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“Those with HDL of more than 75 may even be blessed with what’s called the longevity syndrome.” Lori Mosca, MD, preventive cardiologist, Columbia University

The HDL-Longevity Connection

Gene—Diet/Lifestyle Interactions

We’ve all heard that having a high level of HDL “good” cholesterol protects us against heart disease and stroke. What’s new is that high-density lipoprotein may also help us think more clearly and live longer.

“Just like your LDL can’t be too low, your HDL can’t be too high,” says preventive cardiologist Dr. Lori Mosca. “I have patients with HDL over 120, and I tell them that’s probably how long they will live.” There is, however, a catch: “Such off-the-chart amounts result from good genes, not healthy habits.”

Be that as it may, healthy habits do matter. I’ll explain using my own example.

The new findings stem from an ongoing study of centenarians being conducted by gerontologist Nir Barzilai at the Albert Einstein College of Medicine in New York City. Starting in the late 1990s, Barzilai and his colleagues enrolled 500 Ashkenazi Jews living in New York who had reached age 95 or older and were still able to live independently. They were typically 97 years old when they entered the study, and were followed from one to 11 years.

They found that people in this long-lived group—the researchers called them the “best of the best”—often carry the CETP variant and have very high HDL levels. (CETP is “cholesterol ester transfer protein.”) Good genes seem to be a key factor. As Dr. Barzilai put it, “Behaviors and risk factors do not get you to 100; for that you need the right genetics.”

And there’s more.

“They don’t only live longer, they live healthier, too,” added Dr. Sofiya Milman, an assistant professor at Einstein University. Those with the CETP variant tend to be disease free and have sharper mental function in old age, Milman told Health Day News. (Nov 6, 2014)

Barzilai and many other researchers are searching for drugs that mimic the effects of the favorable CETP genotype. Barzilai predicts that a number of such drugs will become commercially available in the near future.

Many, however, do not share his optimism. “Despite the tremendous power of this work, one shouldn’t underestimate the enormous challenge of extending the healthy lifespan in the general population,” Geoffrey Kabat, a cancer epidemiologist at the Albert Einstein College, wrote on Forbes.com. “Given the complexity of biology and the human genome, the notion that aging can be delayed by modulating a single gene or a single molecular pathway is probably fanciful.”

Dr. Luigi Fontana, co-director of the longevity research program at Washington University in St. Louis, told Health Day News that high HDL is “just one of the pieces of the longevity puzzle.” No doubt true, but the importance of HDL cholesterol should not be discounted. “HDL-C is an extremely good biomarker…with an inverse relationship with all kinds of cardiovascular events,” Peter Libby, MD, chief of cardiology at the Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, said in a verbal exchange with Cleveland Clinic cardiologist Steven E. Nissan on Medscape.com (November 6, 2014). “That is as solid a finding as you can get in observational epidemiology. It is a very reliable prospective marker.”

Researchers are studying a range of factors that can promote a healthier, longer life—including various genes, diet and exercise, Dr. Fontana told Health Day News. Lifestyle choices “have major effects in promoting health and longevity,” Fontana said.

No one knows what the future holds, but finding a drug that mimics the CTEP variant and raises HDL remains a pipedream. As things now stand, lifestyle factors are the only proven way to raise HDL cholesterol levels—perhaps increasing your odds for a longer and healthier life.

Let’s look at my experience.

*   *  *

As I wrote several months back, my latest Cooper Clinic exam produced my best ever HDL cholesterol reading—86. HDL under 40 is bad, and anything over 60 is considered good. Over 85 is very good. Studies suggest that each single point of increase in HDL is matched by a 2 to 3 percent reduction in heart disease. As indicated above, high HDL-C may also portent a longer and healthier life.

How I got there shows the power of healthy living.

My HDL-C has been measured regularly since 1988, a total of 30 times. From 1988 (age 50) until 2008 my average HDL reading was 60; the low was 50 and the high 68. Good certainly, but no indication of unusually good genes. Something changed at that point—my HDL average increased 20 points—and it wasn’t my genes. The low was 75 in 2012 and the high 86 in 2014. My genetic makeup was the same, so the improvement must’ve been due to a change in lifestyle.

I have never smoked and my weight has been well under control. My training was essentially unchanged, a balance of strength and endurance. My diet has always been as good as I know how to make it—whole foods, balanced, near vegetarian. The one thing that has changed over time is the level and kind of fat in my diet. For many years my diet was low fat—as recommended by the medical guidelines of the time.

In 1998, I began adding small amounts of vegetable oil (olive, canola, or flaxseed) to snacks and meals. That cut my triglycerides in half and dropped my total cholesterol below 200 for the first time. (A low dose statin dropped my LDL “bad” cholesterol below 100, where it remains. My latest reading is 79.)

My HDL, however, was unchanged, averaging 61.

The big change came in 2009, when I began having salmon 2 or 3 times a week. That moved my HDL into the 70s—78 in 2009, 76 in 2011 and 75 in 2013. It wasn’t until 2013—when I made sardines a regular part of my breakfast and switched from skimmed to organic whole milk—that my HDL moved into the 80s: 83 in 2013 and 86 in 2014.

So, my very good HDL-C is not an accident of nature. Lifestyle made it happen. You may want to give it a try. The results may be a delightful surprise as it was for me.

As always, talk with your health care provider before making major changes in your diet or lifestyle.

For more details see About HDL “Good” Cholesterol: http://www.cbass.com/HDLCholesterol.htm   

*  *  *

Researchers Look to Genes for Personalized Diet/Lifestyle

We may soon be able to match diet and lifestyle with genetic makeup to achieve the optimum lipid profile for each individual. The status of this effort was summarized by Yan Zheng and Lu Qi in the journal Clinical Lipidology and reproduced on Medscape.com November 17, 2014.

The authors included a very helpful sidebar capsulizing in plain language what has been found so far. Happily, they confirm that those of us who exercise regularly, pay attention to what we eat, and control our bodyweight—and monitor our blood lipids regularly—are on the right track.

Zheng and Qi write that unbalanced diet and sedentary lifestyle are key risk factors for bad or disordered blood lipids. Diet and lifestyle are effective in improving lipid profiles and sustaining weight loss.

Genes are also an important factor. Studies have revealed 157 gene variations significantly associated with blood lipid metabolism. Forty-six of the variants are unique to HDL-cholesterol, while only 9 are unique to LDL-cholesterol and 18 to total cholesterol. Sixteen are unique to triglycerides. Other variants relate to more than one lipid trait. For example, 36 showed significant associations with both total cholesterol and LDL-cholesterol and four showed strong associations with total, HDL- and LDL-cholesterol and triglycerides.

Combining the two findings, they wrote that “emerging data from observational studies and clinical trials have shown that genetic factors may interact with diet and lifestyle factors in determining circulating lipid profiles.” Put another way, genes and diet/lifestyle combine to determine blood lipids. That would explain why diet and lifestyle work better for some people than for others.

Until we learn how to tailor diet and lifestyle to individuals based on genetic makeup, diet and lifestyle interventions to improve lipid profiles will produce mixed results.

The future looks bright, however. “Combination of novel knowledge of genomics and metabolomics with diet/lifestyle intervention holds great promise to better understand the [individual] variation in responses to dietary and lifestyle factors,” the authors wrote. “Recent advances have provided the potential to tailor diet and lifestyle recommendations to individuals based on the genomic makeup, in other words, personalized diet and lifestyle intervention,” they added. The majority of the findings, however, have yet to be replicated. “Further research is warranted in translating the results from gene-diet/lifestyle studies into public health benefit,” Zheng and Qi concluded.

For now, healthy habits will continue to help most of us. The amount and type of fat you eat are up to you. Do your homework, and go with what makes the most sense to you. Keep trying until you get it right.

Again, talk with your health care provider before making major changes in your diet or lifestyle.

Coming in our January, 2015, Update: A report on the small sub-type of HDL cholesterol which appears to increase the risk of heart disease--and ways to deal with it.

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