt;gt;• gt;The evidence:gt; In 1999, a team of Harvard Medical School researchers conducted a gt;meta-analysis of nearly 70 clinical trials that examined the effect of soluble fiber on cholesterol levelsgt;. High soluble fiber intake was associated with reductions in both LDL and total cholesterol in 60% to 70% of the studies they examined. For each gram of soluble fiber that the participants of the various studies added to their daily diet, their LDL levels fell by about 2 points. (The average time frame was seven weeks.)gt;gt;The amount of fiber you’d need to eat to significantly lower your LDL is a bit unwieldy. Most people eat far less than the 25 grams of dietary fiber recommended as a minimum by most health organizations—and only about 20% of your total fiber intake is likely to be soluble. (Eating three bowls of oatmeal a day will only yield about 3 grams of soluble fiber, according to the Harvard researchers.) Taking daily fiber supplements can help, but they can cause some gastrointestinal side effects if taken regularly and can interfere with some prescription medications.gt;gt;• gt;The bottom line:gt; A diet high in soluble fiber can lower your LDL. The effect is likely to be relatively modest, however, and loading up on soluble fiber may be impractical.gt;gt;gt;gt;gt;Fish oilgt;gt;gt;gt;• gt;What it is:gt; Fish is rich in two heart-healthy gt;omega-3 fatty acidsgt;, EPA and DPA. In concentrated form, these fatty acids are the main ingredients in fish oil supplements, which are usually sold as gel capsules.gt;gt;• gt;The evidence:gt; In clinical trials using relatively high doses (3 grams or more), fish oil has been shown to lower triglyceride levels—the third component of your total cholesterol number—by around 10% to 30%. (The higher your triglyceride levels, the more effective it is.) Fish oil doesn’t lower LDL, however. The supplements actually tend to cause a slight in LDL, although the form this additional LDL takes is thought to be less damaging to the arteries.gt;gt;High triglyceride levels have been associated with an increased risk of coronary heart disease, but lowering them is not as important as lowering LDL. In fact, some experts believe that triglycerides are a sign, rather than a cause, of heart disease risk.gt;gt;• gt;The bottom line:gt; Fish oil lowers triglycerides, especially in people with triglycerides. The American Heart Association gt;recommendsgt; that people who need to lower their triglycerides should, in consultation with their doctor, take 2 to 4 grams of fish oil a day; people with heart disease should consume about 1 gram a day of EPA and DPA (combined), preferably by eating fatty fish such as salmon.gt;gt;gt;gt;Garlicgt;gt;gt;gt;• gt;What it is:gt; Garlic is member of the onion family that is available as an oil, extract, or pill (in addition to its natural state).gt;gt;• gt;The evidence:gt; In a 2000 gt;report on garlic’s impact on cardiovascular risk factorsgt;, the federal Agency for Healthcare Research and Quality found that garlic caused a small but measurable drop in both LDL and total cholesterol, but only in the short term (three months).gt;gt;Subsequent research hasn’t been encouraging, however. A high-quality 2007 study in the compared raw garlic and commercial garlic supplements over a six-month period and gt;found no measurable effects of the various garlic forms on total cholesterol, LDL, HDL, or triglyceride levelsgt; versus placebo. The following year, a meta-analysis that included only randomized, placebo-controlled trials also concluded that garlic has no effect on cholesterol.gt;gt;• gt;The bottom line:gt; Though garlic may help lower LDL temporarily, its ability to meaningfully affect cholesterol levels is questionable at best.gt;gt;gt;gt;Ginsenggt;gt;gt;gt;• gt;What it is:gt; Ginseng is an herb native to Asia that has been used in traditional medicine for centuries and is now sold as capsules.gt;gt;• gt;The evidence:gt; The research on ginseng and cholesterol is mixed but unconvincing. In a comprehensive 2005 review, a team of Harvard Medical School researchers noted that several studies had found a beneficial effect from ginseng on one or more cholesterol components. But most of the studies were small, only a few were randomized, and none were blinded or placebo-controlled. In one study, the researchers found a drop of 45% in LDL levels and a rise in HDL of 44%—but it wasn’t controlled, included only eight participants, and was funded by a Korean manufacturer of ginseng products.gt;gt;• gt;The bottom line:gt; Though the results of the nonrandomized studies can’t be ignored, there isn’t enough to evidence to support the use of ginseng to lower cholesterol.gt;gt;gt;gt;Guggulgt;gt;gt;gt;• gt;What it is:gt; A tree-resin extract, long used in Ayurvedic medicine, guggul contains plant sterols (guggulsterones) and is available in capsule form.gt;gt;• gt;The evidence:gt; As with ginseng, the research on guggul and cholesterol is sketchy. Early studies reported reductions in total cholesterol, LDL, and triglycerides of 10% or more, but most of the studies were small and flawed. Then, in 2003, researchers at the University of Pennsylvania published a gt;randomized controlled trial of more than 100 people with high cholesterolgt;—the first guggul study conducted in the U.S.—in the . They found that guggul had no measurable effect on total cholesterol, HDL, or triglycerides—and that it caused an in LDL of about 5%. (LDL levels in the placebo group fell by roughly the same amount.)gt;gt;• gt;The bottom line:gt; The 2003 study was a black eye for guggul. More research is needed, but for now there is not enough evidence to justify using guggul to lower cholesterol. Plus, some gt;researchgt; has found that 20% of Ayurvedic medicines may be contaminated with lead or other toxins.gt;gt;gt;gt;gt;Niacingt;gt;gt;gt;• gt;What it is:gt; Niacin is a B vitamin (also known as nicotinic acid) that occurs naturally in meat, fish, and dairy. It’s also available as a capsule.gt;gt;• gt;The evidence:gt; Experts have known for decades that niacin helps lower cholesterol. Large trials—most notably a six-year study of more than 1,100 people conducted in the 1970s—have found that niacin can cause significant decreases in total cholesterol, LDL, and triglycerides. But its most notable effect is on HDL: Research shows that niacin can raise HDL levels by up to 35%. (In part, for this reason, niacin is commonly used in addition to statins, which lower LDL.)gt;gt;The catch is that it only has this effect at high doses of 2 grams to 3 grams a day, a dose that is typically taken as an extended-release prescription drug (such as Niaspan). Niacin is available as an over-the-counter supplement in extended-release doses of 500 milligrams or more, but consistently taking large amounts of niacin can result in side effects ranging from skin flushing to liver damage.gt;gt;• gt;The bottom line:gt; Niacin boosts HDL, but you shouldn’t take it without consulting a doctor. The AHA warns that niacin supplements should be taken in lieu of a prescription, due to the potentially serious side effects.gt;gt;gt;gt;Red yeast ricegt;gt;gt;gt;• gt;What it is:gt; Red yeast rice is a fungus that grows on rice and contains small amounts of a naturally occurring form of lovastatin, a type of statin that is also found in prescription medications.gt;gt;• gt;The evidence:gt; Compared to that of most dietary supplements, the evidence of red yeast rice’s efficacy is quite strong—which isn’t entirely surprising, given that red yeast rice is, in effect, a low-dose statin. In studies over the years (including in several high-quality trials), various red yeast rice preparations have been shown to lower LDL by around 20% to 30%, comparable to a prescription statin.gt;gt;More recent studies have backed up these results. In the most recent trial, a 2009 study of patients who had stopped taking statins due to muscle pain, red yeast rice capsules gt;lowered total cholesterol and LDL by 15% and 21%gt;, respectively (compared to 5% and 9% for placebo).gt;gt;• gt;The bottom line:gt; Red yeast rice is a potentially effective way to lower cholesterol, but its potency makes some experts wary—and suspicious. The amount of lovastatin in red yeast rice pills varies widely across brands—so much so that some brands appear to be spiked with lovastatin, according to an gt;analysis performed by a consumer watchdog groupgt;. Inadvertently ingesting too much of a statin can cause side effects (such as muscle pain), and due to the safety concerns, experts discourage using off-the-shelf red yeast rice.gt;gt;gt;gt;Soy proteingt;gt;gt;gt;• gt;What it is:gt; Soy protein is found in gt;soy foodsgt; such as tofu, edamame, and soy milk. It is also sold as a powder in nutrition stores.gt;gt;• gt;The evidence:gt; Ten years ago, the U.S. Food and Drug Administration began to allow labels on certain foods that contained soy; the labels said soy protein was low in saturated fat and dietary cholesterol, and it could help reduce the risk of heart disease by lowering LDL.gt;gt;Soy consumption in the U.S. exploded, but since then, research has found that the effect of soy protein on LDL is relatively modest. A 2006 gt;review by the American Heart Association’s nutrition committeegt; found that an average consumption of 50 grams of soy protein a day—twice as much as the FDA says is necessary to reduce the risk of heart disease—resulted in an average drop in LDL of just 3%. Nor did soy intake cause HDL levels to rise significantly.gt;gt;• gt;The bottom line:gt; Soy protein does lower LDL, but only slightly. The size of the effect seems to have been overstated.]]> (GETTYIMAGES)

gt;gt;gt;Myth 1: Americans have the highest cholesterol in the worldgt;gt;One of the world's enduring stereotypes is the fat American with cholesterol-clogged arteries who is a Big Mac or two away from a gt;heart attackgt;. As a nation, we could certainly use some slimming down, but when it comes to gt;cholesterol levelsgt; we are solidly middle-of-the-road.gt;gt;According to 2005 World Health Organization statistics, American men rank 83rd in the world in average total cholesterol, and American women rank 81st; in both cases, the average number is 197 mg/dL, just below the Borderline-High Risk category. That is very respectable compared to the top-ranked countries: In Colombia the average cholesterol among men is a dangerous 244, while the women in Israel, Libya, Norway, and Uruguay are locked in a four-way tie at 232.gt;gt; gt;Myth 2: Eggs are evilgt;gt;It's true that eggs have a lot of gt;dietary cholesterolgt;—upwards of 200 mg, which is more than two-thirds of the American Heart Association's recommended limit of 300 mg a day. But dietary cholesterol isn't nearly as dangerous as was once thought. Only some of the cholesterol in food ends up as cholesterol in your bloodstream, and if your dietary cholesterol intake rises, your body compensates by producing less cholesterol of its own.gt;gt; While you don't want to overdo it, gt;eating an egg or twogt; a few times a week isn't dangerous. In fact, eggs are an excellent source of protein and contain unsaturated fat, a so-called good fat.gt;gt;gt;gt;Myth 3: Kids can't have high cholesterolgt;gt;Most people think high cholesterol is a problem that's strictly for the middle-aged. But guess what? Research has shown that gt;atherosclerosisgt;—the narrowing of the arteries that leads to heart attacks—can gt;start as early as age eightgt;. In July 2008, the American Academy of Pediatrics released gt;guidelines on kids and cholesterolgt; that recommended that children who are overweight, have hypertension, or have a family history of gt;heart diseasegt; have their cholesterol tested as young as two years of age.gt;gt; Children with high cholesterol should be on a diet that restricts saturated fat to 7% of calories and no more than 200 mg per day of dietary cholesterol, according to the guidelines. Fiber supplements and more exercise are also recommended.gt;gt;While the guidelines prompted a bit of an outcry from parents worried that doctors would be pushing cholesterol-lowering drugs for kids, a new study suggests that less than 1% of adolescents aged 12 to 17 would be gt;considered candidates for medicationgt;.gt;gt;gt;Myth 4: Food is heart-healthy if it says "0 mg cholesterol"gt;gt;The Cholesterol portion of the nutritional label refers to dietary cholesterol, which is only one of the things found in food that can cause your cholesterol to go sky-high. (A bigger contributor to elevated cholesterol? A high-fat diet.) It's also believed to be the least important. Saturated fat (found in animal foods and dairy products) and trans fats (found in packaged foods) appear to have a far greater impact on low-density lipoprotein (LDL), the so-called gt;bad cholesterolgt; that causes atherosclerosis, than dietary cholesterol.gt;gt;gt;Myth 5: Cholesterol is always a bad thinggt;gt;When most people hear "cholesterol" they think "bad." Like most things in life, the reality is more complex. High cholesterol can be dangerous, but cholesterol itself is essential to various bodily processes, from insulating nerve cells in the brain to providing structure for cell membranes. That's why your body makes the white, waxy substance (about 75% of the cholesterol in your blood is made by the liver and cells elsewhere in your body).gt;gt; The role of cholesterol in heart disease is often misunderstood. Cholesterol is carried through the bloodstream by low-density and high-density lipoproteins (LDL and HDL). LDL, known as bad cholesterol, and not the cholesterol it carries per se, is responsible for atherosclerosis.]]> American men rank 83rd in the world in average total cholesterol. (ISTOCKPHOTO)

gt;gt;gt;Your 30sgt;gt;gt;gt;Declare a trans fat–free zonegt;gt;Commonly used to extend the shelf life of packaged foods like cookies and crackers, and also found in margarine, trans fats pack a double whammy: They raise gt;bad cholesterolgt; (LDL), while lowering good, protective HDL (your LDL should be below 100; your HDL, above 60). In a Harvard University study, women with the highest level of trans fats in their blood had triple the risk of gt;heart diseasegt;. Take a cue from major U.S. cities like New York and Philadelphia (which have banned trans fats from restaurants), and pitch them out of your pantry. gt;gt;On ingredient lists, they show up as “hydrogenated” and “partially hydrogenated” oils. But scrutinize any product touted as “trans fat–free” at the supermarket too: Some manufacturers have replaced hydrogenated oils with tropical oils that are high in gt;saturated fatgt;, which also raises LDL cholesterol. Eating out in a city where trans fats aren’t banned? Skip the fried stuff; many restaurants still use the oils for frying. gt;gt;gt;Use your ob-gyn as a partnergt;gt;During your prime reproductive years, you may visit your ob-gyn more than you go to your regular doctor. Make sure you talk to her about your heart as well as gynecological health, particularly because gt;blood pressuregt; (BP) can rise if you’re taking birth control pills or when you’re pregnant. gt;gt;Women who develop preeclampsia (pregnancy-related hypertension) are prone to heart disease later in life. And, in general, “how your heart handles pregnancy offers a snapshot of how it will look in middle age,” says Sharonne Hayes, MD, director of the Women’s Heart Clinic at the Mayo Clinic, in Rochester, Minn. To keep BP from creeping up (the safe zone is lower than 120 over 80), substitute herbs and spices for salt; try cumin for a healthy twist on popcorn, for instance. Too much salt causes blood vessels to retain water, which can lead to high BP. gt;gt;gt;Simmer downgt;gt;If you boil over when the shopper in front of you has 16 grocery items in the 15-or-fewer lane, beware: Losing your temper can damage your arteries, according to research by C. Noel Bairey Merz, MD, director of the Women’s Heart Center and endowed chair in Women’s Health at the Cedars-Sinai Heart Institute in Los Angeles. “Raging causes your blood pressure to surge and stay up there,” Dr. Merz says. That’s why it’s crucial to gt;get a grip on angergt; at an early age, before it takes a toll. Instead of venting when a situation makes you furious, take a few deep breaths and describe to yourself what’s making you angry. That should help you calm down. gt;gt;Your 40sgt;gt;gt;gt;Don’t skimp on sleepgt;gt;When your hormones are fluctuating madly, it can be tough to nod off. It’s no wonder, then, that more than half of women in their 40s suffer from gt;insomniagt; at least a few nights a week. That’s nothing to yawn about, either. When your body is deprived of restorative sleep, your heart has to work harder. And piles of studies show that too little shut-eye can lead to heart attack, stroke, heart failure, and diabetes. gt;gt;How little is too little? A recent study in the suggests that less than 7.5 hours per night puts you at risk for heart disease. And recent research from Duke University found that women who take more than a half-hour to fall asleep or those who awaken frequently during the night have inflammation in their arteries and higher levels of insulin, two major risk factors for heart disease. gt;gt;The soporific Rx: Do your best to unwind with a relaxing gt;bedtime routinegt;, like listening to soothing music or a soaking in a tub with bath salts. And despite how difficult it might sound, obey this rule: no technology or work in the bedroom; your bed should be for sleep and sex only. gt;gt;gt;Monitor your moodgt;gt;Between the demands of work and family, it’s easy to worry that something will fall through the cracks—but don’t let that something be your own peace of mind. Perimenopausal women have nearly double the risk for gt;depressiongt;, and that spells trouble for their hearts, says Jennifer Mieres, MD, a cardiologist and associate professor at New York University’s School of Medicine. Uncontrolled stress can raise blood pressure and flood blood vessels with inflammatory chemicals, which in high doses can be toxic to the heart, while depression has been linked to hardening of the arteries. Then there are the unhealthy habits that come with stress and the blues: gt;smokinggt;, excessive drinking, and overeating. gt;gt;Smart medicine for your mood and your heart? gt;Exercisegt;. Thirty minutes of aerobic activity (walking, biking, swimming) most days of the week has been shown to reduce the symptoms of depression by about half, an effect comparable to gt;antidepressantgt; use, while lowering blood pressure and strengthening your cardiovascular system. But if you’re feeling low more often than not, talk to your doctor about therapy, antidepressants, or St. John’s wort. (New research suggests that this herb works as well as antidepressants and has few side effects.) gt;gt;gt;Get more fish, flaxseed, and fibergt;gt;In your 40s, as estrogen dips, your blood pressure, gt;cholesterolgt;, and triglycerides (a type of fat stored in the blood) start creeping up, making a heart-healthy menu more important than ever. Aim for two servings of fish, like salmon or tuna, each week for gt;omega-3 fatsgt;; or pick omega-3-fortified foods like orange juice, margarine, and eggs. Also, sprinkle ground flaxseed on yogurt or cottage cheese to lower cholesterol. And experiment with dishes that contain gt;high-fiber foodsgt; like apples, broccoli, beans, and bran cereal. Health fads come and go, but a high-fiber diet has consistently proved to be good for the heart, says Leslie Cho, MD, director of the Women’s Cardiovascular Center at the Cleveland Clinic, in Ohio. gt;gt;Your 50s-Plusgt;gt;gt;gt;Whittle your waistgt;gt;If a few extra pounds have settled around your middle since menopause, you’re not alone. “Basically, we start putting on weight more like men,” says Nieca Goldberg, MD, medical director of New York University’s Women’s Heart Program and author of . The “meno potbelly” is especially hard on the heart because it builds up around internal organs, triggers inflammation, and leads to insulin resistance. gt;gt;Research from the famous Nurses’ Health Study found that women with a waist circumference of more than 35 inches were twice as likely to die of heart disease than women with a 28-inch waist, regardless of weight. Low-intensity workout routines can help slow down the belly buildup, but to shrink it you’ll need to work up a sweat with 60 minutes of moderate-intensity aerobic exercise at least three times a week. Try jogging, walking on the treadmill on a challenging incline, or swimming laps. gt;gt;gt;Stay stronggt;gt;Since hormone replacement therapy (HRT) is no longer thought to protect your heart and may even harm it (talk to your doctor about the risks if you decide to try it), you need to safeguard your heart with strong muscles. Add strength training, such as a weight-lifting class, yoga, or gt;Pilatesgt;, to your exercise routine at least twice a week, Dr. Goldberg recommends. You’ll keep blood pressure in check, boost metabolism, zap more calories, gt;control cholesterolgt;, and improve endurance. Sum total? A heart that’ll keep pumping happily for years to come. gt;gt;gt;Enjoy some "friend benefits"gt;gt;Whatever causes you stress, leaning on friends for support and commiseration can help keep blood pressure in check. “There are clearly good things that happen to your heart when you care about people and people care about you,” Cedars-Sinai’s Dr. Merz says. Talk out the stress with friends over a walk or at the gym, and you’ll double your heart benefit.gt;gt; gt;Health gt;]]> (ISTOCKPHOTO)

gt; gt; gt; gt; gt; gt;gt; gt; ]]> Your doctor is aiming to bring it below 120 over 80. (DYNAMIC GRAPHICS/CREATAS/GETTY IMAGES)