Dr. Nicholas Pegge : Cardiologist

• DR PEGGE: RESUME
• APPOINTMENTS
• CONTACT

• Symptoms
  • Chest pain: is it angina?
  • Breathlessness
  • Palpitations, arrhythmias and blackout
  • Heart Murmur
• Conditions
  • Coronary artery disease: angina and heart attack
  • Heart Failure and Cardiomyopathy
  • Heart Valvular Disease
  • Arrhythmias
  • Hypertension
  • Cholesterol and other risk factor management
• Investigations
  • ECG and heart rhythm monitoring
  • Echocardiography
  • Exercise treadmill testing
  • Cardiac MRI, CT and other scans of the heart
  • Cardiac catheterisation: coronary angiography
  • Electrophysiology investigations
• Treatments
  • Drug treatment for heart disease
  • Percutaneous coronary intervention: angioplasty and stents
  • Coronary artery bypass grafting
  • Valve replacement
  • Pacemakers, Defibrillators
  • Cardioversion and Ablation

The average UK cholesterol level is 5.5mmol/L for men and 5.6mmol/L for women: these are high by international comparison.

At birth, infants have average total cholesterol of around 2mmol/L, by comparison; and studies of hunter-gatherer communities (specifically, Kalahari) have shown no increase from birth levels in those communities. So, perhaps we in the UK may have cholesterol levels more than double what they would be, if we had stuck to the lifestyle and environment in which our species evolved!

A high cholesterol on its own, whilst clearly a modifiable risk factor for coronary artery disease and stroke, is relatively weak in its effect. However, combine high cholesterol with other factors such as hypertension, immobility, poor diet, diabetes, family history, smoking, poor socio-economic status, older age, and there’s a powerful synergistic effect.

My approach to managing cholesterol is to look at the whole patient and take these other risk factors into account.

Once coronary artery disease is diagnosed, most people will need to be on a statin drug, but up until that point, we are dealing with primary prevention, and this is the area where other factors must be taken into consideration.