More About Cholesterol and Assessing Your Risk
More about cholesterol
In assessing your risk of heart disease, your cholesterol level is important, but it’s far from being the whole story. The problem is that there is much more involved in accurate risk assessment than simply measuring your “good” and “bad” cholesterol. Many other factors also need to be taken into consideration.
Where someone’s cholesterol is very high for genetic reasons (known as familial hyperlipidaemias, a condition where people born with very high cholesterol are at risk of heart disease from a very early age), they should now be treated with one of the new PCSK9 drugs, which lower LDL “bad cholesterol” to just 0.5.
This is available at London Medical and our Specialist cholesterol doctors have experience in using these state-of-the-art drugs.
Who should be concerned?
- Anyone who has already suffered a heart attack, stroke or transient ischaemic attack
- Anyone who has been treated with a coronary stent
- Anyone with:
- Erectile dysfunction
- High blood pressure
- Pains in the legs on exercise
- A family history of cardiovascular disease
- A history of smoking
- An increasing waistline
Exercising and eating a healthy Mediterranean diet are strongly advised; but a healthy lifestyle is no guarantee of a long life if you have the wrong genes, or smoke, or have had previous heart problems.
Accurate testing – based on LDL particle number
Simple LDL cholesterol measurements can be dangerously misleading. Conventional tests don’t measure lipoprotein particle numbers, which they require sophisticated nuclear magnetic resonance spectroscopy equipment, so many people may mistakenly think they are at low risk of developing heart disease.
But LDL particle number ,much more than just LDL cholesterol amount, is much more closely linked to heart disease. That’s because smaller particles more effectively penetrate the cellular barrier and enter arterial walls, where they initiate a chemical process that contributes to atherosclerotic plaque and cardiovascular events.
Another “hidden risk” is that more than 20% of the population have a condition known as cholesterol-depleted LDL. This means your cholesterol may be “normal” but your LDL lipoprotein particle number, and hence your actual risk, could be much higher than anticipated. This is especially common in patients whose triglycerides are high and HDL cholesterol is low, which is often the case with diabetes.
So successful treatment depends on knowing lipoprotein particle number, not just their cholesterol content.
Treating somebody with medication that they do not need and which may cause side effects is as undesirable as not treating or inadequately treating somebody whose risks for heart disease are high.
LDL particle testing – exclusive to London Medical
LDL particle number is among the most powerful tools we have to predict the risk of future heart attack and this test is uniquely available at London Medical. It provides much more powerful feedback on the adequacy of treatment and is therefore a tool for further reduction of risk.
Similarly, “large” HDL, also known as HDL2b, plays a protective role and is crucial for regression (shrinkage) of coronary plaque. For this reason, these advanced lipid markers, including Lp-PLA2 and myeloperoxidase, are used routinely at London Medical.
A comprehensive and rigorous assessment of your heart-risk
London Medical offers a wide range of other tests to assist in accurate cardiovascular risk assessment, including an ultrasound of the carotid arteries to measure the lining thickness and the size of plaques (which all get bigger with inadequate cholesterol control), and a coronary artery calcium score to assess cardiovascular risk, in conjunction with the blood tests for advanced lipoprotein analysis.
Our use of non-invasive ways of assessing arterial thickness progression with carotid ultrasound goes right back to when we started, 25 years ago, and is different to conventional hospital ultrasound tests, which are not done to a standardised protocol.
Managing all the risk factors
We also have in-house expertise in managing all the risk factors for heart disease – including diabetes, hypertension, obesity, sleep apnoea and smoking. Which means that, uniquely, we have all the expertise, and technology, as well as the dietitian support and experience, to help reduce the progression of atherosclerosis – or arterial thickening in at-risk patients.
London Medical is currently the only clinic offering such a comprehensive risk assessment for future heart disease that minimises the exposure to contrast or radiation with imaging studies.
As ever at London Medical, our specialists connect with each other. We have renowned cardiologists, excellent diabetes doctors, and first-class dietitians and ultrasonographers, all of whom play a part in helping the cholesterol doctor give good advice on medication.
When statins aren’t the answer
Medication is never just about taking a statin, important as this may be. There are many other lipid lowering drugs, and problems including the treatment of patients with high triglyceride. Some patients are truly intolerant of taking the statin they are on and there is real expertise here in helping to see if this can be resolved or whether the new PCSK9 inhibitors Repatha or Praluent should be used.