Cholesterol Controversy
Much controversy was generated by the 2013 ABC Catalyst documentary ‘Heart of the Matter’ in relation to cholesterol. The theme, as presented in the Catalyst Documentary, was that much of what we had previously understood about cholesterol and its role in causing cardiovascular disease was dysinformation. By ‘cardiovasculer disease’, we are referring to heart attack and stroke.
As it turns out, much of Catalyst’s research was not as black and white as portrayed, and the independence of the ‘experts’ quoted by the program has been seriously questioned. Bias is always the enemy of objectivity. The rebutal came from many sources including the ABC’s own Media Watch and non-government organisations such as the National Heart Foundation.
Cholesterol of course is one of a number of measurable factors that must be assessed together to determine any one person’s risk of developing cardiovascular disease. Lifestyle factors such as smoking and the presence of diabetes are also very imporant. In that sense, prevention of cardiovascular disease requires a holistic focus. The aim here is to identify those at risk of developing cardiovascular disease, given for example that in 60% of cases of sudden death from heart attack, there was no prior history of cardiovascular problems.
The approach to assessing cardiovascular risk has become more systematic and scientific in recent years. This is through the use of ‘risk calculators’ based on measurable parameters and lifestyle factors. A simple one to use is the ‘Absoulte Risk’ calculator, which is available online. If you know your cholesterol level, including your ‘total’ and ‘HDL’ cholesterol levels, you should be able to calculate your ‘absolule risk’ of developing cardiovascular disease right now via this link. ‘HDL’ cholesterol is often referred to as ‘friendly’ cholesterol because it assists in ‘mopping up’ the ‘unfriendly’ cholesterol. So the calculator subtracts the HDL cholesterol from your ‘total’ cholesterol when assessing risk. If you don’t know your ‘HDL’ cholesterol, you may enter a value of ‘1’, to obtain a preliminary assessment prior to seeing your GP. Things I particularly like about this tool is that it overcomes the advertising hype based on ‘relative risk’ as bestowed by the Pharmaceutical companies. A pharmaceutical company might claim a ‘Relative risk’ reduction in cardiovascular disease of 50% with a new medication, but if that means an ‘absolute risk’ reduction of only 3% to 1.5% over 5 years, you may want to be sure you know as much as possible about the safety profile of the medication before making the switch from your current treatment!
Another trick with the Absolute risk calculator is the ‘compare’ button. Press the ‘compare’ button and enter a lower cholesterol or blood pressure level, after your first calculation. In that way you can see how much better you’ll be off in absolute terms, with a lower level. You might notice that mildly elevated blood pressure does not lead to a significant increase in risk at lower age levels. Therefore with simple interventions, including exercise, weight loss, fluids and a low salt diet, the risk can be managed early.
In my next article I’ll talk about several of the specific claims in the Catalyst program, including controversy in relation to the efficacy (effectiveness) of cholesterol lowering medication.
