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| Inside Medicine: Lipidologist | Inside Medicine: Lipidologist |
| (about 8 hours later) | |
| Treating abnormal blood fat can prevent serious health problems | |
| In a series focusing on medical specialties, the BBC News website meets lipidologist Dr Dermot Neely. | In a series focusing on medical specialties, the BBC News website meets lipidologist Dr Dermot Neely. |
| Lipidology is the study of fats which play a key role in the body. | Lipidology is the study of fats which play a key role in the body. |
| By recognising the metabolic problems underlying abnormal blood fat levels and then treating them, a lipidologist can then prevent serious health problems. | By recognising the metabolic problems underlying abnormal blood fat levels and then treating them, a lipidologist can then prevent serious health problems. |
| Dermot Neely's CV | Dermot Neely's CV |
| WHAT IS YOUR JOB? | WHAT IS YOUR JOB? |
| I am a consultant in clinical biochemistry and metabolic medicine at Newcastle-upon-Tyne Hospitals NHS Trust. | I am a consultant in clinical biochemistry and metabolic medicine at Newcastle-upon-Tyne Hospitals NHS Trust. |
| I am also chairman of the medical and scientific research committee of Heart UK, a heart-health charity. | I am also chairman of the medical and scientific research committee of Heart UK, a heart-health charity. |
| I need to know if a patient gets extremely nervous, or whether they've been widowed, or if there's something else bothering them. Anne Storey | I need to know if a patient gets extremely nervous, or whether they've been widowed, or if there's something else bothering them. Anne Storey |
| My main clinical activities are in lipidology, a sub-specialty of metabolic medicine, which deal with problems in the biochemical processes which take place inside the body. | My main clinical activities are in lipidology, a sub-specialty of metabolic medicine, which deal with problems in the biochemical processes which take place inside the body. |
| Lipid is a technical term for a fat, and lipidology is the study of fats which play a key role in the body. | Lipid is a technical term for a fat, and lipidology is the study of fats which play a key role in the body. |
| Two of the best known are cholesterol and triglyceride (ordinary fat). High levels of either in the blood are significant risk factors for heart disease and diabetes. | Two of the best known are cholesterol and triglyceride (ordinary fat). High levels of either in the blood are significant risk factors for heart disease and diabetes. |
| By recognising the metabolic problems underlying abnormal blood fat levels and treating them - when necessary - by diet and exercise, the lipidologist can prevent serious health problems, principally cardiovascular disease - heart attacks, stokes and lower limb amputations and deaths. | By recognising the metabolic problems underlying abnormal blood fat levels and treating them - when necessary - by diet and exercise, the lipidologist can prevent serious health problems, principally cardiovascular disease - heart attacks, stokes and lower limb amputations and deaths. |
| WHAT IS THE MOST COMMON CONDITION? | WHAT IS THE MOST COMMON CONDITION? |
| These are patients with a mixed increase of cholesterol and triglycerides in the blood. | These are patients with a mixed increase of cholesterol and triglycerides in the blood. |
| Very often this is the pattern we see in patients who have ischaemic heart disease. | Very often this is the pattern we see in patients who have ischaemic heart disease. |
| Triglyceride - or "ordinary fat" is the principal form of fat absorbed from the food for energy storage and it is transported through the blood in globules or particles mixed with cholesterol. | Triglyceride - or "ordinary fat" is the principal form of fat absorbed from the food for energy storage and it is transported through the blood in globules or particles mixed with cholesterol. |
| Problems with delivery and or inefficient storage of triglyceride can contribute to "traffic jams" in the blood fat transport system and can delay removal of left-over cholesterol and contribute to cholesterol deposits in the arteries. | Problems with delivery and or inefficient storage of triglyceride can contribute to "traffic jams" in the blood fat transport system and can delay removal of left-over cholesterol and contribute to cholesterol deposits in the arteries. |
| Delayed clearance of triglyceride and high blood levels of triglyceride are also linked to diabetes, fatty liver disease and occasionally pancreatitis, which is potentially fatal | Delayed clearance of triglyceride and high blood levels of triglyceride are also linked to diabetes, fatty liver disease and occasionally pancreatitis, which is potentially fatal |
| WHAT IS THE MOST COMMON PROCEDURE? | WHAT IS THE MOST COMMON PROCEDURE? |
| We carry out more detailed investigations of lipoproteins to define precisely what lipid disorder lies behind the patient's high cholesterol or triglycerides. | We carry out more detailed investigations of lipoproteins to define precisely what lipid disorder lies behind the patient's high cholesterol or triglycerides. |
| There are a number of primary and secondary causes of this and we need to distinguish which one is at the root of the problem. | There are a number of primary and secondary causes of this and we need to distinguish which one is at the root of the problem. |
| Now we are also able to make a firm diagnosis of familial hypercholesterolaemia (FH), an inherited form of high cholesterol, by using DNA testing. | Now we are also able to make a firm diagnosis of familial hypercholesterolaemia (FH), an inherited form of high cholesterol, by using DNA testing. |
| WHAT IS THE HARDEST THING ABOUT YOUR JOB? | WHAT IS THE HARDEST THING ABOUT YOUR JOB? |
| At the moment trying to get family screening or cascade testing implemented, as recommended by the National Institute for health and Clinical Excellence (NICE) guidance. | At the moment trying to get family screening or cascade testing implemented, as recommended by the National Institute for health and Clinical Excellence (NICE) guidance. |
| We have been successfully piloting this form of testing in Newcastle since 2005 and now need to get it commissioned across the mainstream NHS service. | We have been successfully piloting this form of testing in Newcastle since 2005 and now need to get it commissioned across the mainstream NHS service. |
| Lipidologists study fat levels | Lipidologists study fat levels |
| FH is caused by a defect in one of the genes required for the LDL-cholesterol removal system. | FH is caused by a defect in one of the genes required for the LDL-cholesterol removal system. |
| Two sets of genes, one from each parent, is required for the left-over, LDL-Cholesterol ("bad cholesterol") to be removed at normal speed in order to maintain normal blood cholesterol levels. | Two sets of genes, one from each parent, is required for the left-over, LDL-Cholesterol ("bad cholesterol") to be removed at normal speed in order to maintain normal blood cholesterol levels. |
| If a fault is inherited from either parent, the removal system doesn't work properly and cholesterol deposits and artery blockages can build up around the heart. | If a fault is inherited from either parent, the removal system doesn't work properly and cholesterol deposits and artery blockages can build up around the heart. |
| This causes early heart attacks and deaths in affected families and although FH occurs in only one person in 500, if one member of a family has the gene causing the condition, we know that half of their siblings and children will carry the same gene. | This causes early heart attacks and deaths in affected families and although FH occurs in only one person in 500, if one member of a family has the gene causing the condition, we know that half of their siblings and children will carry the same gene. |
| "Cascade testing" uses this knowledge to test other family members who might also have inherited the gene to ensure that they are offered advice and treatment with a statin which can bring cholesterol back down to normal and prevent early heart disease death. | "Cascade testing" uses this knowledge to test other family members who might also have inherited the gene to ensure that they are offered advice and treatment with a statin which can bring cholesterol back down to normal and prevent early heart disease death. |
| WHAT IS YOUR MOST SATISFYING CASE? | WHAT IS YOUR MOST SATISFYING CASE? |
| My most satisfying case has to be one of my patients with FH who recently participated in the DNA testing arm of the cascade screening study. | My most satisfying case has to be one of my patients with FH who recently participated in the DNA testing arm of the cascade screening study. |
| She was found to be a carrier of a mutation in the APOB gene, a recognised genetic cause of FH, and was referred to our regional clinical genetics centre and had family cascade testing. | She was found to be a carrier of a mutation in the APOB gene, a recognised genetic cause of FH, and was referred to our regional clinical genetics centre and had family cascade testing. |
| I was greatly relieved as she had eight siblings and between them 32 first and second degree relatives at greater than 25% risk were identified. | I was greatly relieved as she had eight siblings and between them 32 first and second degree relatives at greater than 25% risk were identified. |
| So far 10 members of the family have been tested and five have been found to have the same mutation - exactly as predicted - and all five have been referred back to my clinic for assessment, advice and treatment by their GPs when the DNA test results came through. | So far 10 members of the family have been tested and five have been found to have the same mutation - exactly as predicted - and all five have been referred back to my clinic for assessment, advice and treatment by their GPs when the DNA test results came through. |
| I very much doubt if these previously undiagnosed relatives would have been picked up and referred in without the cascade screening initiative. It is such a powerful tool. | I very much doubt if these previously undiagnosed relatives would have been picked up and referred in without the cascade screening initiative. It is such a powerful tool. |
| WHY DID YOU CHOOSE THIS SPECIALITY? | WHY DID YOU CHOOSE THIS SPECIALITY? |
| When I was a medical student I was offered the opportunity to take a BSc in either physiology, anatomy or biochemistry. | When I was a medical student I was offered the opportunity to take a BSc in either physiology, anatomy or biochemistry. |
| I chose biochemistry because it was the subject I found to be the hardest to understand. | I chose biochemistry because it was the subject I found to be the hardest to understand. |
| But despite having to work harder than ever before, I had a wonderfully stimulating year and having heard about lipoproteins for the first time I was hooked! | But despite having to work harder than ever before, I had a wonderfully stimulating year and having heard about lipoproteins for the first time I was hooked! |
| Lipids and lipoproteins still fascinate me and we have much more to learn about them. | Lipids and lipoproteins still fascinate me and we have much more to learn about them. |
| For instance, I have been involved in exciting research with my colleagues in hepatology which has revealed how the Hepatitis C virus hides in lipoproteins to infect the liver and cause chronic infection. | For instance, I have been involved in exciting research with my colleagues in hepatology which has revealed how the Hepatitis C virus hides in lipoproteins to infect the liver and cause chronic infection. |
| IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY? | IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY? |
| Yes, definitely! | Yes, definitely! |
| Because I always like to have a new challenge - to do something completely different would be great. | Because I always like to have a new challenge - to do something completely different would be great. |
| However, I doubt I would enjoy doing anything else so much. I wouldn't mind having a go at keyhole brain surgery though! | However, I doubt I would enjoy doing anything else so much. I wouldn't mind having a go at keyhole brain surgery though! |
| HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE? | HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE? |
| I would hope to see the balance between clinical, laboratory, research and management work change. | I would hope to see the balance between clinical, laboratory, research and management work change. |
| Currently clinical work represents only about one quarter of my time and I would prefer this to be my biggest commitment. To me, seeing patients is the best part of the job. | Currently clinical work represents only about one quarter of my time and I would prefer this to be my biggest commitment. To me, seeing patients is the best part of the job. |
| Click here to return | Click here to return |
| CV - Dr Dermot Neely 1983: Graduated from Queen's University of Belfast 1987: Started seeing patients with lipid problems 2002 : Started running the Lipid and Metabolic Clinic in the Royal Victoria Infirmary, Newcastle upon Tyne | CV - Dr Dermot Neely 1983: Graduated from Queen's University of Belfast 1987: Started seeing patients with lipid problems 2002 : Started running the Lipid and Metabolic Clinic in the Royal Victoria Infirmary, Newcastle upon Tyne |
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