Is GP on the level about cholesterol?
Q I RECENTLY had a cholesterol test and it showed a reading of seven, which my GP considered to be within acceptable limits. I questioned this, saying that I thought anything over five was considered high. I am 63, slightly overweight, have normal blood pressure and stopped smoking 11 years ago. But my father suffered a series of strokes, so I am concerned. Is my doctor right?
A A DECADE or two ago, if you had a high cholesterol level you were given a statin and that was that. Now, with the benefit of countless studies looking at all the risk factors and treatment to prevent cardiovascular disease, the decision to issue statins and other drugs is far more complicated.
The aim of treating cholesterol is to prevent a stroke or a heart attack in someone who has not had one before. This is now all based on risk calculators, with the preferred one being the QRISK2 calculator.
This tool uses all the risk factors a person has – not only their cholesterol figures – but also their ethnicity, their age, their smoking history and a number of others, and calculates a likelihood of an event in the next ten years.
This is called a QRISK2 score, and statins will be offered only if this QRISK2 score is more than ten per cent. For people with diabetes or chronic kidney disease, statins would be offered at a much lower threshold.
Using these risk calculators means that the absolute figures for cholesterol as a standalone value are less important than they were – though a total cholesterol is still considered high if it is above five. We may also look at
Q I HAVE been on a high-bloodpressure medicine called losartan for a long time. But for the past three weeks I’ve been suffering from swollen ankles and dreadful stiffness in both legs. The leaflet in my pill packet says this is a rare side effect, but my GP says it is not the losartan. I have always been very active, even now I’m 80, and want to get back to it. Can you advise me?
A ANKLE swelling is not an uncommon side effect of medication, particularly for blood-pressure tablets. It is indeed listed as a side effect of losartan, although it is not a common side effect of this medication. The way to establish this is to stop the tablet, under the supervision of the GP, and see if it resolves: a replacement tablet will need to be found.
Anyone with new ankle swelling, whether on medication or not, should have some investigations performed to find the cause.
It can also be caused by problems with the liver or kidneys as well as thyroid disease, and this can be evaluated with blood tests.
Ankle oedema – a build-up of fluid in the tissues of the ankles – will develop in someone who is not very mobile. Importantly, lower-limb oedema is also a sign of worsening heart function, and it is more likely in someone with high blood pressure. This can be tested on a blood test and may need a follow up echo cardiogram. ratios of ‘good’ HDL cholesterol to ‘bad’ LDL cholesterol, but this alone does not indicate the need for treatment. It is just part of the equation.