‘Good’ cholesterol-raising drug on horizon

A drug being tested now may kick off a new heart health revolution by raising levels of HDL, or “good” cholesterol, in the body, much as statins used today lower LDL, or “bad” cholesterol, according to a prominent cardiologist at one of the nation’s top heart hospitals.

Steven E. Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic and president of the American College of Cardiology, said Monday (Oct. 23) that he is encouraged by drug trials now under way, whose final results he expects by January. The trials are of an experimental drug, torcetrapib, manufactured by pharmaceutical giant Pfizer Inc. that raises levels of high-density lipoprotein, or HDL.

“I believe 2007 will be the year of HDL. There is a revolution about to occur,” Nissen said. “We think this will lead to another huge decrease in the rate of heart disease.”

Nissen was a panelist at a conference on heart health at Harvard Medical School, sponsored by Newsweek and Harvard Health Publications. Nissen said he expects to announce the results of the trial in March.

The HDL-raising drug represents a new approach toward fighting heart disease, the number one cause of death in the United States.

High levels of cholesterol, a waxy, fatty substance that builds up inside blood vessels, has long been known to be a risk factor for heart attack and stroke. Not all cholesterol is bad, however. The body has two types: LDL, or low-density lipoprotein, and HDL, or high-density lipoprotein.

High LDL levels are responsible for clogging blood vessels, and physicians have long sought to fight heart disease by getting patients to lower the levels of LDL in their blood. Diet has been a major weapon in this fight, as cutting cholesterol and saturated fat intake can reduce LDL levels.

In the late 1980s, doctors gained another weapon in the fight against high cholesterol with a group of drugs called statins, which lower LDL levels.

The new drug, Nissen said, will open a new front on the war for heart health by raising levels of HDL, which has been shown to have protective qualities and can prevent cholesterol buildup on blood vessel walls. Torcetrapib, Nissen said, has been shown to raise HDL levels by as much as 60 percent.

Nissen spoke during an afternoon panel discussion on “Frontiers in Diagnosis,” with Peter Libby, Mallinckrodt Professor of Medicine and chief of cardiovascular medicine at Brigham and Women’s Hospital, and Thomas Brady, Lawrence Lamson Robbins Professor of Radiology and director of cardiovascular imaging and intervention at Massachusetts General Hospital.

Though a new weapon in the fight for heart health would be welcomed, speakers on both that panel and an earlier one, “Community Approaches to Prevention,” emphasized that tried-and-true paths to a healthy heart are both low-tech and well known.

JoAnn Manson, Elizabeth F. Brigham Professor of Women’s Health and chief of preventive medicine at Brigham and Women’s Hospital, said during the earlier discussion that studies have consistently shown that the keys to a healthy heart are a healthy diet, regular exercise, not smoking, maintaining a healthy weight, and not drinking more than a moderate amount of alcohol.

Those factors are not only responsible for a healthier heart, but have also been shown to lead to drastic reductions in stroke, type 2 diabetes, and, to a lesser extent, cancer, Manson said.

For many Americans, however, those things are easier said than done. Despite the increasing knowledge about a healthy lifestyle, the nation is growing fatter and experiencing an increase of related diseases, such as type 2 diabetes.

Tom Farley, chair of the Department of Community Health Sciences at Tulane University’s School of Public Health and Tropical Medicine, said changing people’s entrenched behavior is the key to improving heart health.

“What people know and what they do have been disconnected,” Farley said. “Our environment makes it too easy to not get enough physical activity, makes it hard to get physical activity, and too easy to have high-energy snack foods.”

Farley said that efforts focused on education have failed, not because people don’t become educated, but because behavior change doesn’t follow. He suggested a campaign similar to the one that radically changed the way society views another health hazard: smoking.

Among the successful tactics in the smoking campaign were raising taxes, counter-advertising to deflate smoking’s positive image, and banning smoking in public places.

“We can apply that same method to obesity prevention and cardiovascular disease prevention,” Farley said.

Some steps are already being taken against junk food in the schools, and Farley suggested taking those further, banning junk food in the workplace, where many employers pay employees’ health insurance costs and so have an interest in a healthy workforce. He also suggested levying a tax on junk food and using the money raised to subsidize healthy fruits and vegetables.