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Managing dyslipidaemia for the primary prevention of cardiovascular disease

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k946 (Published 23 March 2018) Cite this as: BMJ 2018;360:k946

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Re: Managing dyslipidaemia for the primary prevention of cardiovascular disease

Sir,

Having read the response of Uffe Ravnskov « Is it wise to lower cholesterol », 28 March 2018, to the article « Managing dyslipidaemia for the prevention of cardiovascular disease » of Ryan et al. (BMJ 2018;360:k946 ), as a non-medical reader, I think it is time for us, the well informed and sensible patients, to contribute to the topic of cholesterol.
My account, hopefully, will shine some light to the decades long cholesterol story.

I am a fit 73 years old female retired Australian scientist (microbiologist) of Vietnamese background with a cholesterol level of 8.9 to 9.2 mmol/L for the last three years. I have always been on a healthy, well balanced diet with little processed and deep fried food. Ten years ago, when my cholesterol was around 7 mmol/L, my GP put me on 10 mg Lipitor which gave me insomnia. I stopped taking Statin.

My weight is 54 kg and my height 155 cm. My average blood pressure is 120/70.
The results of my recent fasting full blood test of 19/10/2018, with the exception of cholesterol, are within the normal range including glucose (5.3 mmol/L).
Of interest are the results of the lipids.
Cholesterol 8.9 mmol/L
Triglycerides 0.9 mmol/L
HDL cholesterol 2.4 mmol/L
LDL cholesterol 6.1 mmol/L

My caring GP shook her head while showing me the cholesterol results saying, I don’t want to lose you! I had to convince her that she will see me for at least another decade or more.
Poor medical practitioners, they worry if they do not follow guidelines!

To complete the picture of a healthy patient, I need to report my liver abscess episode of 19 June 2015.
Following an introductory class of Zumba, I felt pain in the upper abdomen region. Thirty six hours later, I had recurrent spiking fevers, took panadol 1000mg to control them.
After 24 hours, I realised I had septicaemia and went to Emergency, had the blood taken which grew a Mucoid Klesiella, the same strain I grew from my UTI three years earlier!

Following is the summary of the discharge report sent to my GP:
19/6: presented with lethargy, fevers, rigors, RUQ pain, anorexia, diagnosed with liver abscess.
20/6: Several cysts including three cysts within the left lobe seen on CT. 20 ml of pus were drained from each of the two largest abscesses.
Blood culture results were positive for Mucoid Klebsiella susceptible to ceftriaxone.
Treatment: ceftriaxone 2g, BD.
29/6: discharged on ceftriaxone 2g, daily for four weeks via left PICC line followed by 3 weeks of oral ciprofloxacin.
Fevers resolved, nil abdo pain and CRP declined from 500s to 39 mmol/L.
CT shows no evidence of Klebsiella infiltration.

That was three years ago. I have since resumed my normal activities including teaching weekly French to members of the University of Third Age (U3A), honorary consultant to the CDS testing reference laboratory and looking after my elderly sister who lives in an aged care facility, 20 min by bus from my home. I exercise regularly, walk to the shops and I love cooking using fresh seasonal produces.

Four decades ago, my poor sister, who is now 83 y old, then weighed 48 kg, was put on Lipitor for her “high cholesterol”. She has since developed diabetes and is now on 40 mg Lipitor daily and insulin injection TD. And along with that, due to macular degeneration possibly caused by her diabetes, she has lost the vision of the right eye.

Please note that my CRP of 512 mmol/L recorded the day I was admitted to Emergency was unusual high. The CPR of my recent blood test was 1.7 mmol/L. Being a microbiologist, working with bacteria for over 43 years, I am aware of the toxins released by Gram-negative bacilli which could easily cause septic shock in a patient. I believe that my healthy liver has worked efficiently to protect me with a high level of cholesterol and an incredible high level of protecting CRP.

The same way as I trust my immune system to protect me, I trust my liver to manufacture a level of cholesterol necessary for the optimal functioning of my body.
Nowadays, our understanding of body function is better than decades ago, it is time to look at the cholesterol theory again in a more logical way. I sincerely do not believe that I have dyslipidaemia.
What is the normal level of cholesterol?

That way, millions of people around the world would be allowed to stop the sabotage of their liver with Statin drugs.

Also, please take a minute to imagine a way to divert the money spent unwisely on statins, to feed starving children. The world will be a better and happier place and no one has to live with the side effects due to statins.

Competing interests: No competing interests

13 November 2018
Jeanette N Pham
Retired Microbiologist
Sydney Australia