I recently visited my GP service and was advised it was time to have my “cholesterol” checked again. This was suggested because my last test showed that my bad and total cholesterol was raised, while at the same time my triglycerides were great and my good cholesterol was fine as well. So I requested that a bad cholesterol subfraction test be added to the slip you have to take to the pathology. This request resulted in a rather problematic conversation which finished with me saying to the doctor “you’re treating the population but the population is not sitting in your office, I am, and I’m an individual, not the population!” I now wonder how many people visiting the GP are offered ‘population’ advise as compared to advice particular to them. Setting The Scene. The fact is that not all bad cholesterol is bad, only certain types of bad cholesterol are bad that is why I requested bad cholesterol subfractions be included in the new test. To my surprise the response was “we are doing subfractions”. This was explained as being the fractions of good cholesterol, bad cholesterol, triglycerides, and total cholesterol, but I was talking about bad cholesterol subfractions and the Doc had absolutely no idea. The Doc further commented that if my bad cholesterol was still raised I might consider medication, and a statin was mentioned as being the initial medication of choice. Some Facts You Should Know Statin drugs reduce bad cholesterol and it is assumed lower the risk of a heart attack or stroke, but they can have side effects, for most patients they are minimal or not even noticed, for a small percentage they can be quite debilitating. If the patient already has Cardiovascular disease (CVD) statins reduce the risk of heart attack and strokes caused by blood vessel blockage by 20% to 30%. It should be noted that this is population risk. The fact is statins, while lowering bad cholesterol for all, only actually prevent heart attack and stroke for a percentage of the population with CVD (atherosclerosis). Which part of the population are you in? Are you an individual they will work for or one that they won’t? This is the question I want answered for me. About Bad Cholesterol Fats and water (our blood is water based) don’t mix, so in order that fats, cholesterol, and insoluble vitamins (all insoluble molecules are referred to together as lipids) can be carried safely in our blood they are wrapped up inside water soluble particles. As the contents are delivered these particles shrink and can become damaged, at which time they are recycled by the liver into new large fesh particles. Large numbers of small bad cholesterol particles are the ones that are associated with plaque build up, leading to ‘blocked’ arteries that eventually increase the risk of heart attack and stroke. Large buoyant bad cholesterol particles are not only safe but necessary for good health! Thus not all Bad Cholesterol is actually bad. As you can see these particles result from the necessary distribution of vital lipids to our cells, but large numbers of small dense bad cholesterol do cause arterial damage that can result in a heart attack or stroke. The bad cholesterol subfraction test (officially known as LDL-c Subfractions) will tell me whether my bad cholesterol is Pattern A (safe) or Pattern B (unsafe) and will help me decide whether medication is required or not. Or more correctly, whether medication will likely be beneficial or not. What’s The Point? If my new test (without the subfraction test) showed that my cholesterol is still high it would be recommended that I take a statin drug. This recommendation is based on population statistics. The point is this, if my bad cholesterol is Pattern A I probably will receive little benefit from the drug and be exposed to the possible statin side effects. I want to be treated as an individual, not a population statistic. What Now? This will be my course of action, I will get my blood test done and find out if I’m pattern A or Pattern B. If I’m Pattern B I will find out if I have signs of CVD by taking a Coronary Artery Calcium score test (CAC test) and after that I will discuss the results with an expert and decide the best course of action I (the individual) should take. I will not accept being treated as population statistic. That is to be relegated to the high bad cholesterol population statistic, take a statin to lower bad cholesterol for the rest of my life, and wait to see what happens down the track, that’s not for me, and might I suggest neither should it be for you! Extra Info Does Low Bad Cholesterol Mean We Are Going To Be OK? Well no it doesn’t! Around 20% of sudden death heart attacks occur in individuals who have perfectly good Bad Cholesterol readings! Furthermore CVD takes many decades to develop and there would seem to be little point if you’re of Boomer Age to be taking medication if you don’t have any signs of CVD! It’s just assumed you will have CVD to some degree if the bad cholesterol is higher than the normal “population” range, and also assumed you don’t if the bad cholesterol is Ok. Paranoia Personally I do not believe one has to live eating lettuce, rolled oats, drinking water every five minutes and going to the gym five days a week. If our reason for doing so is solely because we worry too much about our future health, then that worry (stress) itself could contribute to poor health outlooks. Enjoy life, just try to be a little bit sensible about it. Australian Statin Brand Names Some common Australian Statin brands are Lipitor, Crestor, Lescol, Pravachol, and Zocor. Cheers Glenn.