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Posted on Tuesday March 19, 2024 in Health Screening
Tags: Cholesterol, Coronary heart disease, CHD, PCSK9, Statin, LDL, search website using Tags to find related stories.
The latest European and UK guidelines reflect the finding that there is no lower limit for LDL yet discovered, basically meaning the lower the LDL the lower the risk of future cardiovascular events. These recommendations come after new trials with lower targets showed better outcomes. As a result, millions of people taking statins around the world need to be looking more carefully at whether they are taking sufficient medication to lower their LDL to these new targets if the very best outcomes are to be achieved.
| Risk category | Clinical | LDL-C (LDL) Target |
| Very high risk | ASCVD, either clinical or unequivocal on imaging (CT scan included in these guidelines) Diabetes mellitus with target organ damage, long standing duration (>20 years), or associated with other risk factors eGFR <30 mL/min/1.73 m2 Familial hypercholesterolemia (FH) with ASCVD or with another major risk factor SCORE >10% | < 1.42 mmol/L (55 mg/dL) both in primary and secondary prevention < 1.03 mmol/L (40 mg/dL) in selected patients with recurrent ASCVD |
| High Risk | Markedly elevated single risk factors, including total cholesterol >8 mmol/L (310 mg/dL), LDL-C >4.9 mmol/L (190 mg/dL) or blood pressure >180/110 mmHg FH without other risk factors Diabetes with a duration >10 years or with another risk factor eGFR 30-59 mL/min/1.73 m2 Calculated SCORE >5% and <10% | < 1.8 mmol/L (70 mg/dL) |
| Moderate-risk | Younger patients (Type 1 diabetes mellitus <35 years; Type 2 diabetes mellitus <50 years) with diabetes mellitus duration <10 years, without other risk factors Calculated SCORE >1 % and <5%; | < 2.6 mmol/L (100 mg/dL) should be considered |
| Low-risk | Low-risk calculated SCORE <1% fatal cardiovascular disease | < 3 mmol/L (116 mg/dL) |
ASCVD: atherosclerotic cardiovascular disease; CT: computed tomography; eGFR: estimated glomerular filtration rate; FH: familial hypercholesterolaemia; LDL-C: low-density lipoprotein cholesterol.
(Summary table showing the target LDL recommended by the European Society of Cardiology from reference [2] Mach F, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1;41(1):111-188. doi: 10.1093/eurheartj/ehz455
Some research suggests that non-HDL cholesterol may be a better predictor of heart disease than LDL cholesterol. This is because non-HDL cholesterol includes all the atherogenic lipoprotein particles, which transport triglycerides to tissues. These particles eventually turn into LDL. The NHS elected to simplify population blood testing for lipids, by measuring a random (non fasting) total blood cholesterol and HDL Cholesterol fraction. The term ‘non HDL cholesterol’ is widely used as an approximate equivalent to LDL and is simply derived by subtracting the HDL from Total Cholesterol.
For patients who have been diagnosed with an acute coronary syndrome, requiring bypass surgery or stent, or have CT Angiography and or raised FAI where the risk of future coronary events is increased, effective secondary prevention is required. The target LDL in such patients has been lowered to <1.8 mmol/L.
Download the guideline as PDF Locally-developed-Lipid-SCVC
The idea of predicting a heart attack may have once seemed like science fiction, but it is rapidly becoming a reality. With the advent of advanced imaging techniques and artificial intelligence, we are now able to detect the early signs of coronary heart disease and intervene before a heart attack occurs. This represents a major shift in the way we approach cardiovascular care, moving from a reactive model to a proactive one.
Is is increasingly obvious that not everyone with raised coronary inflammation and elevated risk of heart attack simply has a raised LDL Cholesterol- in fact there appears to be a mixed bag of risk factors associated with high coronary artery inflammation, including raised LDL, raised LP (a), raised Homocysteine, hypertension and dysregulated glucose. Our metabolic health assessment is therefore designed to offer a comprehensive dive into known contributory causes, the latest and most controversial of which is 'glucose dysregulation', the principle topic of this article.
Ultimately, the approach to cardiac CT screening is highly individualized, reflecting the diverse presentations and risk factors among patients. By employing a sophisticated pre-consultation process, cardiologists can tailor their assessment and management plans to best suit each patient's unique needs, enhancing the precision and effectiveness of cardiac care.
There are two main reasons left atrial thrombus forms then detaches to cause embolic stroke. The first is that during atrial fibrillation or flutter, a thrombus may develop in the left atrial appendage, which does not move as much as it does when in sinus rhythm. The likelihood of this occurring in any given year is low, correlated to the CHA2DS2-VASc score. The second reason is not related to CHA2DS2-VASc score
Lp(a) testing is advised for individuals at high risk for cardiovascular disease, including those with a prior stent or bypass operation, coronary syndrome or heart attack as well as anyone with a family history of coronary heart disease, high FAI (coronary inflammation) or high risk patterns on Cardiac CT angiograms. In our practice, Lp (a) is offered as part of our comprehensive Metabolic Health assessment (MHA1).
Being born with almost no circulating cholesterol (or reduction of LDL to zero by drugs) results in nothing except a zero-lifetime risk of atherosclerosis (or cessation and reduction in atherosclerosis).
We have designed a package of core tests, largely funded by the employer, where the employee attends our one stop clinical diagnostic centre (CDC) to have advanced health screening. These packages go way above and beyond what is offered in any of the standard available health screening packages available at general screening services elsewhere, with the possible exception of some very exclusive executive programs, affordable by few.