Oh my goodness what a difference a week makes! I have loved feeling the sun on my face for what seems like the first time in a long while. Getting up in the morning is a whole lot easier with sun streaming in, and I’ve played golf wearing just a t-shirt. The lawn has had its first mow of the year, and I’ve tackled a whole lot of weeds in the garden. In short, spring finally seems to be here and I’m relishing it!
The only fly in the ointment for me this week has been a sudden realisation that I have a teenager in the house. My son appears to have gone from a boy to a teenager in a week. Aloof is probably the best word to describe him! Firstly I guess it makes me feel older which is not a good thing, but also reflecting on it, the fact that he no longer needs my wife and I for entertainment or to look after him probably makes us both feel a bit redundant. I know this is a normal part of being a parent, but not one I’ve as yet experienced. Getting the balance of being supportive, but giving enough freedom to make mistakes and grow is hard. I’m sure anyone reading this who has children will have their own version of this chapter in their own lives.
Back to medicine. A colleague of mine came to see me this week for some medical advice. He isn’t a cardiologist, but had a family history of a few heart issues and wanted to get checked out. Thankfully all was well, but what struck me in our meeting was how even as a doctor, he had a great many misconceptions about heart disease, and cholesterol in particular. If a doctor doesn’t really understand it, what chance does the general public have?
In particular was one of my pet peeves – so called ‘good’ and ‘bad’ cholesterol. I have written about this before, but it’s so important I think worth briefly re-visiting, but also adding something I only discovered this week. Cholesterol is vital for a whole host of functions in our bodies, for example many hormones are made of it, and it is involved in the transport of molecules across our cells membranes. It is not therefore good or bad. The mis-conception often hinges around HDL and LDL. HDL is commonly called good cholesterol, and LDL bad. Both particles are the body’s solution to the fact that cholesterol is not soluble in blood, and so it packages it up in this stuff to move it from the liver where most is produced, to other parts of the body. LDL particles can get stuck in artery walls, and if they get stuck there and oxidised, a whole sequence of events starts which over many years leads to coronary artery disease. HDL particles go in the reverse direction, trafficking cholesterol back to the liver for recycling.
People often think that having a high HDL is protective (I have de-bunked this in previous posts in the member’s area) whereas it is LDL that is the important piece in causing coronary disease (as well as other Apolipoprotein B particles and lipoprotein (a) (again – see previous posts, as this is important stuff)
The thing I only found out this week, was that in some circumstances, patients can have a low LDL, a high HDL, and think they are at relatively low risk of heart disease but it’s not the case! Why? The reason is to do with HDL clearance, which is the way the liver gets rid of HDL. These people are often genetically programmed to have high HDL levels, but the particles themselves vary in function, size, density and the ability to transport cholesterol. Therefore patients may actually be at higher risk, and a CT scan would be a useful way of looking at that individuals heart arteries.
HDL’s effectiveness at removing cholesterol from arteries can also be influenced by things like infection, auto-immune disease, menopause and cardiometabolic conditions during pregnancy. I had never known that before! Every day is a school day it seems!