How to look at your cholesterol profile?

Elevated cholesterol level (hyperlipidaemia) is an important cardiovascular risk factor. Most of us would go to doctor or “pathology labs” requesting to check our cholesterol (lipid) levels. Patients fast for at least 12 hours (excluding medications and clear fluids) before blood taking. Hence, Fasting Serum Lipid (FSL) or Fasting Lipid Profile (FLP). There would be at least 4 parameters that we look at. Three of them are cholesterol-bound-protein (lipoproteins); Total Cholesterol (TC), High Density Lipoprotein (HDL) and Low Density Lipoproteins (LDL). The final parameter would be Triglyserides (TG).

Lipoprotein is produced by liver and excreted into the bloodstream. These lipoproteins have essentially two main components, lipid and protein. Immediately after being released in the blood, these lipoproteins have low lipid but high protein content. Hence it is called HDL. As these lipoprotein moves around the circulation, it absorbs lipids or cholesterol. This will increase the quantity of lipid in these lipoproteins. Hence it is called LDL. LDL then is reabsorbed by liver. Cholesterol then is excreted or released as bile.

TG is actually fatty acid which comes from our diet. The excessive energy which is not used up by our body is converted into TG which then stored in fat cells.

pathways of lipids..

So we actually measure the lipoprotein levels as a reflection of our cholesterol profile. This is because free cholesterol is absent from our blood. It is a hydrophobic molecule.

HDL and LDL have low and high lipid content respectively. Hence increased HDL level is a good sign as it acts as a scavenger to lipid. Increase LDL however is a sign that there is too much cholesterol in our circulation. The higher the LDL, the high the risk of cardiovascular event (eg stroke or heart attack). The FSL measurements are given in either µmol/L or mmol/L.

Of these 4 parameters, LDL has the strongest link to cardiovascular disease. Numerous studies have shown that the lower the LDL level the lower the risk of cardiovascular event. TC, HDL and TG levels are not as strong predictor of cardiovascular events.

These measurements should take into account the patient profile too. Each patient has his or her own target cholesterol levels. The high the risk, the lower the LDL level should be.

LDL targets

High Risk Patients (previous heart attack / type II DM) less than 2.0mmol/l

Intermediate Risk Patients (hypertension) less than 2.5mmol/l

Low Risk Patients less than 3.0mmol/l

Until these targets are reached, only then one should consider modifying the other lipid profile parameters, namely TG and HDL.

Tomorrow the big day..

I will be starting tomorrow at my new clinic. Very excited. Hopefully I can help a lot of people and I pray to God that my venture would be a spiritually rewarding one.

I would like to thank these people to make it happen for me..

My wife

She has been very patient and hard working past few weeks sorting out the clinic and our new home. She also have given me comfort and shoulder to lean on through difficult times.

My 4 lovely kids

Siti Aishah, Muhammad Adam, Siti Umayrah and Muhammad Amirul. They may not understand much but they are the ones who have inspired me to become who I am. And all these are for them..

My parents

They were initially have mixed feelings about me coming back to Ipoh. They were very happy indeed as I am closer to them but on the other hand they felt that I should stay in Kedah. Nevertheless, they helped me find a house, clean it fix a few broken glasses and finally help me move in. They do this with sincerity and nothing in this world can replace them.

Syariman and Haslina

I sincerely thank them with the bottom of my heart, particularly Syariman. He single handedly fix the Astro and few other things. Haslina too has been very helpful...

Mr Yau of Binnova Interior Decorator

He has done an excellent job with my clinic renovation.

Tn Hj Nasiruddin, ISH General Manager

He has helped me a lot with the clinic and a few other things..

Dr Ng Teng Chun, Cardiologist ISH

Well, he was then one who called me somewhere in April 08 and telling me that ISH is looking for another cardiologist.

ISH personel

Especially the PR department, Store department and Cleaners...

So tomorrow is the big day...

Let us all pray for it..

Dr Hasral Noor Hasni

Cardiologist and Physician

Suite 2-10

ISH

UPDATE ON CLINIC RENOVATIONS DEC 25TH 08..

Finally my clinic is almost ready... except for my chair, patient and relative chairs in my consultation room and sofa in the clinic waiting area.

View from the corridor.. my clinic is at an angle..

compass at waiting area

Consultation room, and finally sink is been installed

Clinic counter

display built in cabinet..

my degrees...

This evening I prayed Jemaah Asar with some of Abah's friends our relatives and of course Man in my consultation room. I am really grateful that I can start my practice in Ipoh.

MERRY CHRISTMAS AND HAPPY NEW YEAR

ayat seribu dinar

CLINIC RENOVATION by 23rd December 2008..

waiting area.. wall paper just paste yesterday evening..

looks cool with the chinese writing..

may add some flowers and side table..

inside the clinic..

they have not fix the johnson suisse sink..

nurse counter

LCD TV 32inch LG..

contractor talking on phone...

by the way..

my clinic in Ipoh Specialist Hospital will be officially open on 29th December 2008. This coincide with Awal Muharam and Siti Umayrah's birthday

DR HASRAL NOOR HASNI

CONSULTANT CARDIOLOGIST AND PHYSICIAN

SUITE 2-10

IPOH SPECIALIST HOSPITAL

This afternoon, will go out for furniture hunting..

LOW MOLECULAR WEIGHT HEPARIN

ANTICOAGULATION IS VERY ESSENTIAL IN MANAGEMENT OF ACUTE CORONARY SYNDROME. (ANTICOAGULATION = MAKING THE BLOOD THINNER THAN USUAL) IT HAS BEEN SHOWN TO IMPROVE MORTALITY AND MORBIDITY. PREVIOUSLY WE USED UNFRACTIONATED HEPARIN (UFH) AS AN INFUSION FOR ABOUT 48 HOURS. THE DRUG ITSELF IS VERY CHEAP. HOWEVER, IT REQUIRES INFUSION PUMP AND CLOSE MONITORING APTT (A MEASUREMENT OF THE DEGREE OF THINNING OF BLOOD).

THEN THE LOW MOLECULAR WEIGHT HEPARIN (LMWH) CAME INTO PICTURE. THE ATTRACTIVENSS IS THAT IT IS ONLY GIVEN AS SUBCUTANEOUS INJECTION (LIKE INSULIN) TWICE A DAY FOR TOTAL OF 6 DOSES. ENOXAPARIN (CLEXANE), ONE OF THE LMWH HAS BEEN SHOWN TO BE MORE SUPERIOR THAN UFH. THE PROBLEM IS THAT THE EARLIER GENERATION LMWH IS PORCINE BASED. THIS MAY NOT BE VERY PLEASING TO THE EARS OF MUSLIMS...

RECENTLY GLAXOSMITHKLINE PRODUCED A NEW ANTICOAGULATION, FONDAPARINUX (ARIXTRA) WHICH IS NOT PORCINE BASED. ARIXTRA HAS BEEN SHOWN TO BE SUPERIOR THAN LMWH IN REDUCING FURTHER MORTALITY AND MORBIDITY IN ACUTE CORONARY SYNDROME. IT IS GIVEN AS ONCE DAILY SUBCUTANEOUS INJECTION FOR 3 DAYS.

SO PLEASE ASK YOUR DOCTOR REGARDING THE CHOICES OF ANTICOAGULATION.