PATIENT INFORMATION LEAFLETS
At Dr Sophia Khalique and Associates, we are dedicated to providing you with the highest quality care and empowering you to make informed decisions about your health.
To support you, we’ve compiled a collection of Patient Information Leaflets, available online and for download.
Our leaflets cover a wide range of health topics, conditions, and treatments, offering reliable and easy-to-understand guidance. Whether you’re managing a chronic condition, preparing for a procedure, or looking for general wellness tips, our resources are here to help.
Background
Cardiovascular disease (CVD) remains one of the leading causes of disease and premature death globally. Early detection of risk factors is essential in preventing heart attacks, strokes, vascular dementia and other life-threatening events.
Standard cholesterol testing offers good insight into your cardiovascular risk, but for those seeking a more advanced and precise assessment, testing for Apolipoprotein B (ApoB) provides a significant step forward.
What is Apolipoprotein B?
Apolipoprotein B is a protein found in certain lipoproteins, including low-density lipoprotein (LDL), which is often called “bad cholesterol.” Importantly, each atherogenic particle (those that cause plaque build-up) carries one ApoB molecule. This makes ApoB an excellent measure of the total number of potentially harmful particles in your blood.
Unlike LDL cholesterol, which measures the amount of cholesterol in lipoproteins, ApoB provides a more direct and precise assessment of the LDL AND other particles most associated with cardiovascular risk.
Why Choose ApoB Testing?
Precision:
ApoB measures a greater number of harmful lipoprotein particles, giving a more accurate risk assessment than LDL or total cholesterol.
Early Detection:
ApoB can identify risk even when standard lipid panels appear normal.
Proven Evidence:
Research shows that ApoB is a stronger predictor of cardiovascular events than LDL or non-HDL cholesterol.
Meta-analyses and guidelines from groups such as the European Society of Cardiology (ESC) and other leading authorities recommend ApoB testing for advanced cardiovascular screening.
Comparison: ApoB vs Standard Lipid Panel
| Feature | Standard Lipid Panel | ApoB Testing |
|---|---|---|
| Measures | LDL, HDL, total cholesterol | Total atherogenic particles |
| Sensitivity | Moderate | High |
| Predictive Power | Good | Superior |
| Recommended for | General population screening | Advanced, precision risk stratification |
| Availability in the UK | Commonly offered | Rarely checked in public healthcare sectors |
While standard lipid testing is effective for monitoring improvements in CVD risk (e.g., through lifestyle changes or medication), ApoB offers unmatched precision for establishing baseline risk.
Who Benefits from ApoB Testing?
This test is ideal for individuals who:
- Have a family history of premature cardiovascular disease.
- Are seeking personalised, high-end healthcare.
- Want a more detailed understanding of their
cardiovascular risk profile.
Integrating ApoB into Comprehensive Screening
ApoB works alongside other advanced markers like Lipoprotein(a) (Lp(a)) to provide a full picture of your cardiovascular health. While testing for Lp(a) will be discussed separately, combining these insights can help develop a targeted prevention plan.
What Happens Next?
After your cardiovascular risk is established, further management is critical. Regular follow-up tests can help monitor improvements in your cardiovascular health, whether through lifestyle changes, targeted therapies, or both.
Monitoring with LDL:
Standard lipid panels, including LDL cholesterol, are effective for tracking changes in cardiovascular risk over time.
Refining with ApoB:
For those seeking the highest level of precision, ApoB can provide a clearer picture of the effectiveness of your interventions.
We offer bespoke follow-up plans tailored to your unique needs, ensuring you remain on track to optimise your long-term heart health.
Glossary of Terms
Apolipoprotein B (ApoB): A protein found in lipoproteins responsible for carrying cholesterol; an advanced marker for cardiovascular risk.
Lipoproteins: Particles in the blood that transport fats like cholesterol.
LDL (Low-Density Lipoprotein): Known as “bad cholesterol,” it contributes to plaque build-up in arteries.
HDL (High-Density Lipoprotein): Known as “good cholesterol,” it helps remove cholesterol from the bloodstream.
Lipoprotein(a) [Lp(a)]: A genetic risk marker associated with CVD, which can further refine risk assessment.
Background
High-sensitivity C-reactive protein (hs-CRP) is a marker for inflammation in the body. It’s much more sensitive than a standard CRP test, allowing us to detect really low levels of inflammation. Whilst inflammation helps the body’s natural defence against infection or injury, chronic inflammation is thought to increase the risk of conditions like cardiovascular disease (CVD).
Why is hs-CRP Important for Heart Health and Longevity?
Atherosclerotic Cardiovascular Disease (ASCVD) is the leading cause of preventable death worldwide. Inflammation plays a role in the development of ASCVD by increasing the risk of plaque formation in blood vessels. This can cause blockages and/or an increased risk of heart attacks and strokes.
- A higher hs-CRP level can signal inflammation in your blood vessels, meaning a higher risk of ASCVD.
- hs-CRP is a marker of inflammation, but it is not the direct cause of atherosclerosis.
How is hs-CRP Measured?
As part of an advanced Preventative Health Assessment, we may check hs-CRP with a simple blood test to measure levels. Your results, together with other investigations, help us identify if you’re at a higher risk.
hs-CRP levels may temporarily rise due to infections, injuries, or chronic inflammatory conditions like arthritis. Therefore, to ensure accurate results, we advise against testing whilst you’re ill.
Who Should Have an hs-CRP Test?
The hs-CRP test is beneficial for anyone wanting a full evaluation of their cardiovascular risk. We often include it as part of a comprehensive Preventative Health Assessment.
We recommend it if:
- You have risk factors for ASCVD such as high blood pressure, cholesterol, smoking, obesity, or a family history of heart disease.
- You need additional information for preventative medicine purposes to guide treatment decisions, such as whether to start a statin or other measures.
What Does a High hs-CRP Level Mean?
- High hs-CRP levels indicate inflammation in your body, which suggests a higher risk for developing ASCVD.
- hs-CRP is not specific to ASCVD. Elevated levels may also result from:
- Infections (e.g., colds, flu, or urinary tract infections).
- Autoimmune conditions like lupus or rheumatoid arthritis.
- Smoking, obesity, or lack of physical activity.
How Can You Lower hs-CRP Levels?
- Medications:
- Statins: these cholesterol-lowering drugs reduce inflammation and thus lower hs-CRP levels.
- Anti-inflammatory treatments: emerging therapies specifically targeting inflammation are under investigation.
- Lifestyle Changes:
- Healthy diet: Adopt an anti-inflammatory diet rich in fruits, vegetables, wholegrains, and healthy fats like omega-3 fatty acids.
- Exercise regularly: Aim for at least 150 minutes of moderate exercise per week.
- Quit smoking: Smoking contributes to chronic inflammation and raises hs- CRP levels.
- Maintain a healthy weight: Obesity is associated with higher inflammation and hs-CRP levels.
- Get good quality sleep: Sleep deprivation or poor-quality sleep increase bodily inflammation.
- Reduce alcohol: Excess alcohol consumption increases inflammation.
- Manage stress: Chronic psychological stress and conditions like depression are linked to elevated inflammatory markers.
- Treat underlying conditions:
- Address infections or chronic inflammatory diseases that may be contributing to raised hs-CRP e.g. Dental problems, gum disease.
Is hs-CRP Alone Enough to Predict Heart Disease?
No. Whilst hs-CRP provides valuable insights into your cardiovascular risk, it is typically used in conjunction with other risk factors, such as:
- Age
- Blood pressure & smoking status
- Other cardiovascular risk markers including cholesterol
- Family history of heart disease
Background
Most health assessments test for the ‘usual suspects’: cholesterol, blood pressure, and blood glucose. Homocysteine is a marker that doesn’t get enough attention. Keeping this amino acid in check can help lower your risk of heart disease, dementia, and even pregnancy complications. Identifying an issue with it and managing it can be game-changing for your anti-ageing and longevity health plan.
What Is Homocysteine?
Homocysteine is a byproduct of your body’s metabolism. It’s part of the process of breaking down an amino acid, methionine. You get this from eating protein-rich foods such as meat, fish, eggs and legumes. Normally, your body uses certain vitamins — folate (B9), B12, and B6 — to regulate or recycle homocysteine levels.
However, a B12 / Folate deficiency or a genetic quirk, or other underlying conditions can cause homocysteine levels to rise—a situation called hyperhomocysteinaemia. Over time, high levels can increase the risk of several health problems.
Why Does High Homocysteine Matter?
High homocysteine doesn’t cause obvious symptoms, so it’s often referred to as a “silent risk factor.” But —its long-term effects can be serious.
Key problems:
- Heart and Blood Vessel Health
High homocysteine can damage blood vessel linings, cause inflammation, and even contribute to arterial plaque buildup (ASCVD). It’s linked to an increased risk of heart attacks, strokes, and blood clots. - Brain Health
Research suggests high homocysteine may accelerate brain shrinkage and agerelated changes, leading to increased dementia or Alzheimer’s disease. - Pregnancy Outcomes
For women, high homocysteine levels have been linked to complications like preeclampsia, recurrent miscarriages, and low birth weight babies. - Bone Health
Studies have found that high homocysteine levels can weaken bones, increasing the risk of fractures, especially in older adults.
Should You Get Tested?
Homocysteine isn’t included in most routine health check blood tests. However, we offer it to our patients as part of our Cardiac Risk Factors panel in our Preventative Health Assessments. Testing can be especially valuable if you:
- Have a family history of heart disease, strokes, or cognitive decline.
- Have experienced unexplained blood clots or other cardiovascular issues.
- Are planning a pregnancy or have had complications like miscarriages or preeclampsia in the past.
- Live with chronic conditions such as kidney disease or autoimmune disorders.
- Are concerned about maintaining strong bones as you age.
- Want to ensure you’re doing everything you can to improve ageing and longevity.
What Causes High Homocysteine?
Several factors:
- Genetics: Certain genetic mutations e.g. those of the MTHFR gene, can make it harder for your body to process homocysteine.
- Vitamin Deficiencies: Low folate, B12, and B6 levels.
- Lifestyle: Smoking, drinking too much alcohol, and poor diet.
- Underlying Health Conditions: Kidney disease, underactive thyroid, or certain medications can contribute to higher levels (e.g. Omeprazole, Anti-epileptics, oral birth control).
How to Lower Your Homocysteine Levels
Managing high homocysteine is usually straightforward. We may recommend:
- Eat a Nutrient-Rich Diet
Foods packed with folate (like leafy greens, beans, and avocados), vitamin B12 (found in eggs, meat, and dairy), and vitamin B6 (in bananas, potatoes, and fortified cereals). - Consider Supplements
Diet alone may not be enough – taking supplements containing folate, B12, and B6 can help bring levels back to normal. - Make Lifestyle Changes
Quitting smoking, reducing alcohol intake, and managing stress can lower homocysteine. - Monitor Your Progress
Regular blood tests can help you track your homocysteine levels and adjust your plan as needed.
What’s Next for Homocysteine Research?
Scientists are still exploring how homocysteine impacts health. While its role in heart disease and cognitive decline is well-documented, emerging research is uncovering links to other conditions, like some pregnancy complications.
Testing your homocysteine levels could be a vital step your longevity health plan is missing. At our practice, we can easily arrange testing and provide personalised advice tailored to you. Whether your goal is to protect your heart, boost brain health, or simply stay ahead of potential issues, understanding your homocysteine levels is part of the ideal panel of tests.
Background
Hormones are the body’s messenger molecules, controlling functions like energy, mood, metabolism and reproductive health. When something doesn’t feel right – maybe unexpected tiredness, shifts in weight or problems with sleep or stress, your doctor may order some of the tests below to see what’s going on.
Checking hormone levels helps us read your body’s signals, detecting the potential problems and then making a bespoke plan to rebalance things. We’ve outlined some of the common hormonal blood tests below.
Cortisol
- Where it’s made: Produced by the adrenal glands, located on top of each kidney.
- What it does: Known as the “stress hormone,” cortisol helps regulate the body’s response to stress, blood sugar, metabolism, and inflammation.
- Timing: Best measured between 08:00 and 09:00 when levels naturally peak.
- What it means:
- High cortisol: May indicate stress, Cushing’s syndrome, or adrenal gland disorders.
- Low cortisol: Could signal adrenal insufficiency or Addison’s disease, affecting energy levels and stress response.
Insulin
- Where it’s made: In the pancreas.
- What it does: regulates blood glucose by allowing cells to take up glucose from blood.
- Timing: Typically measured after fasting for 8-12 hours.
- What it means:
- High insulin: Suggests insulin resistance, often linked to prediabetes or metabolic syndrome.
- Low insulin: May indicate insufficient pancreatic function or low blood sugar levels.
DHEA (Dehydroepiandrosterone)
- Where it’s made: In the adrenal glands.
- What it does: A precursor hormone, DHEA can be converted into other hormones like oestrogen and testosterone and plays a role in sexual health, brain and immune function.
- Timing: Can be measured at any time of the day as levels remain stable.
- What it means:
- High DHEA: Could indicate polycystic ovary syndrome (PCOS) or adrenal tumours.
- Low DHEA: Often related to adrenal insufficiency or hypopituitarism.
Testosterone
- Where it’s made: In the testes in men, and in smaller amounts by the adrenal glands and ovaries in women.
- What it does: Essential for muscle strength, bone density, and libido in both men and women.
- Timing: Best measured in the morning between 07:00 and 10:00 due to diurnal variation.
- What it means:
- High testosterone: May point to PCOS, adrenal gland disorders, or certain tumours.
- Low testosterone: Linked to fatigue, reduced libido, or conditions like hypogonadism.
Oestrogen
- Where it’s made: Primarily the ovaries, with smaller amounts from the adrenal glands and fat tissue (including men)!
- What it does: Supports reproductive health, bone development, regulation of adipose tissue and skin healing.
- Timing: Ideally timed according to menstrual cycle phase for premenopausal women. Menopausal women can measure at any time.
- What it means:
- High oestrogen: May be due to hormone therapy, ovarian cysts, or certain tumours.
- Low oestrogen: Common in menopause or ovarian insufficiency, potentially leading to symptoms like hot flashes or bone loss.
TSH (Thyroid-Stimulating Hormone)
- Where it’s made: In the pituitary gland in the brain.
- What it does: Regulates thyroid function, which controls metabolism, energy, and temperature regulation.
- Timing: Ideally measured in the morning (09:00) when TSH levels are most consistent.
- What it means:
- High TSH: Suggests underactive thyroid (hypothyroidism), which may cause fatigue or weight gain.
- Low TSH: Indicates overactive thyroid (hyperthyroidism), often associated with weight loss, anxiety, or irregular heartbeat.
LH (Luteinising Hormone)
- Where it’s made: In the pituitary gland in the brain.
- What it does: In women, it triggers ovulation and supports ovarian function. In men, it stimulates testosterone production in the testes.
- Timing: For women, LH should ideally be measured in line with the menstrual cycle phase. In men, timing is less critical but is usually done in the morning.
- What it means:
- High LH: May indicate menopause, polycystic ovary syndrome (PCOS), or primary ovarian or testicular failure.
- Low LH: Could be due to pituitary or hypothalamic problems, leading to reduced reproductive function.
FSH (Follicle-Stimulating Hormone)
- Where it’s made: In by the pituitary gland in the brain.
- What it does: In women, FSH helps regulate the menstrual cycle and stimulates egg production. In men, it aids in sperm production.
- Timing: Best measured days 2-5 of the menstrual cycle. Timing is less critical for men but often done in the morning.
- What it means:
- High FSH: May indicate menopause, ovarian failure, or testicular dysfunction.
- Low FSH: May result from pituitary or hypothalamic dysfunction, affecting fertility.
Additional Notes
- Hormonal tests can be highly sensitive to timing and circadian rhythms. For accurate results, testing is best coordinated ensure tests are performed as recommended.
- Our longevity clinic partners with world-class laboratories to provide the most accurate and comprehensive evaluations tailored to your needs.
Explore More
Learn how these tests are part of our personalised health assessments: Preventative Health Assessments
Discover the latest insights into longevity and anti-ageing medicine: Anti-Ageing Microsite
Background
As we deepen our understanding of cardiovascular health, it’s becoming clear that traditional cholesterol tests may only scratch the surface. A crucial – yet often overlooked – factor is Lipoprotein(a), or Lp(a). This genetic variant of LDL cholesterol could have a significant impact on our heart health…even if our standard cholesterol results come back normal.Understanding Lp(a) The Sticky Issue
Think of Lp(a) as LDL cholesterol’s ‘troublesome cousin’. Both carry cholesterol through your bloodstream, but Lp(a) has an extra protein component called Apo(a) that makes it especially “sticky.” This stickiness means it’s more likely to cling to artery walls, leading to the build-up of arterial plaques. Additionally, Lp(a) can promote blood clotting, which raises your risk of heart attacks and strokes. Finally, it also seems to increase inflammation and can in this way can increase risk of narrowing of the aortic valve – Aortic Valve Stenosis.
Why Conventional Healthcare Often Misses This Risk
Despite its importance, Lp(a) testing isn’t typically included in standard cholesterol screenings and is not widely available. In the U.K. few healthcare providers routinely test for it which means a significant cardiovascular risk factor may go unnoticed. Unlike other risk factors, Lp(a) levels are determined by genetics and remain mostly stable throughout life, unaffected by diet or lifestyle.
The Case for Proactive Testing
Knowing your Lp(a) levels could fundamentally shift your approach to managing cardiovascular risk. Raised levels might mean you need to adopt a more aggressive preventative approach, even if your regular cholesterol levels seem fine. Testing for Lp(a) is especially valuable for:
- People with a family history of heart disease
- Those who’ve had unexplained heart issues despite good control of traditional risk factors
- Individuals with a family history of aortic valve disease
- Anyone wanting a comprehensive assessment of their cardiovascular risk
Modern Management Strategies
If high Lp(a) levels are detected, several management options are available:
- Tighter control of traditional risk factors, possibly with more rigorous preventative treatments
- Consideration of advanced lipid-lowering therapies that might not usually be considered
- Regular monitoring of heart health, potentially with advanced imaging
The Future of Treatment
The medical field is on the brink of new treatments that specifically target Lp(a). Ground-breaking therapies using genetic approaches are showing promising results in clinical trials, with some reducing Lp(a) levels by as much as 98%. While these treatments are still under development, knowing your Lp(a) status now is still extremely useful.
Taking Action
Checking your Lp(a) levels should be part of any comprehensive heart health assessment. Although it’s not a standard test, it’s available in via the Practice and can give us crucial insights into your cardiovascular risk profile. Armed with this knowledge and the right medical guidance, we can help you take control and adopt a more personalised approach to protecting your heart health.
Checking Lp(a) is one a number of steps you can take to embrace a more sophisticated, proactive approach to managing your health.
Disclaimer: The information contained in this leaflet is provided for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult your GP, pharmacist, or other qualified healthcare professionals for advice regarding a medical condition or healthcare treatment.
Please contact us on 020 7935 4357, [email protected] or alternatively complete the form below and we will endeavour to respond to you as soon as possible.
