HYPERLIPIDEMIA PART 1
HYPERLIPIDEMIA PART 1.
"I'd like you all to dwell upon these figures."
Far too many patients are concerning themselves unnecessarily with blood lipids when they should be addressing other priorities. Listed below are risk considerations in CVD (cardiovascular disease). You will note that blood fats are third from the bottom. I don't think this is the best chart available, but it is a good simple chart and I use it for this reason. I can't remember its source, however, I have made one change to it over the years, and that is I've put homocysteine further up the list in light of more recent evidence since the chart was originally published. The chart is, after all, only intended as a general guide and reminder/prompter. Nearly all the patients I see taking cholesterol lowering medicine are taking it unnecessarily and could easily have herbal medicines instead - especially antioxidants. You will recall that cholesterol is harmless until it is oxidised! It is completely benign of itself.
CARDIOVASCULAR DISEASE RISK CONSIDERATIONS.
THE FOLLOWING ARE CVD RISK FACTORS PLACED IN ORDER OF IMPORTANCE, MORE OF LESS;
COMBINATION OF THREE OR MORE FACTORS ON THIS SHEET
VERY STRONG GENETIC ANCESTRAL HISTORY
SLEEP APNOEA/INSOMNIA WITH EXCESSIVE DAYTIME FATIGUE
LACK OF REGULAR PHYSICAL ACTIVITY
ELEVATED SYSTOLIC BLOOD PRESSURE
HIGH BLOOD LIPIDS
PRE-DISPOSITION TO RECURRENT INFECTIONS
FOOD INTOLERANCES AND/OR ONGOING INFLAMMATORY DISEASE, E.G. IRRITABLE BOWEL SYNDROME, DIVERTICULITIS.
These risk factors vary in importance; that is to say, a young patient with diabetes has less risk of a cardiac event than a very old patient who is non-diabetic, and so forth.
So, lets have a look at at study, and of course you all well know my views on some so-called research being largely a waste of time - ergo, if I highlight a study, it is a meaningful study, (even if it's American) :-)
Here is a paper: McCully KS, 'Atherosclerosis, serum cholesterol and the homocysteine theory: a study of 194 consecutive autopsies' , American Journal of Medical Science, 299(4), 1990, pp 1149 - 1155. This was a study of 194 consecutive autopsies of patients all with some form of atheroma, and divided into four groups. (Note too, that this study was published in a journal of medical science, which is mostly what the naturopathy degree now is, and not a journal of a medicine! This is most significant and curious - there are any number of medical journals to which the study could have been submitted, and one has to wonder whether it was rejected by those journals, or whether the authors were afraid of submitting it because it brings into question long held beliefs. Most people are unaware that a bachelor of medical science is different from a bachelor of medicine, and so medical journals are sometimes skewed to support western medicine rather than stand alone science.)
Here's how the cadavers were grouped:
Group 1. Comprised more than 50% narrowing of the abdominal aorta, and all of whom had died from some sort of vascular event.
Group 2. Comprised more than 50% narrowing of the abdominal aorta who had died of other chronic diseases.
Group 3. The third group comprised atheroma measuring up to 50% narrowing of the arteries. This still represents significant atheroma.
Group 4. This group had no arteriosclerosis (arterial hardening) and less than 10% atheroma formation. This represents insignificant atheroma.
Groups 1, 2 and 3 comprised 170 patients. Of these, 123 had a history of serum cholesterol under the recommended 5.2 mmol/L. Of the remainder (47), only 27% had cholesterol levels from 5.2 to 6.5, and only a minute 7% had figures greater that 6.5.
It gets more interesting... 92% of all of the cases who had neither diabetes or hypertension had cholesterol levels less that 6.5, and of these the cholesterol was less than 5.2 in 74% of cases. In the total of 122 cases in groups 1 and 2, severe atherosclerosis developed in 80 cases where no diabetes, hypertension or elevated cholesterol were present.
From these figures, you can see that it isn't the cholesterol so much which was the cause of death, but more likely oxidation of the cholesterol of some other factor.
Now, I'm going to leave it there for this week, because I'd like you all to dwell upon these figures.
Next week, we are going to discuss the dangers of low cholesterol, and all the unusual events that occur in patients with HYPOlipidemia. In 26 years of practice, I've never had a patient complain of low cholesterol, but in a significant number of patient cases, it is so. I've seldom had a patient complain of high oxidation - more on this next week.
Before I go... You will recall my saying that western man is the only primate on the planet that doesn't ingest therapeutic amounts of herbal medicine on a daily basis. Well, I saw a cooking programme during the week, part of which was about what a traditional Thai ate for breakfast, and from what I could deduce, the family members were each having more herbal medicine for BREAKFAST than I prescribe to patients for a whole day! The problem is of course that most of the culinary herbs we use in the west these days are not that high in medicinal quality - the high quality medicines having gone to our pharmaceutical companies. (The Thai family were using freshly picked plants.)