Queen Amrose Ne­fertari’s housem­aid suffered fr­om a hardening of the arteries some 3,500 years ago. Less than 40-year-old Lady Rai and five of the 16 Egyptian priests and members of pharaoh courts showed atherosclerosis a few millennia before it became a disease associated with life­style, as doctors in the US and Egypt found from medical scans of ancient mummies.

Long before fast food be­came the bane of modern living, high cholestrol had afflicated human beings, showing signs that could lead to heart attack and stroke. The nature of disease may not have changed, but living habits have, increasing the percentage under threat of dying younger.

Cholesterol has become a household term for urbanites, thanks to numerous TV commercials, especially those of refined oil companies.

The wa­xy, fat-like substance, which occurs in the body naturally or is processed from food intake, is essential to maintain the fluidity of blood in all living creatures.

In excess quantity, it can become fatal. It can stick to the walls of heart and brain arteries, clogging them and increasing a person’s chance of developing heart disease or stroke.

Increase in cholesterol level is attributed to unhealthy eating habits, smoking and alcohol consumption. According to the World Health Organi­sation, more than 12 million people die each year from cardiovascular diseases worldwide. And some 80 per cent of the deaths take place in developing countries. By 2010, the diseases are expected to be the leading cause of death in developing countries.

Cholesterol is produced in the liver and travels through blood in different types of bundles called lipoproteins, a substance that contains both protein and fat molecules. The low-density lipoprotein (LDL) is known as the ‘bad’ cholesterol and high-density lipoprotein (HDL) is the ‘good’ cholesterol.

“Higher the level of LDL in blood, more is the risk of coronary heart disease. But higher levels of HDL cholesterol protect the heart while low levels increase the risk of artery diseases,” said Dr Harsh Wa­rdhan, head cardiologist at Ram Manohar Lohia Hospital in New Delhi.

Doctors across the globe prescribe statins to check or re­duce LDL levels and the markets are flooded with generic ones. The drugs re­corded $34 billion in worldwide sales last year and about Rs 1,000 crore in India, growing at about seven per cent. “Statins have been found to lower the risk of coronary artery disease by lowering LDL cholesterol,” says Harsh Wardhan.

The drugs, says Dr Vinayak Deb, interventional cardio­logist at Rabindranath Tagore In­ternational Institute of Ca­rdiac Sciences in Kolkata, blocks a key enzyme in the production of cholesterol that inhibits the liver’s ability to produce LDL.

“This causes an increase in the number of the LDL receptors on the surface of liver cells, resulting in more cholesterol being removed from the bloodstream,” Dr Deb said.

But LDL lowering pills have come under strong scrutiny. In a clinical trial reported last week, researchers found that Merck & Co’s pills Vytorin and Zetia didn’t reopen clogged arteries.

The thickness of artery walls in patients given Zetia showed no change, the study by Allen Taylor, director of the Advanced Cardi­ovascular Im­aging and Lipid/Prevention Clinic in the Department of Medicine at Washington Hos­pital Centre said. Artery thickness is beli­eved to be a predictor of risk in heart attack and stroke be­cause it restricts blood flow, researchers said. On the other hand, Abbott Laboratories’ Niaspan, a form of niacin, or Vitamin B that increases HDL, reduced the wall’s thickness.

The finding is expected to raise doctors’ awareness of the role of HDL. “There will be an up-tick in the use of niacin because of this,” Steven Nissen, chief of cardiology at the Cleveland Clinic in Ohio told media. “It was quite a compelling result. Yes, it is a small study; but I do think it will get attention.”

However, Merck dismissed the study. “The results of the small study do not, in any way, change our view of Zetia and Vytorin as effective medicines for fighting high LDL cholesterol,” Peter S Kim, president of Merck Research Lab­oratories, said in a statement mailed to Financial Chronicle.

He quoted the New En­gland Journal of Medicine editorial to say there were ‘several limitations’ of the study. He said it would encourage pat­ients to continue taking their medication as prescribed by their physicians.

According to Richard Karas, professor of medicine at Tufts University medical school in Boston, even with statins, patients continue to have heart attacks and strokes, so doctors continue to seek additional treatments. He told media that previous studies suggest that HDL-raising drugs could double the benefit of lowering bad cholesterol.

However, most of the doctors in India say that to maintain the healthy level of cholesterol in human body, both the methods are essential and neither of them is of much use in isolation. Dr KK Sethi, director of cardiology at Delhi Heart and Lung Institute said, “Lo­wering LDL is a well validated step toward improving cardiovascular health, though in­creasing HDL should also be given the same preference.”

To keep cholesterol at a healthy level, one needs to have LDL level below 100 milligrams per deciliter of blood and HDL level above 45. Ironically, there are fewer dr­ugs to increase the HDL level. The imbalance is partially because of the doctor’s traditional approach that aims to decrease the bad cholesterol.

However, AK Sood, senior cardiologist at Rockland Hos­pital in New Delhi said boosting good cholesterol was not being given enough attention. “We need to focus on both of these factors as it has been noticed that chances of heart related problems are high in those patients who do not have the recommended level of HDL,” Sood said.

Dr T S Kler, executive director of cardiac sciences and head of the department of cardiology at Escorts Heart Institute & Research Centre in New Delhi said that dip in HDL should be avoided.

“Life style modifications such as change in dietary ha­bits and regular exercise are very helpful in reducing the bad cholesterol and increasing good cholesterol,” he said.

According to Dr I Saty­amurthy, director of car­diology at Chennai’s Ap­ollo Hos­pitals, niacin, which im­proves HDL levels, can also elevate blood sugar levels and therefore is being used in select patients only.

The drug is also found to have side-effects such as palpitation, warm sensation, flushing and abdominal irritation. Trials are being conducted to introduce formulations in which there is a sustained release of the drug.

Statins too have their share of side effects which can vary from muscle pain, nausea, gastric irritation and high levels of liver enzymes. But they have been in use for long, and most doctors see benefit in its continued use.

Dr Subhajit Dutta Roy, who recently returned from the UK and is associated with Kolkata-based Columbia Asia Hospital said statins have “been seen to lower LDL levels by 18 to 55 per cent.”

A study in the Journal of American Medical Association said LDL levels in the US fell by one-third from 32 per cent to 21 per cent between 1999 and 2006 as more people took cholesterol-lowering drugs. Despite the Washington Hos­pital study, the jury may still be out on statins, especially since they have been seen to be effective for so long.

For any refocusing of the approach to cholesterol treatment, a more detailed study would be needed. zz

With inputs from Kumar Shankar Roy in Kolkata and Sangeetha G in Chennai