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Welcome to Doctor Warrick's Podcast Channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and I'd like to welcome you to my consulting room. Today I'd like to talk a little bit about a meeting I went to just recently. And that meeting had a lot of information about cholesterol. Lots of people want to know lots of stuff about cholesterol and whether it's important or not. I'd like to share with you today some of the take-home messages that I got from that meeting. One of the first important messages is that, if we're going to reduce the risk of heart attack in someone who is at high risk, then we really want to get that cholesterol as low as possible. A lot of our work and a lot of our research has been done on what we call LDL cholesterol or low density lipo protein. This is the component of the cholesterol profile which we think is most linked to depositing fat or cholesterol in the arteries. We know over many years of trials now that as we bring that LDL cholesterol down, we also bring down rates of event. We've now seen studies with modern lipid-lowering agents that can reduce the total cholesterol and the LDL cholesterol down to levels that we previously hadn't even imagined possible. We can get LDL cholesterols down to 0.3, 0.4, 0.5 mmols per liter with some of these new agents. This is really quite extraordinary. To put that into context, the average LDL cholesterol is probably somewhere around 2 to 3. What's important to remember though, is that even though we do still get incremental benefit by lowering cholesterol, that if we're able to get cholesterol very very low, there still remains residual risk. And what I mean by residual risk is that although we've got the cholesterol to incredibly low levels, patients still have events. They still have events at a reduced rate but nonetheless they're still having events. This tells us really that although cholesterol is an important part of the plaque story; it's an important component of reducing risk; clearly it's not the whole component. One of the studies that came out fairly recently was a study looking at anti-inflammatory agents. Something to dampen down inflammation within the body and therefore inflammation with plaque. That study was called The Cantos trial and you looked at an agent called...Well I can't remember what it's called actually, but it was an anti-body directed at reducing inflammation and reducing inflammatory markers. That agent did demonstrate a reduction in risk without any difference in cholesterols. So this means that some of their residual risk in these high risk patients is probably related to inflammation within the arteries as well. I suspect there is no question that there are other factors going on that we just don't know about yet. One of the questions about how low you can go and still be safe, to a degree has been answered by these recent trials, but we know that a child - a newborn infant - is born with an LDL cholesterol of 0.7. So it would seem pretty reasonable at the very first assumption to believe that an LDL cholesterol of zero point seven would be a safe level for a human being, given a newborn child is probably one of the most synthetical growing stages of their entire life. One of the other things that came up during this meeting was the concept of staten intolerance or side effects from statins there's a lot of work going on around this and there's a lot of stuff on social media which I think confuses the picture a bit and that sometimes ramps up or amps up the sort of expectation that patients have when they're taking medication. There has been a bit of nice work done in this space and there was a series of trials just recently, specifically looking at patients who had indicated that they were intolerant to staten or lipid-lowering therapy, but specifically statens. They took several thousand of these patients and they randomize them, they double blind randomized them to a crossover study which meant that they gave them placebo or staten and crossed over without the patients knowing. At the end of the trial period which I think was four or six months the number of patients that were able to take statens with the same side effect profile reported as on placebo was 75 percent. What this tells us is that statens get blamed for aches and pains which are probably not caused by the staten probably 75 percent of the time, but it probably tells us that 25 percent of people really are having some intolerance to these medications and that we need to figure out the best solution for them. I think the take home message from that, for me, is that if statens really are an important part of the medication regime for an individual, we've got to be careful not to throw out the baby with the bathwater too soon and look more closely before we make a decision about putting a particular agent on the shelf and leaving it forever - particularly and specifically if it's going to help that individual in the future. I thought that was really interesting. I hope you've enjoyed this little chat about cholesterol and some of the stuff that I gleaned from the recent meeting. As always I wish you good health and take care. You have been listening to another podcast from Dr Warrick. Visit his website at www.drwarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
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