News within Clinical Medicine
ALMAR Research Indicates Significant Levels of High Cholesterol Amongst Irish Adults - September 2018
Research undertaken by Tallaght University Hospital indicates high levels of untreated cholesterol and triglyceride results amongst Irish adults. Abnormalities in cholesterol levels are causally linked with cardiovascular disease which accounts for 32% of all deaths in Ireland making it the greatest cause of mortality in the country.
The research, entitled A Snapshot of lipid levels in the Republic of Ireland in 2017 , was undertaken as part of a cholesterol awareness campaign in July 2017. The research just published in the Irish Journal of Medical Science reveals that 60% of those tested had some form of lipid abnormality.
Random testing took place in five counties throughout the country - Aughnasheelin, Co. Leitrim; Athlone, Co. Westmeath; Killarney, Co. Kerry; Claremorris, Co. Mayo and Kilcock, Co. Kildare. 110 of those tested were men and 149 were women. All were aged between 18 and 92 years.
With limited data available in Ireland regarding the extent and type of lipid abnormalities in the general population, members of the ALMAR team from Tallaght University Hospital obtained fingertip blood samples to perform a full lipid profile for all 259 participants. Total cholesterol, triglycerides, LDL cholesterol (low density lipoprotein i.e. 'bad' cholesterol), HDL cholesterol (high density lipoprotein i.e. 'good' cholesterol), non-HDL and Glucose were all tested.
Low density lipoprotein (LDL) cholesterol levels are linked with cardiovascular disease, while raised triglyceride levels may cause life threatening pancreatitis. Environmental factors such as poor diet, lack of exercise, hormones, weight and stress levels together with familial cardiac risk factors can increase the cardiac risk and risk of pancreatitis.
Overall the average total cholesterol was 5.1mmol/l with Total cholesterol levels of 5.3mmol/l and 5.3mmol/l in those over 50 years of age. Total cholesterol levels were also higher in females due to higher HDL cholesterol levels.
Concerning each region studied, there were a greater number of lipid disorders in Athlone despite the younger age of this population studied. While this is of interest, numbers were small and would require confirmation in a larger national cholesterol screening program.
Awareness of cholesterol risk was low amongst the participants with most people being unaware of their cholesterol level or that different types of cholesterol particles exist.
Professor Vincent Maher, Consultant Cardiologist at Tallaght University Hospital said, 'Whilst these observations are not fully representative of the national population, they do highlight significant lipid abnormalities in the Irish population. The results also highlight low levels of awareness which is very concerning. There has been a steady decline in cardiovascular mortality in Ireland with over 20% of that attributed to cholesterol reduction. Despite this, heart disease accounts for 32% of all Irish deaths. The study also highlights that significant genetic disorders of lipid metabolism are likely with three participants having very high LDL of above 5mmol/l.
Genetic testing would help individuals assess their risk and take appropriate action in order to prevent cardiovascular disease and potentially life-threatening pancreatitis.
In order to ensure further decline in cardiovascular disease in Ireland, a representative sample of lipid levels in the population should be considered at least every five years. This would help assess trends and enable cascade screening and genetic testing of relatives of those who have severe lipid abnormalities.
The main importance of our finding was that significant lipid abnormalities were identified in Ireland many of which were previously undiagnosed. It is therefore very important that the national lipid profile should be determined on a periodic basis to examine population trends in lipid levels. Investment in population surveillance is very limited in Ireland and points towards a fire fighting approach rather than more appropriate preventative strategies. Studies have shown that even if identified, treatment levels are inadequate. Therefore, screening together with education and knowledge of appropriate lipid targets will be necessary to correct this major atherosclerotic risk factor.'
Ireland lacks accurate information on the extent of its cholesterol related problems. There is no national screening strategy or dedicated resources in hospitals, primary care or the community to diagnose and treat cholesterol-related disorders effectively so as to reduce cardiovascular risk. It is hoped that a dedicated and adequately resourced centre such as the proposed Advanced Lipid Management and Research (ALMAR) Centre at Tallaght University Hospital, will provide support to patients with challenging cholesterol disorders, facilitate family screening and help refine patients' diagnoses with the use of more specialised investigations.
Research carried out by the ALMAR Centre at Tallaght University Hospital
Blood samples taken in Westmeath, Kerry, Mayo, Leitrim and Kildare
60% of the 259 people tested had some form of lipid abnormality