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Leading the way in patient care......
 

Ash Surgery

Chilton Place
Ash
Canterbury
Kent
CT3 2HD
Telephone: 01304 812227
Fax: 01304 813788

A cholesterol blood test is done in order to help assess a person’s future risk of cardiovascular disease. It will not, in itself, give the answer- but can be used, together with other information (eg age, sex and more) to calculate the, so called, cardiovascular (CV) risk.

Cardiovascular disease (CVD) includes diseases of the heart and blood vessels which are characterized by narrowing of the blood vessels and/or blockage of those vessels with clots. The results include such diseases as angina, heart attacks, and strokes.

Various calculators have been used to assess CV risk. In Ash Surgery we use the Q Risk calculator (as recommended by National Institute for Health and Clinical Excellence NICE) which is incorporated into our clinical system.

When the lab report cholesterol results they report on the different types of cholesterol in the blood. Broadly speaking we have the “good” one- High Density, HDL, cholesterol, and the “bad” one- Low Density, LDL, cholesterol. In the past the lab could not directly measure the bad, LDL, and so they report the Cholesterol Ratio- the HDL cholesterol divided into the total cholesterol result. This gives us an indirect view of how much bad stuff there is around. Although the point of this article is to explain that the result, in itself, is not the answer- it is generally felt that a ratio of 3.5 or less is the “optimal” level.

So you might think that, if you have your bloods done, and your ratio comes back under 3.5, then your doctor will congratulate you and reassure you that all is well. Sadly, this is not the case.

First and foremost. If you have already suffered CV disease (eg a past heart attack, or stroke), then whatever your cholesterol result is, it is deemed to be too high for you. In such circumstances, we know that, by reducing your cholesterol further (whatever it is to start with) we can reduce the risk of recurrent CV disease. So such cases do not form part of the further discussion.

If you have no relevant past history, the decision as to whether your cholesterol is ok or not is made by making an assessment of your CV risk.

The Q risk calculator of 10 year CV risk uses a number of patient characteristics in its calculation. These include age, sex, body mass index (BMI), cholesterol ratio, BP, smoking habits and ethnicity/ deprivation. NICE guidance suggests that we should be considering using statins to reduce cholesterol for those with a 10 year CV risk of >10%.

As you can see, cholesterol is only part, and not the biggest part, of the calculation. Age is by far the biggest mover of CV risk and so a cholesterol reading done at the age of 40, which would be deemed OK at that age might put one in a treatment bracket when rechecked aged 60. Smoking too, is a big mover of CV risk and smoking cessation would doubtless lead to a greater risk reduction than cholesterol medication. That does not mean that the cholesterol should not be tackled at the same time as attempts at giving up.

I will leave with a few examples of cholesterol and Q risk calculations

All of the following being male, living in Ash, with a normal BP and a cholesterol ratio of 3.5 (so called “ideal”)- but you can see that by the age of 60 they are all hitting the 10% figure at which management of cholesterol is recommended.

 

                                                                                                                Age 40                   Age 50                   Age 60

  • Non Smoker, BMI 25 (upper normal)                               1.5%                       4.4%                       10%
  • Moderate smoker, BMI 25                                 3.1%                       7.8%                       15.1%
  • Non Smoker, BMI 30 (upper end overweight)               1.7%                       4.8%                       10.5%

 

 

In the absence of any potion for eternal youth… the next best thing seems to be to try all methods to stop smoking.

Why not try it out for yourself… ask your doctor for your cholesterol ratio result and you can access the CV risk calculator on line (https://qrisk.org/2016/index.php). But please note for those under the age of 40, the GP is unlikely to recommend a cholesterol blood test unless there is a strong family history or other indication.

 
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