Walnuts Lowered LDL Cholesterol in Seniors

Emilio Ros, MD, PhD led the Walnuts and Healthy Aging Study (WAHA) looking at healthy seniors in Loma Linda, California and Barcelona, Spain. He followed 636 patients who were randomly assigned to a walnut supplemented diet or walnut free diet.

Senior Citizens who ate a diet supplemented with walnuts lowered their LDL cholesterol significantly.  The walnut supplemented group exhibited a reduction of total cholesterol of 8.5 mg/dl with an LDL cholesterol reduction of 4.3 mg/dl.  Triglycerides and HDL cholesterol were not affected. In addition to lowering cholesterol, Dr. Ros said other studies showed a positive result in lowering blood pressure. 

Christie Ballantyne MD, chief of cardiology at Baylor College of Medicine, and director of cardiovascular disease prevention at Methodist DeBakey Heart Center, said nutritional studies are difficult to complete. The number of participants is usually small and the length of the study short. This study encompassed large numbers over two years in two different locales. 

Dr. Ros commented that adults are always wondering what can they eat as a healthy snack?  Walnuts can now be added to that list.

PCSK9 Inhibitors Not All They Are Cranked Up To Be

For months now physicians treating patients with elevated cholesterol have been looking forward to learning how to use the new monthly injectable PCSK9 inhibitor medicines that were touted to dramatically lower LDL cholesterol and cause far fewer side effects. They were designed to be used in patients with a hereditary form of elevated cholesterol traditionally very hard to control with oral statin medications and for statin intolerant patients with coronary artery disease.

The drawbacks to the new medication is its costly nature running more than $1,200 a month with many insurers, including Medicare, not yet covering it. There were additional concerns that the lowering of LDL cholesterol was so dramatic that it may cause problems in other organ systems that require cholesterol for certain functions.

The April 3rd edition of the University of Pennsylvania’s online Medical Review known as MedPage Today revealed data from Steven E Nissan, MD, of the Cleveland Clinic on the use of evolocumab (Repatha) in the phase III GAUSS -3 trial. This study looked at statin intolerant patients who had failed on two previous statin drugs or were unable to raise the statin dose from the minimal available level.  This study compared the effects of Repatha to oral Zetia (ezetimibe) at 22 and 24 weeks.  The study clearly showed that Repatha lowered LDL cholesterol levels by about 55% compared to ezetimibe at 17%.  The level of LDL cholesterol level was similar to results of the other cholesterol lowering PCSK9 inhibitor alirocumab (Praluent).

What I found most interesting is not that these expensive new injectables worked well but that 20% of the statin intolerant patients had similar muscular aches and pains and complaints with this new non statin injectable. Less than one percent of the patients on the new injectable in the study actually stopped the drug due to the muscular pains.

At this point my practice is still investigating the new injectables. Part of that investigation is determining which insurers will pay for the use of the drug and which will not.  In the past I have waited a good year for a new type of medication to be out on the US market to observe the true adverse risk profile before prescribing it. This promising injectable monoclonal antibody to reduce LDL cholesterol will be treated no differently.