What is cholesterol?
The fat that we eat gets changed by the liver into cholesterol, a waxy substance that is important for our bodies to functions but (it) could also cause problems if there is too much in our blood.
Why is too much dangerous?
High cholesterol levels have been shown to be a cause for heart disease, when arteries of the heart are blocked; and stroke, when arteries to the brain are clogged.
Cholesterol can also cause blockages in the blood vessels to the legs or arms, causing pain.
How is "good" and "bad" cholesterol detected?
After you fast, a blood test would be able to differentiate "good" cholesterol (high-density lipoprotein or HDL which pick up excess cholesterol in your blood and take it back to your liver where it is broken down) from "bad" cholesterol (low-density lipoprotein or LDL which can enter your blood vessel walls and start to build up under the vessel lining, narrowing blood vessels).
What if you have high levels of both good and bad cholesterol?
The primary target would still be the bad cholesterol or the LDL.
If the patient already has vascular disease (heart disease, stroke, etc), then lowering of the LDL with a statin (a cholesterol-lowering drug), for example Lipitor, is required.
Similarly, for patients with diabetes or other risk factors that increase the risk of a cardiovascular event, statin therapy should be strongly considered.
In some patients without any risk factors but with a very high LDL level, therapy with a statin should also be considered.
Are only overweight people at risk of having high cholesterol?
The cholesterol level in a person is due to many factors but genetics plays an important role.
So skinny people can have a high cholesterol level too.
Of course, if the person is overweight and has an unhealthy diet, the cholesterol level would be even higher.
When should I worry and see a specialist?
If you have high cholesterol levels, particularly if you also have diabetes or there are other risk factors like high blood pressure, smoking, family history of heart disease or stroke.
Or, if you had a previous cardiovascular disease (heart artery blockage, stroke, narrowing of the arteries supplying the limbs, etc).
Is it an occupational hazard that you notice what people eat?
I think eating in moderation is the key, and the occasional sinful treat is unlikely to significantly change one's risk.
Of course, this does not apply if one eats char kway teow every day.
How would you describe your job?
I get to manage patients with cardiovascular disease, control their risk factors, that is, their cholesterol levels with both drug therapy and lifestyle changes.
I also get to perform angioplasty (ballooning and stent placement) of my patients' arteries, if they require it.
Best moment ever?
I did a heart angiogram for a patient.
He had no real blockages in his heart arteries, but he told me he had severe pain in his legs whenever he walked a few metres.
He couldn't even go out of his house very often.
Tests showed that the arteries to his legs were completely blocked.
Due to the very complicated blockages, it took several angioplasty procedures to successfully open them up.
He improved tremendously, and could even go on a holiday to China and walked a few kilometres.
This article was first published on May 24, 2015.
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