Information for patients

Links

Wellington Hospital
Imperial College Healthcare NHS Trust
Clementine Churchill BMI (Harrow)
Lindo Wing, St Mary's Hospital

Patient testimonials

First, I can’t thank you enough for all your time, interest and care on Thursday.

Secondly, the one stop ‘plumb and sparks’ shop is seriously impressive, staffed by great, caring and efficient people who are fun. In about an hour to do an echo, treadmill test and take 49 blood samples etc. must be close to a W.R....

Seriously, from the patients point of view you are offering full diagnostics almost in the ‘golden hour’ whereas with most other approaches it takes more like a month! The expeditious approach apart from removing patients uncertainty which often weighs heavily means if necessary you are in to treatment almost immediately....

Patients will definitely feel that they and their quality of lfe is being put first.

Mr Y. (2010) Suffolk.

High Cholesterol

Almost all of the population has a cholesterol that is too high for health. A 10% reduction in cholesterol results in a 25% reduction in coronary heart disease deaths over 5 years. National guidelines suggest that all patients should aim for a total cholesterol (TC) of 5 mmol/l and an LDL cholesterol (LDL-C) of <3mmol/l. However, in diabetic patients or those who have suffered a heart attack, lower targets of TC < 4mmol/l and LDL-C<2mmol/l have been suggested.

If you do have an elevated cholesterol, this should be taken in the context of your other cardiovascular risk factors, including age, gender, blood pressure, family history and smoking history. In addition, the level of HDL Cholesterol (HDL-C) should be taken into account. High levels of HDL-C are protective against heart disease.

Assessment involves blood tests to exclude medical problems such as underactive thyroid and kidney disease, and electrocardiogram to exclude silent coronary artery disease. Further tests depend on the results of these.

What are the treatments?

Statins-these have the most evidence for saving lives
- competitively inhibit the enzyme HMG CoA reductase and thereby prevent cholesterol synthesis in the liver.
- They are more effective than fibrates at lowering LDL, but less effective at reducing triglycerides.
Fibrates –second line agents unless low HDL-C is the only problem
- Activating the nuclear transcription factor PPARα
- They have been shown to reduce triglycerides by 30-50%, to increase HDL-cholesterol by 2-20%, and to reduce LDL-cholesterol by 0-20%.
Ezetimibe – used when other agents alone are not effective
- inhibits the intestinal absorption of cholesterol. It is sometimes used in conjunction with a statin when the latter isn’t sufficiently potent on its own. It has only a marginal effect on HDL and triglycerides.