Boiled coffee, like the kind drunk in Scandinavia and Turkey, tends to raise cholesterol and the risk of heart disease. But filtered coffee does not raise cholesterol or increase the risk of heart disease.

Researchers at Boston University polled 858 women hospitalized with a first heart attack and an equal number of healthy women on their health habits, including coffee consumption. Researchers found that compared with non coffee drinkers, women who said they drank five to six cups of coffee a day had a 40 percent greater risk of having a heart attack, women who drank seven to nine cups, a 70 percent greater risk.

But women who drank less than five cups of coffee a day had no higher risk than women who didn’t drink coffee at all. Investigators at Kaiser Permanente Medical Center in Oakland, California, evaluated the relationship between coffee and tea intake and mortality rate including deaths from coronary heart disease in nearly 129,000 people.

After an eight year follow up period, neither coffee nor tea was found to have increased the overall death rate in these individuals. Drinking four or more cups of coffee a day wastied to a slightly higher risk of death from heart attack, however.

Researchers at Johns Hopkins Medical Institutions in Baltimore had 100 healthy men drink varying amounts of filtered coffee: 24 ounces of regular coffee, 12 ounces of regular coffee, 24 ounces of decaffeinated coffee or no coffee at all. After eight weeks, the men who drank the 24 ounces of regular coffee a day experienced small increases in their total cholesterol, due to slight rises in their “bad’ LDLm and “good” HDL cholesterol.

The researchers concluded that these small increases in LDL and HDL together “should not affect coronary heart disease risk.” That’s because small changes in HDL can protect against much larger changes in LDL.

In Israel, researchers analyzed coffee and tea consumption and cholesterol levels in 5,369 people. The investigators’ conclusion:

The individuals who drank five or more cups of coffee a day had higher levels of total cholesterol as much as 18 milligrams/deciliter higher than the individuals who abstained from coffee. The researchers also noted that the people who drank the most coffee in their study were also the most likely to have negative health habits, especially smoking. “It is conceivable that the increased cholesterol levels in smokers may be confounded by coffee drinking,” wrote the researchers.

Some coffee drinkers may make other lifestyle choices that may be responsible for elevating their cholesterol levels.  For example,  caffeine tends to stimulate hunger in certain people. Some people may respond by eating foods that increase their cholesterol levels. But it’s difficult to isolate the effect of caffeine on cholesterol and to determine whether the increases in cholesterol are caused by caffeine or by something else.

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“A fresh apple is a great snack food,” says Evelyn Tribole, R.D., a dietitian in Beverly Hills, California, and author of Healthy Home style Cooking .

But there are other ways to enjoy the delicious taste of apples. Try these suggestions.

•    Mix sliced apples with a low-fat cheese, sprinkle with fresh chives and serve on romaine lettuce. You might also toss sliced apples with raisins, almonds and cooked chicken and splash the salad with tarragon vinegar.
•    Add apples to baked goods. “You can grate apples into almost anything that you bake, including low fat muffins and cakes,” . Try grating one large apple into a recipe that yields six large
muffins.
•    Saute a side dish. Sauteed apples are a delicious accompaniment to meat (preferably leaner cuts). After sauteing turkey cutlets, for example, remove the meat from the pan and add sliced peeled apples
to the meat juices. Saute the apples for five minutes, then stir in 1/2 cup of apple juice and cook until the apples are soft (about three minutes). Serve with the cutlets.
•    Bake a guilt free pastry. Chop up some apples, add cinnamon and a little sugar, wrap the apples in phyllo dough and bake, suggests Tribole. “You’ll end up with something like apple strudel that’s very low in fat,”.

As healthful as apples are, you can sabotage their goodness. “Consuming apples in a pie with a thick crust loaded with butter isn’t the best way of eating them,” says Sheah Rarback, R.D., director of nutrition at the University of Miami School of Medicine’s Mailman Center.

You can indulge your sweet tooth occasionally. But if you want to help lower your blood cholesterol, it’s best to munch fresh apples or to prepare them in some other healthy way. To keep apples crisp, wrap them in a plastic bag and store them in the refrigerator. Apples kept at room temperature soften ten times faster than refrigerated fruit.

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If so, your risk of coronary heart disease will depend on the presence of other factors, including certain inherited blood lipid problems. Or you may be the one person in five with known coronary heart

disease who has a cholesterol level less than 200 mg/dl. If so, this  will help you understand why you developed coronary heart disease despite a desirable blood cholesterol level.

What is your family history? If your blood cholesterol level is less than 200 mg/dl but you have a positive family history of premature (less than age ~) coronary heart disease, you should obtain a complete

lipid profile. That is, following an overnight fast, you should have a blood test that measures your levels of total cholesterol, triglyceride, and HDL cholesterol.

If your triglyceride level is high (250—500 mg/dl) or very high (over 500 mg/dl), you have probably inherited one of the blood triglyceride problems. It is the combination of a positive family history of

premature coronary heart disease and a blood triglyceride problem that places you in this category.

If your HDL cholesterol level is less than ~ mg/dl, it is too low. A low HDL level combined with a positive family history of premature coronary heart disease may indicate that you carry a gene for hypoHDL, a condition discussed below. When the HDL cholesterol is too low, bad things can happen even when the blood cholesterol is less than 200 mg/dl. For example, take the case of a patient, who developed coronary heart disease requiring coronary artery bypass surgery at age 33 despite having a desirable cholesterol level. He smoked two packs of cigarettes a day right up to his bypass operation; his blood pressure was normal.

Nine years later, a repeat heart catherization showed that one of the bypass grafts was completely blocked, and that the blockages in the native coronary arteries had become narrowed further. When I saw him, his blood cholesterol level was 148 mg/dl, his LDL cholesterol 89 mgI dl, and his triglyceride i 8o mg/dl; but his HDL cholesterol was low at 31 mg/dl. After one year of a good low-fat diet, his triglyceride had increased to 234 mg/dl and his HDL cholesterol remained very low at 32 mgI dl.

I couldn’t use nicotinic acid because he was being treated with a medicine to decrease the high acid content of his stomach. I prescribed Lopid to try to lower his triglyceride level and increase his HDL. Before I could check him again, he developed more heart trouble and had to have a second triple-vessel coronary artery bypass, at the age of 45.

When I saw him again, Lopid had lowered his triglyceride to 109, but his HDL remained at 3’ mg/dl, and his LDL/HDL ratio was above 4.0, indicating that he was still in the higher-risk category for coronary heart disease. I knew I had to do something, particularly in view of the second bypass operation. I stopped Lopid and started Mevacor, one pill with dinner, to see if I could lower his LDL cholesterol and improve his LDL/HDL ratio.

This is precisely what happened. On Mevacor, his LDL cholesterol decreased from 132 to 70 mgldl, and his ratio of LDL/HDL fell to 2.0. A repeat coronary angiogram showed that his new bypass grafts were completely open. Further, even if your blood cholesterol level is less than 200 mgldl you are at increased risk of coronary heart disease if you have high blood pressure, smoke cigarettes, are considerably overweight, or have diabetes.

If you have even one of these other risk factors for coronary heart disease, you should have your levels of cholesterol, triglyceride, and HDL cholesterol determined.

What is your lifestyle?Do you eat whatever you want? Is your diet high in calories, total fat, saturated fat, and cholesterol? Do you exercise rarely or never? Are you ten to twenty pounds overweight?

You are certainly not alone, but with such a lifestyle a blood cholesterol level of less than 200 mg/dl is not particularly reassuring. An assessment by your doctor of your levels of triglyceride, HDL cholesterol, and LDL cholesterol will provide further information, and may suggest modifications that will improve your health.

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Cholesterol does not dissolve in the blood, but is carried to and the cells by special carries called lipoproteins. Low density lipoproteins (LDLS) are the major cholesterol carries in the blood. If too much LDL cholesterol circulates in the blood, it can slowly build up in the arteries feeding the heart and brain, forming plaque that clogs those arteries.

High density lipoproteins (HDL) carry cholesterol  away from the arteries and back to the liver, where it is passed from the body, HDL cholesterol is known as “good” cholesterol because a high HDL levels seem to protect against hearts attacks. Exposure to smoke and other toxins appears to lower HDL levels.

People get cholesterol in two ways:

The body, mainly the liver produces cholesterol. The rest comes from eating animals that contain it. Eating saturated fatty acids raises blood cholesterol. So does trans fat. You should limit your average daily cholesterol intake to under 30 milligrams, or less if you have high blood cholesterol.

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Do take with:

Milk thistle ( Silybum marianum). Although there are no studies to date, silymarin, the active compound in the herb milk thistle, may protect against the liver damage that can occur as a side effect of this type of drug. Consider taking supplements( 150 mg three to four times daily)

Keep in mind

The dietary supplement, red yeast rice, sold as Cholestin, works in a way similar to the statin drugs. Do not use red yeast rice with atorvastatin. Lovastatin, a drug similar to atovastatin, interacts adversely with grapefruit juice.

There are no studies yet of atorvastatin and grapefruit juice, but similar problems are possible. Until more is known do not take atorvastatin with grapefruit juice. Hight doses of niacin can lower cholesterol levels.

Combining high-dose niacin with atorvastatin, however, can lead to a serious muscle disorder. The niacin in a daily multivitamin or B vitamin supplement does not cause problems, thought. According to one study, statin drugs can significantly lower your level of coezyme q10, a substance needed for energy production in your cells. Consider taking supplements ( 100 mg daily).

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Red yeast rice seems to be one of the most promising natural treatments on the market for lowering cholesterol. This product is a traditional Chinese food that is made by fermenting a type of yeast called Monascus  papyrus over rice.Under the traditional name Hong Qu,red yeast rice has been used in China as a food and medical substance since at least A.D 8OO.

It is used to treat indigestion ,diarrhea ,and abdominal pain.Today,it is also used in wine making and as a food coloring. It was recently discovered that this ancient Chinese preparation contains more than 11 naturally occurring substances closely related to approved stating drugs,the leading cholesterol lowering drugs on the market .

Based on this discovery and other related studies,red yeast rice has become a popular over-the counter cholesterol-reducing agent.

One product of the fermentation process of red yeast rice is mevinolin,an HMG-CoA reeducates inhibitor that is similar to the synthetically produced lovastatin.Other constituents produced from fermentation include flavonoids and unsaturated fatty acids,which may also contribute to the cholesterol-lowering effect.

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