What’s your attitude about information? Too much is too much? Too little is dangerous? But what’s the right amount? Is there really anything we shouldn’t know? Is there a reason we sometimes balk at learning? Is that reason our limitations, our laziness, or our disinterest? All three? Others? Oh! And one more question: Does it seem that you’ve never left school because of all the new and sometimes contradictory information that daily inundates you?
Not that I know anything significant about the subject of heart disease or atherosclerosis. I don’t. But like most of the laity, I’ve heard that some things, like HDL, are good, and other things, like LDL, are bad because they either jeopardize our health or maintain it. So, when someone wants to add more to my general knowledge about cholesterol, I can easily say, unless I have already had some negative health effect or have some specific interest in the subject: “Too much. Just give me the basics. Do I eat butter and coconut oil or not?”
So, in Mitch Leslie’s online report* about the research of cardiologist Allan Sniderman has done on apolipoprotein B (apoB), I like many others might find the information lying on the periphery of my interest or beyond my level of expertise. It’s a matter of information, new information. Do I really want to get into the level of detail a researcher does on a blood protein?
What’s the story? Well, it seems that all these years of cholesterol testing for cardiovascular risk might have been focused on the wrong “thing.” Sniderman says a $20 test for apoB is more indicative of that risk than the traditional cholesterol test. And, according to Leslie, his work seems to be supported by lipidologist Daniel Rader, who is quoted as saying, “…the question of whether LDL cholesterol is the best measure of cardiovascular risk now has a clear answer: ‘No.’”
That brings me back to my initial question: What’s your attitude about information? You might not be a lipidologist or cardiologist, so what should you do about this information? And what should any doctor who has relied for decades on cholesterol tests do? Relearn? Incorporate the information? Get all the details to add to all the details already in a super-packed brain? Will there be a test in the morning?
Want a complication? Many doctors disagree with Sniderman and Rader’s conclusion. Either they believe long-term research on LDL is of greater value than Sniderman’s, or they believe the effort to switch gears is coming a little too late in their careers to change the testing model. Yet, regardless of their past practice, doctors do see a number of heart attack victims who have normal or low LDL. Is that supposed to happen? That’s why Sniderman wants apoB tests. It reveals the LDL particles rather than the cholesterol they contain, and those particles seem to be the “bad actors.” And here’s where doctors face the dilemma we all face. For doctors, according to epidemiologist Jennifer Robinson, “It’s too much information—and when you give people too much information, they ignore it.”
What’s your attitude about information? Can’t get enough about subjects of current interest? Don’t want any that makes your head spin? Feel you are just too overwhelmed to acquire highly specific information that might even be related to your well-being? Long for simpler times before Gutenberg invented his printing press, before people used it and subsequent means to disseminate news from every corner of our round Earth? Happy that we live in an era of specialists, but sad that they can’t agree on something like which method is best for determining cardiovascular risk factors?
So, what will you do? Will you ask your doctor to give you an apoB test instead of or in addition to a blood test for cholesterol? Or because, as Jennifer Robinson says, “It’s too much...," will you ignore this new information?
Now, would you like butter on your popcorn?
*Leslie, Mitch. Science. Sciencemag.org, December 6, 2017, online at http://www.sciencemag.org/news/2017/12/it-time-retire-cholesterol-tests , doi:10.1126/science.aar6854
Not that I know anything significant about the subject of heart disease or atherosclerosis. I don’t. But like most of the laity, I’ve heard that some things, like HDL, are good, and other things, like LDL, are bad because they either jeopardize our health or maintain it. So, when someone wants to add more to my general knowledge about cholesterol, I can easily say, unless I have already had some negative health effect or have some specific interest in the subject: “Too much. Just give me the basics. Do I eat butter and coconut oil or not?”
So, in Mitch Leslie’s online report* about the research of cardiologist Allan Sniderman has done on apolipoprotein B (apoB), I like many others might find the information lying on the periphery of my interest or beyond my level of expertise. It’s a matter of information, new information. Do I really want to get into the level of detail a researcher does on a blood protein?
What’s the story? Well, it seems that all these years of cholesterol testing for cardiovascular risk might have been focused on the wrong “thing.” Sniderman says a $20 test for apoB is more indicative of that risk than the traditional cholesterol test. And, according to Leslie, his work seems to be supported by lipidologist Daniel Rader, who is quoted as saying, “…the question of whether LDL cholesterol is the best measure of cardiovascular risk now has a clear answer: ‘No.’”
That brings me back to my initial question: What’s your attitude about information? You might not be a lipidologist or cardiologist, so what should you do about this information? And what should any doctor who has relied for decades on cholesterol tests do? Relearn? Incorporate the information? Get all the details to add to all the details already in a super-packed brain? Will there be a test in the morning?
Want a complication? Many doctors disagree with Sniderman and Rader’s conclusion. Either they believe long-term research on LDL is of greater value than Sniderman’s, or they believe the effort to switch gears is coming a little too late in their careers to change the testing model. Yet, regardless of their past practice, doctors do see a number of heart attack victims who have normal or low LDL. Is that supposed to happen? That’s why Sniderman wants apoB tests. It reveals the LDL particles rather than the cholesterol they contain, and those particles seem to be the “bad actors.” And here’s where doctors face the dilemma we all face. For doctors, according to epidemiologist Jennifer Robinson, “It’s too much information—and when you give people too much information, they ignore it.”
What’s your attitude about information? Can’t get enough about subjects of current interest? Don’t want any that makes your head spin? Feel you are just too overwhelmed to acquire highly specific information that might even be related to your well-being? Long for simpler times before Gutenberg invented his printing press, before people used it and subsequent means to disseminate news from every corner of our round Earth? Happy that we live in an era of specialists, but sad that they can’t agree on something like which method is best for determining cardiovascular risk factors?
So, what will you do? Will you ask your doctor to give you an apoB test instead of or in addition to a blood test for cholesterol? Or because, as Jennifer Robinson says, “It’s too much...," will you ignore this new information?
Now, would you like butter on your popcorn?
*Leslie, Mitch. Science. Sciencemag.org, December 6, 2017, online at http://www.sciencemag.org/news/2017/12/it-time-retire-cholesterol-tests , doi:10.1126/science.aar6854
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