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Cholesterol tests 'could be missing thousands of people at-risk'

Cholesterol test GPs use to predict patients at risk of heart attacks could be missing THOUSANDS in need of life-saving statins, expert warns

  • Dr Richard Webb, of Liverpool Hope University, called for more tests to be used
  • He said they could spot high cholesterol cases and help to save lives 
  • About two in five people have highest cholesterol in the UK, in the US it is 1 in 3 

Thousands of Britons are being left at risk of heart disease and stroke by standard NHS tests for cholesterol, an expert warned today.

Patients who are over 40, overweight or thought to be at risk are routinely offered blood tests to check their levels of low-density lipoprotein (LDL-C) — known as bad cholesterol.

Those who have high levels are offered treatments including diet plans and drugs like statins to bring their levels down, and reduce the risk of serious disease. 

But Dr Richard Webb, an expert on the topic from Liverpool Hope University, says the tests are missing thousands with high cholesterol — who are then left at risk.

He called on the NHS to use the apoliopoprotein B (ApoB) test alongside the current test. It counts the exact number of LDL-C particles in the blood, whereas the routine test measures the amount of cholesterol stored inside them.

About two in five people in the UK have high cholesterol, and in the US nearly one in three adults are suffering from the condition.

Patients who are over 40, overweight or thought to be at risk are routinely offered the low-density lipoprotein (LDL-C) test to check their cholesterol levels. But medics say they should also be offered the apoliopoprotein B (ApoB) test (stock image)

Both tests require samples to be sent to a lab, but the LDL-C test costs around £30 a go whereas the ApoB test is more than £130. 

Most of the time, scores for the tests are roughly aligned.

But in about two per cent of cases — equivalent to thousands of patients — there is a ‘discordance’ where only the ApoB test says there is a cause for concern.

What is an LDL-C and ApoB test for cholesterol?

In the LDL-C test:

Blood samples are sent to the lab for analysis. Medics check the amount of cholesterol inside lipoprotein particles, which are used in the blood to transport fats.

In the ApoB test:

Blood samples are also sent to the lab for analysis. But this time medics count the number of lipoprotein particles over a set area of the blood.

Doctors say this method is more reliable and better able to pick up those at risk of high cholesterol which can lead to heart disease and a stroke. 

The NHS normally carries out LDL-C tests for all patients, but will also offer an ApoB test to those in hospitals. 

Dr Webb said: ‘Someone may go to the GP and have their LDL-C checked and it may come back normal and not raise any red flags. 

‘However, our findings show they could very well be consuming a poor diet and also be predisposed to chronic disease.’

The number of patients missed is a ‘relatively low number’, he said.

‘But it’s still potentially many thousands of people who go to see their GP and who are not warned about their risk of having a heart attack,’ Dr Webb added.

Last year Dr Webb, a clinical nutritionist, and his colleagues looked at 14,265 patients who had received both tests for a paper in the journal of Nutrition, Metablolism and Cardiovascular Diseases.

He found 285 — or two per cent — had low levels of cholesterol according to the LDL-C test, but high levels according to the ApoB test.

Heart disease is the second leading cause of death in England, triggering an average of 120 deaths per 100,000 people every month, and stroke is the sixth biggest killer, causing around 66 fatalities per 100,000 individuals.

It is just behind dementia which leads to 150 deaths per 100,000, according to official figures. 

Charities suggest the pandemic could lead to an extra 12,000 deaths from heart attacks and strokes over the next five years, without rapid intervention from ministers.

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