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AHA Plugs 'Dietary Patterns' Over Dietary Cholesterol Targets – TCTMD



The new science advisory seeks to dispel confusion around the relevance of dietary cholesterol for heart health.

With a flurry of New Year’s resolutions around the corner, a newly released advisory paper from the American Heart Association (AHA) is seeking to dispel lingering confusion over dietary cholesterol intake that may have arisen when specific targets were eliminated in the recent guidelines.

Instead, the document emphasizes that a diet rich in fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and liquid vegetable oils is the better bet for promoting cardiovascular health.

Whereas the 2010 Dietary Guidelines for Americans once put a limit on the consumption of dietary cholesterol at less than 300 mg/day, the 2016 update removed this specific threshold and shifted focus to more general healthy eating patterns.

“A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health,” write Jo Ann S. Carson, PhD, RDN (University of Texas Southwestern Medical Center, Dallas), and colleagues in their review paper published online in Circulation.

“There’s just a lot of confusion out there,” Andrew M. Freeman, MD (National Jewish Health, Denver, CO), who was not involved with the document, told TCTMD, calling the 300-mg cholesterol limit “arbitrary.”

“A lot of people interpreted that as you can have a free for all and eat whatever you want, and that’s obviously that’s not what the message was,” he said. “You still have to eat well, and diets that are heart healthy are naturally low in cholesterol. So that’s the key message there.” What has complicated matters in the interim is that a variety of food industries have spun the removal of the specific cholesterol threshold to mean people can eat however much of a once-limited food item they want, Freeman added.

Stop Counting, Think Holistically

In the paper, Carson and colleagues outline all of the contemporary studies looking at dietary cholesterol as well as egg consumption and cardiovascular risk, including a meta-analysis published in March showing a positive association (HR 1.17; 95% CI, 1.09-1.26). They note some discrepancies in the literature, but ultimately conclude that it “is difficult to distinguish between the effect of dietary cholesterol per se and the effect of dietary patterns high in cholesterol or saturated fat, for example, sausage or bacon eaten with eggs.”

There’s just a lot of confusion out there. Andrew M. Freeman

Additionally, studying dietary cholesterol can be complicated by the type of dietary fat included, they write. “In many intervention studies, the fatty acid composition of the diets was not matched; likewise, because the majority of observational studies do not adjust for saturated, monounsaturated, and polyunsaturated fat, it can be difficult to distinguish between the independent effects of dietary cholesterol and dietary fat type.”

There are two aspects of diet that cannot be ignored when considering the relationship between dietary cholesterol and risk of cardiovascular disease, the authors conclude. “First, most foods contributing cholesterol to the US diet are usually high in saturated fat or consumed with foods high in saturated fat. Second, heart-healthy dietary patterns (eg, Mediterranean-style and DASH-style diets) are inherently low in cholesterol, with typical menus containing < 300 mg/d cholesterol, similar to the current US intake.”

Freeman added that there are variations in metabolisms among people, giving the example that some can eat eggs without increasing their cholesterol and others have trouble doing so. “There are some studies from a long time ago that basically showed that if you’re eating a standard American diet and you add a few eggs, your overall cholesterol number may not go up very much,” he said. “But if you’re not used to eating that amount and then you suddenly eat some, your cholesterol can go up quite a bit, and I think that’s the distinction.”

Ultimately, “it’s not so important to count the amount of cholesterol that one’s consuming, . . . but there does seem to be an increased risk of cardiovascular events when people are consuming lots of eggs,” Freeman said.

For physicians advising patients with known cardiovascular disease, “the evidence to date, at least in my mind, still significantly pushes us toward a predominantly low fat, whole food, plant-based diet,” he concluded. “And then if you have a patient that’s particularly high risk, you might really want to push them to being very, very strict and not having lots of shellfish or eggs or whatever it may be.”


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Austrian government proposes law to legalise assisted suicide



Austria’s federal government has submitted a draft law to make assisted suicide for seriously ill adults legal, the federal chancellery said in a statement on Saturday.

The new law lays out the conditions under which assisted suicide will be possible in the future, following a ruling by Austria’s Constitutional Court last December according to which banning assisted suicide was unconstitutional because it violated a person’s right to self-determination.

“Seriously ill people should have access to assisted suicide,” the federal chancellery said in the statement.

The new law allows chronically or terminally ill adults to make provisions for an assisted suicide.

They have to consult two doctors who have to attest the person is capable of making his or her own decisions. A delay of 12 weeks also has to be respected that can be reduced to two weeks for patients in the final phase of an illness.


(Reporting by Silke Koltrowitz; Editing by Christina Fincher)

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Namibia suspends use of Russian COVID vaccine after S.Africa flags HIV concerns



Namibia will suspend the rollout of Russia’s Sputnik V COVID-19 vaccine, its health ministry said on Saturday, days after the drugs regulator in neighbouring South Africa flagged concerns about its safety for people at risk of HIV.

Regulator SAHPRA decided not to approve an emergency use application for Sputnik V for now because some studies suggested that administration of vaccines using the Adenovirus Type 5 vector – which Sputnik V does – can lead to higher susceptibility to HIV in men.

South Africa and Namibia have high HIV prevalence rates.

Namibia’s health ministry said in a statement that the decision to discontinue use of the Russian vaccine was “out of (an) abundance of caution that men (who) received Sputnik V may be at higher risk of contracting HIV,” adding it had taken SAHPRA’s decision into account.

The Gamaleya Research Institute, which developed Sputnik V, said Namibia’s decision was not based on any scientific evidence or research.

“Sputnik V remains one of the safest and most efficient vaccines against COVID-19 in use globally,” the institute told Reuters, adding over 250 clinical trials and 75 international publications confirmed the safety of vaccines and medicines based on human adenovirus vectors.

Namibia said the suspension would take effect immediately and last until Sputnik V receives a World Health Organization Emergency Use Listing. But it will offer people who received a first dose of Sputnik V a second to complete their immunisation course.

Namibia received 30,000 doses of Sputnik V as a donation from the Serbian government, but only 115 had been administered as of Oct. 20.

Namibia has also been using COVID-19 vaccines developed by China’s Sinopharm, Pfizer, AstraZeneca and Johnson & Johnson, acquired through a mix of procurement deals and donations.

So far it has only fully vaccinated around 240,000 of its 2.5 million people, reflecting African nations’ difficulties securing enough vaccines amid a global scramble for shots.


(Reporting by Nyasha Nyaungwa in Windhoek and Polina Devitt in Moscow; Editing by Alexander Winning and Ros Russell)

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Britain reports highest weekly COVID-19 cases since July



Britain recorded the highest number of new cases of COVID-19 since July over the past week, government figures showed on Saturday, a day after Prime Minister Boris Johnson played down the prospect of a return to lockdown.

Some 333,465 people in Britain tested positive for COVID-19 over the past seven days, up 15% on the previous week and the highest total since the seven days to July 21.

Daily figures showed there were 44,985 new cases on Saturday, down from 49,298 on Friday. Daily death figures were only available for England, and showed 135 fatalities within 28 days of a positive test.

Deaths have risen by 12% over the past week, and the total since the start of the pandemic now stands at 139,461, the second highest in Europe after Russia.

While vaccination and better medical treatment have sharply reduced deaths compared with previous waves of the disease, hospitals are already stretched and Britain’s current death rate is far higher than many of its European neighbours.

Government health advisors said on Friday that preparations should be made for the possible reintroduction of measures to slow the spread of the disease, such as working from home, as acting early would reduce the need for tougher measures later.

Johnson, however, said he did not expect a return to lockdown.

“We see absolutely nothing to indicate that is on the cards at all,” he said on Friday.


(Reporting by David Milliken, Editing by Timothy Heritage and Christina Fincer)

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