- The Washington Times - Saturday, January 31, 2004


Heart researchers may be closing in at last on a long-fantasized goal — treatments that flush out the nasty globs of gunk that clog the heart’s plumbing.

This idea goes beyond merely preventing new coronary artery disease. The intention is to actually clear away what’s already there, to clean up the source of heart attacks before they happen.

Ideally, the human body already does this cleaning on its own, and the new medicines are intended to enhance the natural artery cleansing process. If testing goes as scientists hope, the strategy could prove to be as important for preventing heart disease as the cholesterol-lowering statin drugs introduced in the late 1980s.

“If it works, we are talking about the potential of reducing cardiac events by 50 or 60 percent or more,” said Dr. Steven Nissen of the Cleveland Clinic. “We are talking about really controlling the disease.”

Dr. Nissen is working with about a half-dozen of these drugs, and it is too soon to know which of them and others in the pipeline eventually will make it into drug stores. But when they arrive — and many researchers seem confident some will — the medicines are likely to become part of a heart-protecting cocktail of medicines doctors envision to increase good cholesterol, lower the bad variety and reduce bloodstream inflammation.

The new drugs boost high-density lipoproteins (HDL), the friendly half of cholesterol’s yin and yang, often outgunned by its evil counterpart, LDL.

The interest in HDL marks a big shift in attention to heart disease prevention. Ever since the arrival of statins, its main preoccupation has been reducing LDL, which carries in the cholesterol that clogs the arteries.

The statins’ benefits have been impressive, even though cardiovascular disease remains the world’s biggest killer. They cut LDL in half, which helps stabilize the disease and reduce heart attacks and deaths by one-quarter to one-third.

“To an optimist, that’s terrific,” said Dr. Prediman Shah, cardiology chief at Cedars-Sinai Medical Center in Los Angeles, “but the glass is still two-thirds empty. To contain the continuing ravages of this disease, there has to be something else.”

He and many others said they believe that something is HDL. In its garbage truck role, HDL scoops up cholesterol from the arteries and carries it back to the liver for disposal.

Doctors have suspected its importance since the 1970s. Studies that follow people through life show the higher a person’s HDL, the lower the risk of heart attacks. Each point of HDL increase is matched by a 2 percent to 3 percent reduction in heart disease.

In the United States, the average HDL in men is about 45 and in women, 55. HDL less than 40 is an especially bad sign, while anything more than 60 is considered good. Individuals with HDL of more than 75 may even be blessed with what’s called the “longevity syndrome.”

“Just like your LDL can’t be too low, your HDL can’t be too high,” said Dr. Lori Mosca, head of preventive cardiology at Columbia University. “I have patients with HDL over 120, and I tell them that’s probably how long they will live.”

Such off-the-chart amounts result from good genes, not healthy habits. For most people, budging HDL upward is difficult, although exercising, losing weight, drinking modestly, and quitting smoking all can help.

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