By: Henry Bodkin

Cholesterol does not cause heart disease in the elderly and trying to reduce it with drugs like statins is a waste of time, an international group of experts has claimed.A review of research involving nearly 70,000 people found there was no link between what has traditionally been considered “bad” cholesterol and the premature deaths of over 60-year-olds from cardiovascular disease.
Lowering cholesterol with medications is a total waste of time. Professor Sherif Sultan, University of IrelandThe authors have called for a re-evaluation of the guidelines for the prevention of cardiovascular disease and atherosclerosis, a hardening and narrowing of the arteries, because “the benefits from statin treatment have been exaggerated”.
The results have prompted immediate scepticism from other academics, however, who questioned the paper’s balance.
High cholesterol is commonly caused by an unhealthy diet, and eating high levels of saturated fat in particular, as well as smoking.
It is carried in the blood attached to proteins called lipoproteins and has been traditionally linked to cardiovascular diseases such as coronary heart disease, stroke, peripheral arterial disease and aortic disease.

Co-author of the study Dr Malcolm Kendrick, an intermediate care GP, acknowledged the findings would cause controversy but defended them as “robust” and “thoroughly reviewed”.
“What we found in our detailed systematic review was that older people with high LDL (low-density lipoprotein) levels, the so-called “bad” cholesterol, lived longer and had less heart disease.”
Vascular and endovascular surgery expert Professor Sherif Sultan from the University of Ireland, who also worked on the study, said cholesterol is one of the “most vital” molecules in the body and prevents infection, cancer, muscle pain and other conditions in elderly people.
“Lowering cholesterol with medications for primary cardiovascular prevention in those aged over 60 is a total waste of time and resources, whereas altering your lifestyle is the single most important way to achieve a good quality of life,” he said.
Lead author Dr Uffe Ravnskov, a former associate professor of renal medicine at Lund University in Sweden, said there was “no reason” to lower high-LDL-cholesterol.
But Professor Colin Baigent, an epidemiologist at Oxford University, said the new study had “serious weaknesses and, as a consequence, has reached completely the wrong conclusion”.
Another sceptic, consultant cardiologist Dr Tim Chico, said he would be more convinced by randomised study where some patients have their cholesterol lowered using a drug, such as a stain, while others receive a placebo.
He said: “There have been several studies that tested whether higher cholesterol increases the risk of heart disease by lowering cholesterol in elderly patients and observing whether this reduces their risk of heart disease.
“These have shown that lowering cholesterol using a drug does reduce the risk of heart disease in the elderly, and I find this more compelling than the data in the current study.”
The British Heart Foundation also questioned the new research, pointing out that the link between high LDL cholesterol levels and death in the elderly is harder to detect because, as people get older, more factors determine overall health.
“There is nothing in the current paper to support the author’s suggestions that the studies they reviewed cast doubt on the idea that LDL Cholesterol is a major cause of heart disease or that guidelines on LDL reduction in the elderly need re-valuating,” a spokesman said.

In recent years, a deficiency of vitamin D has been linked to type 2 diabetes and heart disease, two illnesses that commonly occur together and are the most common cause of illness and death in Western countries. Both disorders are rooted in chronic inflammation, which leads to insulin resistance and the buildup of artery-clogging plaque.

Now, new research in mice at Washington University School of Medicine in St. Louis suggests vitamin D plays a major role in preventing the inflammation that leads to type 2 diabetes and atherosclerosis. Further, the way key immune cells behave without adequate vitamin D may provide scientists with new therapeutic targets for patients with those disorders.

The study appears March 19 in the journal Cell Reports.

Studying mice that lacked the ability to process vitamin D in immune cells involved in inflammation, the researchers found that the animals made excess glucose, became resistant to insulin action and accumulated plaques in their blood vessels.

“The finding that vitamin D helps regulate glucose metabolism may explain previous epidemiological studies identifying an increased risk of diabetes in patients with vitamin D deficiency,” said senior investigator Carlos Bernal-Mizrachi, MD, associate professor of medicine and of cell biology and physiology. “In our study, inactivation of the vitamin D receptor induced diabetes and atherosclerosis, so normalizing vitamin D levels may have the opposite effect.”

In addition, he said inadequate vitamin D turned immune cells into transporters of fat. That may help researchers better understand how diabetes and atherosclerosis are linked and provide new possibilities for therapy.

For years, researchers have been studying vitamin D’s possible roles in inflammation and inflammatory diseases, such as type 2 diabetes and atherosclerosis. By engineering mice without the vitamin D receptor on important immune cells called monocytes and macrophages, the researchers were able to learn how those conditions are linked, according to Bernal-Mizrachi.

Monocytes are white blood cells made in the bone marrow that circulate in the bloodstream. After a few days, they typically move into the body’s tissues where they mature into cells called macrophages.

“Inactivating the vitamin D receptor on monocytes and macrophages promotes inflammation of the liver and in artery walls,” he said. “It also increases the ability of monocytes in the blood to adhere and migrate into blood vessel walls, where they deposit cholesterol and secrete inflammatory substances that lead to diabetes and heart disease.”

He said the findings suggest that getting enough vitamin D may reduce those properties in immune cells, decreasing inflammation and reducing the onset of a combination of heart disease and diabetes, which is often referred to as cardiometabolic disease. In addition, the researchers found that without vitamin D, monocytes carried fat to the walls of blood vessels, which is something that hadn’t been observed previously.

“We knew that when monocytes matured and became macrophages, they would eat cholesterol deposited inside the blood vessel wall,” said co-first author Amy E. Riek, MD, assistant professor of medicine. “But in these experiments, we found that when they don’t have vitamin D, the monocytes, while they’re still in circulation, also eat up cholesterol and carry it in the bloodstream.”

That’s an important discovery, Riek explained, because it’s much easier to find treatments that target something in the blood than it is to target the same cells after they move into the wall of a blood vessel.

“So that provides us, potentially, with a new target for therapy,” she said.

It also changes the way that scientists think about how lipids are carried into the blood vessel wall to cause plaques. Scientists already knew that LDL, the so-called bad cholesterol, carried fat deposits to the vessel wall. Now this study suggests that when monocytes don’t have enough vitamin D, they can do it, too.

“The monocytes were laden with fat in the absence of vitamin D receptor,” Bernal-Mizrachi said. “And they carried that fat into the artery, so that’s a new understanding of another way fat may get into blood-vessel walls in patients who are vitamin D deficient.”

Interestingly, the problem was reversible in the mice. When the animals that had developed type 2 diabetes and atherosclerosis received bone marrow transplants from mice with healthy vitamin D receptors on their monocytes and macrophages, their inflammation levels decreased, and the animals had lower blood glucose and became more sensitive to insulin.

Currently, Bernal-Mizrachi and Riek are conducting clinical studies in people who have type 2 diabetes, treating them with vitamin D to see whether it can prevent some of the complications of diabetes and inflammation in humans, too.

“As part of that study, we’re actually isolating monocytes from the blood of patients before and after vitamin D therapy,” Riek said. “So we can look at the inflammatory properties of those cells to see whether vitamin D is causing any changes.”

Funded by grants from the National Heart, Lung and Blood Institute (NHLBI) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), the Children’s Discovery Institute, and the American Diabetes Association. NIH grant numbers R01HL094818-0, K12HD001459, UL1 TR000448, KL2 TR000450. T32 DK007120 and P60DK20579.


Reference: The above post is reprinted from materials provided by Washington University in St. Louis. The original item was written by Jim Dryden. Note: Materials may be edited for content and length.


For educational purposes only. This information has not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Acupuncture significantly enhances peripheral blood flow. Photoplethysmography results published in Electron Devices and Solid-State Circuits demonstrates that acupuncture induces “significant elevation of peripheral blood flow.” The research team making this discovery notes that a prior investigation using single-channel photoplethysmography demonstrates that acupuncture enhances “local microvascular blood flow in tissue surrounding Zusanli after acupuncture at that site.” The new research takes the investigation another step further. Using multi-channel photoplethysmography, the researchers demonstrate that needling acupuncture point ST36 (Zusanli) induces “significant elevations in whole body peripheral blood flow and parasympathetic activities after acupuncture at Zusanli.”

The ancient principles of traditional Chinese medicine (TCM) posit acupuncture as a means to regulate qi and blood flow throughout the body through a transporting network of meridians and acupuncture points along those meridians. The researchers note that the study “reinforces the theory of traditional Chinese medicine….” The researchers measured acupuncture’s ability to induce “significant elevations in peripheral blood flow over the upper and lower limbs during and after acupuncture.” Based on the findings, the researchers conclude that “the results of this study support the theory of Chinese medicine that acupuncture at Zusanli augments systemic gastrointestinal and circulatory functions.”

The researchers provide background concerning the need for this investigation. In 1996, the World Health Organization (WHO) denoted that acupuncture is beneficial in the treatment of 64 conditions including those involving pain, psychiatric concerns, neurological disorders, digestive imbalances, respiratory disorders, dermatological conditions, and gynecological diseases. They add that in Taiwan, acupuncture is commonly used for the treatment of many conditions including “stroke, dementia, Parkinson’s disease, epilepsy, Bell’s palsy, carpal tunnel syndrome, and headache.” The study was designed to clarify the mechanisms by which acupuncture exerts its effective actions. 

About The Point
Acupuncture point ST36 is located on the lower leg. According to TCM principles, it is a he-sea, earth, lower he-sea of the stomach, and sea of nourishment point. It is also a Gao Wu command point and a Ma Dan-yang heavenly star point. ST36 functions to order the spleen and stomach, regulate qi and blood, and strengthen weak and deficient conditions. Traditional indications for using ST36 include: gastrointestinal pain, emesis, abdominal distention, diarrhea or constipation, mastitis, abscessed breast, enteritis, gastritis, edema, asthma, anemia, lassitude, exhaustion, indigestion, hemiplegia, mania, and neurasthenia. 

Equipment
Photoplethysmography is a non-invasive optical technique used to measure blood volume changes in microvascular beds. The researchers used an eight-channel photoplethysmography device made by the Lite-On Electronics Company. High and low-pass filters with cutoff frequencies of 0.48 - 10 Hz were implemented. The signals were processed by a USB-6210 DAQ analog to digital converter made by National Instruments (Austin, Texas). A computer was used to store the data and perform waveform monitoring and analysis.


Reference:
Yang, Cheng-Chan, Wei-You Zhuang, and Hsien-Tsai Wu. "Assessment of the impact of acupuncture on peripheral blood flow with multi-channel photoplethysmography." In Electron Devices and Solid-State Circuits (EDSSC), 2014 IEEE International Conference on, pp. 1-2. IEEE, 2014.



For educational purposes only. This information has not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.