Patients with family history of high cholesterol should be screened early

Health Care, Heart Care Foundation of India, Medicine Comments Off

New Delhi, 02nd April 2018: A person is said to be suffering from pre-mature heart disease when he is diagnosed with the condition before the age of 55 years in men 65 years in women. The prevalence of dyslipidemia in these patients is usually found to be as high as in the range of 75-85%, said Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA).

Dyslipidemia is high levels of cholesterol and/or triglycerides in the blood. About 54% of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Hence, it is recommended that the first-degree relatives of patients who have had a heart attack, especially if premature, should be screened for lipid abnormalities.

First-degree relatives of a person include brothers, sisters, father, mother or children; second-degree relatives are aunts, uncles, grandparents, grandchildren, nieces, or nephews and third-degree relatives refer to first cousins, or siblings of grandparents.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “Screening should begin with a routine lipid profile and if the results of this are normal, then further testing should be done for lipoprotein (a) and apolipoproteins B and A-I. About 25% patients with premature heart disease and a normal standard lipid profile may have abnormal Lp(a) or apo B profile. High apo B levels and reduced apo A-I levels are associated with increased risk of heart disease. Similarly, a high Lp(a) level increases the risk of developing heart disease”.

Familial hypercholesterolemia (FH) is a genetic disorder, which runs in families and is characterized by high cholesterol levels, in particular, very high levels of LDL or the bad cholesterol and premature heart disease. Patients with FH are at an increased risk of developing premature heart disease at an earlier age of 30 to 40 years.

Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant.

Heterozygous FH is when the FH gene is inherited only from one parent. If both parents have FH and the FH gene is inherited from both of them, this is homozygous FH.

Universal screening at the age of 16 years should be done to detect familial high cholesterol levels. In patients with heterozygous FH, the cholesterol levels are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.

Maintain the dignity and honor of patient at all times

Health Care Comments Off

Respect for others is inherent in our Indian culture. This is what we teach our children, to always respect other human beings and importantly, to be respectful towards every living being.

Doctors have an ethical duty to uphold the dignity and honor of the medical profession (Regulation 1.1.1 MCI Code of Ethics). Patients are our assets. A healthcare establishment cannot serve its purpose without patients; nor can doctors. The human body, both living and the dead body, has to be respected all times.

Recently, a video of an amputated foot being used as a pillow for a patient in Jhansi went viral. And, as recent as Saturday, a video of a patient supposedly in the emergency ward in JN Medical College and Hospital in Aligarh, with his hands and legs tied on a bed with no side railings, was probably seen by hundreds of people.

Such instances are indicative of the ‘apathy’ that has become so pervasive in almost all walks of life.

But we are different. Doctors cannot disrespect the patient, nor can they be rude to the patient. Anybody else can, but not doctors.

The dignity and honor of the patient needs to be maintained at all times. “God is watching you” this fear of a punishment from the Almighty acted as a deterrent earlier, but not now.

This is the age of the smartphone and the camera in the phone has its eye on you all the time; Google and Facebook are now “God” and any video can be made viral at any instant of time.

Etiquettes and respect need to come back in our day to day interactions with not only our patients, but also with others. “Patience and delicacy should characterize the physician”, says MCI Regulation 2.2.

Patients are our first and foremost concern and their health and well-being is our responsibility and also a priority. An apathetic attitude needs to be shed off; it cannot be a routine for us.

This attitude speaks volumes about lack of attention to detailing and acceptance of mediocrity in place of excellence. Patients now are not generally accepting of any mishap that may occur during the course of treatment.

No excuse will work now – being stressed or overworked, lack of resources and infrastructure, insufficient staff etc.

Few months back, I had written, “if nothing goes wrong then “chalta hai”, but if something goes wrong then this “chalta hai” becomes “chalta nahi hai”. So change your attitude from “Kya pharak padta hai” to “bahut pharak padta hai”.

It’s important to reiterate these lines as their significance has become all the more relevant today.

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA