Patients do not need to fast before having their cholesterol tested, a major report has found.
After analysing data from 300,000 people, Cambridge researchers found results were just as accurate if the patient had eaten before the test.
While a number of studies have pointed to this, the "no need to fast" message has not yet been absorbed, experts say.
It is hoped the review in the Journal of the American Medical Association will inform guidelines everywhere.
Cholesterol tests have long been a key part of assessing a patient's risk of cardiovascular problems.
Fasting was recommended as it had been thought the body needed enough time to digest food in the system and to clear any fatty particles from the blood. This was in order to produce an accurate reading of so-called "bad" cholesterol - or low-density lipoprotein (LDL).
But data from 68 long-term surveys in 21 countries suggests this is not the case.
"For decades, people have been asked to fast overnight before their cholesterol tests," lead researcher Professor John Danesh said.
"These findings indicate that cholesterol measurements are at least as good - and probably somewhat better - when made without fasting."
The study also adds to the ongoing controversy over whether testing for blood proteins called apolipoproteins is a more reliable way of predicting heart risk than cholesterol testing.
The studies showed that analysing "good" cholesterol - or high-density lipoprotein (HDL) in conjunction with LDL was just as informative as testing for apolipoproteins AI and B.
Professor Peter Weissberg, medical director of the British Heart Foundation, which funded the study, said: "Given the financial pressure the NHS is under, it's good news that doctors don't need to spend money on setting up more sophisticated tests based on apolipoproteins.
"But the study underlines the importance of all GPs being able to measure HDL cholesterol as well as total cholesterol, in order to make the best predictions about heart disease risk."
Not all doctors currently use tests which differentiate between the two different forms of cholesterol.
Cardiovascular disease - CVD - is the leading form of death in the UK and many other parts of the world.
Dr Dermot Neely of charity Heart UK said the findings on fasting confirmed what many clinicians already knew.
"But it has been very slow to get through, particularly in primary care. There are still labs that will not take non-fasting specimens, so patients get sent home. Hopefully this analysis, which backs up current guidelines, will drive the message home."
Israeli study shows red grapefruit lowers cholesterol, fights heart disease
By David Brinn February 19, 2006
A grapefruit a day - particularly the red variety - can help keep heart disease at bay, according to a new study by Israeli researchers. Heart disease is the number one killer of women in the United States, and February has been designated as American Heart Month.
The research team led by Hebrew University of Jerusalem Dr. Shela Gorinstein, found patients who ate the equivalent of one grapefruit a day had lower cholesterol levels than those who did not - due to the antioxidants in the fruit. Chronic high blood cholesterol is a major risk factor for heart disease.
Gorinstein of the university's Department of Medicinal Chemistry and Natural Products, collaborated in the study with her long-time research partner Prof. Abraham Caspi, head of the Institute of Cardiology at Kaplan Hospital in Rehovot, as well as scientists from Poland and Singapore who participated in laboratory work connected with the project.
"For over 25 years, I've worked researching different foods and diets and their effects on cholesterol. I've done studies on beer, persimmons, hybrids like the pomelit, as well as traditional fruits like apples and pears - all with the goal of finding a diet that will decrease cholesterol," Gorinstein told ISRAEL21c.
The grapefruit study, which strengthens a growing body of evidence supporting the heart-healthy benefits of eating citrus fruit, was published on the website of the American Chemical Society's Journal of Agricultural and Food Chemistry and will appear in the journal's March print issue.
"I'm very proud of this study, because it included Israeli scientists, Israel grapefruit and Israeli patients," said Gorinstein.
The study included 57 patients at Kaplan Hospital, both men and women, with hyperlipidemia (high blood cholesterol) who recently had coronary bypass surgery and did not take statin drugs during the study period. According to Gorinstein, statins are commonly prescribed to lower cholesterol.
The patients, equally divided into three treatment groups, were given either a single serving of fresh red grapefruit, white (blond) grapefruit or no grapefruit, along with regular, balanced meals for 30 consecutive days. Israeli Jaffa red Star Ruby and white grapefruit varieties - also available in the US - were used in the study.
This study was very similar to the study that we conducted on the pomelit. But in this case, we used three groups ? two experimental and one control group," Gorinstein said.
The patients who received either red or white grapefruit showed significant decreases in blood lipid levels, whereas the patients that did not eat grapefruit showed no changes in lipid levels, according to the researchers. Red grapefruit was more effective than white in lowering lipids, particularly blood triglycerides, a type of cholesterol whose elevated levels are often associated with heart problems, Gorinstein reported.
"In both experimental groups, the level of cholesterol was lowered. In addition, the triglyceride level ? which is a very important factor in arteriosclerosis ? decreased, considerably more in the group that ate the red grapefruit," she said.
"It is likely that antioxidants in the grapefruits are responsible for their health benefits," says Gorinstein, adding that the red variety generally has higher antioxidants than the white.
"But, perhaps in addition to antioxidants, there may be some other important compounds in red grapefruit which could be influencing the decrease of the triglyceride levels. Future research is very important."
Both the fresh fruit and the juice are believed to be equally beneficial, Gorinstein and her associates say. One cup of fresh grapefruit is roughly equivalent to half a cup of juice.
Grapefruit is known to interact with certain medications - sometimes adversely - so the researchers caution people on prescription medication to consult with their doctor or pharmacist to determine whether their medicine will interact before consuming grapefruit products.
"But, if you can lower cholesterol with natural products instead of medication, then it will be our victory," said Gorinstein.
Refusing to rest on her laurels, the effervescent Gorinstein is already enthusiastically looking ahead to her team's next challenge.
"The next project will be very interesting. We're going to study the effects of exotic fruit on cholesterol."
Study: Atkins Good for Cholesterol By DANIEL Q. HANEY, AP Medical Editor
CHICAGO (AP) - Multitudes swear by the high-fat, low-carbohydrate Atkins diet, and now a carefully controlled study backs them up: Low-carb may actually take off more weight than low-fat and may be surprisingly better for cholesterol, too.
For years, the Atkins formula of sparing carbohydrates and loading up on taboo fatty foods has been blasphemy to many in the health establishment, who view it as a formula for cardiovascular ruin.
But now, some of the same researchers who long scoffed at the diet are putting it to the test, and they say the results astonish them. Rather than making cholesterol soar, as they feared, the diet actually appears to improve it, and volunteers take off more weight.
Still, the number of overweight people studied this way is small, and the research does not examine possible long-term ills or advantages, including how long people keep the pounds off.
So for now, the researchers say that much more research is necessary before the Atkins diet can be given an across-the-board endorsement, but at least they believe it is safe enough to take into much larger studies.
At least three formal studies of the Atkins diet have been presented at medical conferences over the past year, and all have reached similar results. The latest, conducted by Dr. Eric Westman of Duke University, was presented Monday at the annual scientific meeting of the American Heart Association (news - web sites), long a stronghold of support for the traditional low-fat approach.
Westman, an internist at Duke's diet and fitness center, said he decided to study the Atkins approach because of concern over so many patients and friends taking it up on their own. He approached the Robert C. Atkins foundation in New York City to finance the research.
Westman studied 120 overweight volunteers, who were randomly assigned to the Atkins diet or the heart association's Step 1 diet, a widely used low-fat approach. On the Atkins diet, people limited their carbs to less than 20 grams a day, and 60 percent of their calories came from fat.
"It was high fat, off the scale," he said.
After six months, the people on the Atkins diet had lost an average of 31 pounds, compared with 20 pounds on the AHA diet, and more people stuck with the Atkins regimen.
Total cholesterol fell slightly in both groups. However, those on the Atkins diet had an 11 percent increase in HDL, the good cholesterol, and a 49 percent drop in triglycerides. On the AHA diet, HDL was unchanged, and triglycerides dropped 22 percent. High triglycerides may raise the risk of heart disease.
While the volunteers' total amounts of LDL, the bad cholesterol, did not change much on either diet, there was evidence that it had shifted to a form that may be less likely to clog the arteries.
"More study is necessary before such a diet can be recommended," Westman said. "However, a concern about serum lipid (cholesterol) elevations should not impede such research."
No single study is likely to change minds the issue, especially since an initial weight loss is hard to maintain on any diet. Some answers could come from a yearlong study being sponsored by the National Institutes of Health (news - web sites). That experiment, being directed by Dr. Gary Foster of the University of Pennsylvania, will test the Atkins diet on 360 patients.
In the meantime, the heart association's president, Dr. Robert Bonow of Northwestern University, said the organization will reconsider the Atkins diet as more research results become available.
"Having our top academic centers look at this is wonderful," he said. "We are still dealing with small numbers of patients. We just need more data."
Dr. Sidney Smith, the heart association's research director, said it was a surprise that the Atkins diet did not raise LDL cholesterol. "One small study like this flies in the face of so much evidence. We can't change dietary recommendations on the spot," he said.
Dr. Alice Lichtenstein, a nutrition expert at Tufts University, said she thinks too much is made of the amounts of carbohydrates and fats in people's diets as they try to shed weight.
"There is no magic combination of fat versus carbs versus protein," she said. "It doesn't matter in the long run. The bottom line is calories, calories, calories."
CHOLESTEROL AND HEART DISEASE I.Q.
Prepared by the National Heart, Lung, and Blood Institute NATIONAL INSTITUTES OF HEALTH
Are you cholesterol smart? Test your knowledge about high blood cholesterol with the following statements. Circle each true or false. The answers are given on the back of this sheet.
1. High blood cholesterol is one of the risk factors for heart disease that you can do something about. T F
2. To lower your blood cholesterol level you must stop eating meat altogether. T F
3. Any blood cholesterol level below 240 mg/dL is desirable for adults. T F
4. Fish oil supplements are recommended to lower blood cholesterol. T F
5. To lower your blood cholesterol level you should eat less saturated fat, total fat, and cholesterol, and lose weight if you are overweight. T F
6. Saturated fats raise your blood cholesterol level more than anything else in your diet. T F
7. All vegetable oils help lower blood cholesterol levels. T F
8. Lowering blood cholesterol levels can help people who have already had a heart attack. T F
9. All children need to have their blood cholesterol levels checked. T F
10. Women don't need to worry about high blood cholesterol and heart disease. T F
11. Reading food labels can help you eat the heart healthy way. T F
How cholesterol smart are you?
Answers to the Cholesterol and Heart Disease I.Q. Quiz
1. True. High blood cholesterol is one of the risk factors for heart disease that a person can do something about. High blood pressure, cigarette smoking, diabetes, overweight, and physical inactivity are the others.
2. False. Although some red meat is high in saturated fat and cholesterol, which can raise your blood cholesterol, you do not need to stop eating it or any other single food. Red meat is an important source of protein, iron, and other vitamins and minerals. You should, however, cut back on the amount of saturated fat and cholesterol that you eat. One way to do this is by choosing lean cuts of meat with the fat trimmed. Another way is to watch your portion sizes and eat no more than 6 ounces of meat a day. Six ounces is about the size of two decks of playing cards.
3. False. A total blood cholesterol level of under 200 mg/dL is desirable and usually puts you at a lower risk for heart disease. A blood cholesterol level of 240 mg/dL is high and increases your risk of heart disease. If your cholesterol level is high, your doctor will want to check your level of LDL-cholesterol ("bad" cholesterol). A HIGH level of LDL-cholesterol increases your risk of heart disease, as does a LOW level of HDL-cholesterol ("good" cholesterol). An HDL-cholesterol level below 35 mg/dL is considered a risk factor for heart disease. A total cholesterol level of 200-239 mg/dL is considered borderline-high and usually increases your risk for heart disease. All adults 20 years of age or older should have their blood cholesterol level checked at least once every 5 years.
4. False. Fish oils are a source of omega-3 fatty acids, which are a type of polyunsaturated fat. Fish oil supplements generally do not reduce blood cholesterol levels. Also, the effect of the long-term use of fish oil supplements is not known. However, fish is a good food choice because it is low in saturated fat.
5. True. Eating less fat, especially saturated fat, and cholesterol can lower your blood cholesterol level. Generally your blood cholesterol level should begin to drop a few weeks after you start on a cholesterol-lowering diet. How much your level drops depends on the amounts of saturated fat and cholesterol you used to eat, how high your blood cholesterol is, how much weight you lose if you are overweight, and how your body responds to the changes you make. Over time, you may reduce your blood cholesterol level by 10-50 mg/dL or even more.
6. True. Saturated fats raise your blood cholesterol level more than anything else. So, the best way to reduce your cholesterol level is to cut back on the amount of saturated fats that you eat. These fats are found in largest amounts in animal products such as butter, cheese, whole milk, ice cream, cream, and fatty meats. They are also found in some vegetable oils--coconut, palm, and palm kernel oils.
7. False. Most vegetable oils--canola, corn, olive, safflower, soybean, and sunflower oils--contain mostly monounsaturated and polyunsaturated fats, which help lower blood cholesterol when used in place of saturated fats. However, a few vegetable oils-- coconut, palm, and palm kernel oils--contain more saturated fat than unsaturated fat. A special kind of fat, called "trans fat," is formed when vegetable oil is hardened to become margarine or shortening, through a process called "hydrogenation." The harder the margarine or shortening, the more likely it is to contain more trans fat. Choose margarine containing liquid vegetable oil as the first ingredient. Just be sure to limit the total amount of any fats or oils, since even those that are unsaturated are rich sources of calories.
8. True. People who have had one heart attack are at much higher risk for a second attack. Reducing blood cholesterol levels can greatly slow down (and, in some people, even reverse) the buildup of cholesterol and fat in the wall of the coronary arteries and significantly reduce the chances of a second heart attack. If you have had a heart attack or have coronary heart disease, your LDL level should be around 100 mg/dL which is even lower than the recommended level of less than 130 mg/dL for the general population.
9. False. Children from "high risk" families, in which a parent has high blood cholesterol (240 mg/dL or above) or in which a parent or grandparent has had heart disease at an early age (at 55 years or younger), should have their cholesterol levels tested. If a child from such a family has a cholesterol level that is high, it should be lowered under medical supervision, primarily with diet, to reduce the risk of developing heart disease as an adult. For most children, who are not from high-risk families, the best way to reduce the risk of adult heart disease is to follow a low saturated fat, low cholesterol eating pattern. All children over the age of 2 years and all adults should adopt a heart healthy eating pattern as a principal way of reducing coronary heart disease.
10. False. Blood cholesterol levels in both men and women begin to go up around age 20. Women before menopause have levels that are lower than men of the same age. After menopause, a women's LDL-cholesterol level goes up--and so her risk for heart disease increases. For both men and women, heart disease is the number one cause of death.
11. True. Food labels have been changed. Look on the nutrition label for the amount of saturated fat, total fat, cholesterol, and total calories in a serving of the product. Use this information to compare similar products. Also, look for the list of ingredients. Here, the ingredient in the greatest amount is first and the ingredient in the least amount is last. So to choose foods low in saturated fat or total fat, go easy on products that list fats or oil first, or that list many fat and oil ingredients.
THE LOWER CHOLESTEROL FOOD SHOPPING LIST
Apples- buy organic and eat the peel
Flaxseed meal- keep it refrigerated or it goes rancid
Smart Balance or Benecol cooking spray/margarine substitute