An interview with Dr Carl Shakespeare #NationalCholesterolMonth

GP education, cholesterol and an apple a day

National Cholesterol Month is an entire month devoted to raising awareness of the dangers of high cholesterol. We interviewed Dr Carl Shakespeare, an invasive cardiology consultant in south east London.


Can you tell us a little about yourself?

I’ve been an invasive cardiology consultant in south east London for the last 25 years, and more recently at St Thomas’ Hospital as well looking after Bexley cardiology. I’m semi-retired from Queen Elizabeth Hospital in Woolwich but continue my weekly on-call duties there. I have been an invasive cardiologist doing a lot of angiograms, pacemakers and procedures. 

I want to take things further and set up local services in Bexley to support the referrals of appropriate lipid patients as well as hypertension patients.

Do you use genomics in your current clinical practice?

No, currently we provide a generalised cardiology service. From attending lots of international conferences, I’ve become aware how much more prevalent Familial Hyperlipidaemia is than previously advertised, and there is very little knowledge in general practice about how to manage patients with Familial Hyperlipidaemia. I am planning to raise awareness with GPs who look at various risk scoring systems including smoking, diabetes and hypertension etc.

I think to run a proper cardiology service, you need to be doing it in association with a specialised lipid clinic like at St Thomas’. Then with the introduction of genomics, close links to Clinical Genetics would be needed.

What I have been discussing with colleagues such as Professor Tony Wierzbicki (see our interview with Tony here), is the introduction of more simplified testing such as the measurement of lipoprotein ‘little a’. This would already be an improvement in our good clinical practice within the lipid world. This is obviously a precursor to doing genomics but it’s a step along the way to upping what we normally do for a cholesterol profile.

"This is obviously a precursor to doing genomics but it’s a step along the way to upping what we normally do for a cholesterol profile."

What will be your approach in raising awareness with GPs?

You need to always understand how other people work and the restrictions that they face. General Practice has to deal with so many different specialties, let alone subspecialties. They are limited in the time that they can spend with patients. I want to start giving lipid talks to the GPs in the primary care setting, to emphasise the need to have family history screening for any existing patients with very high cholesterol, and anyone with a very high cholesterol for whom Familial Hyperlipidaemia is likely, that they start treating and perhaps refer on for more specialised things such as genomics.

What would be your key message to patients during National Cholesterol Month?

Number one is that if a family member has a significantly increased cholesterol, it’s worth getting other relatives also tested. In the US they are now routinely doing family screening on children from age five. I do have concerns about that in terms of the psychology of getting a five year old not to eat all of the things that their friends might on the way to school or back home. But primarily, families need to be aware that if one family member has very high cholesterol, they should have family screening.

Number two is to listen to the advice of medical professionals. Last week when I was on call at Queen Elizabeth’s, a patient came in who had had coronary artery stents put in previously and given cholesterol lowering medication, but he watched a YouTube video that told him he shouldn’t be taking statins, so stopped. A year later he has now presented with acute coronary syndrome and has had two more stents put in. As a result of mass media, people are often not taking their statins contrary to medical advice. When you do a lot of acute cardiology like I have been doing for the last 25 years, you see this continually. People stopping statins, or not wanting to take them in the first place. It’s a constant war that we face in trying to provide a balanced view on statins.

1. Family testing

2. Listening to medical advice

Genomics in primary care- Educational Resources

What should the general public do to protect their heart health?

That’s a tough question and I’ve written lots of things previously for media outlets when I’ve been asked the same question. One is to stop smoking. Two is to exercise on a regular basis and maintain a balanced, low cholesterol diet. As much as avoiding things that raise your cholesterol, it’s also about adding things in your diet that help reduce cholesterol, such as porridge and apples with skin. English people tend to peel the skin away from the apple which is the only good part of the apple! An apple a day keeps the doctor away. Now we know why! It can lower cholesterol by 20% in certain people. It doesn’t matter if it’s green or yellow.

"An apple a day keeps the doctor away. Now we know why!"

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With any Whole Genome Sequencing (WGS) test ordered, a Record of Discussion (RoD) form will also need to be submitted. This document is to record the patient’s consent for genomic testing and their choice on taking part in research. Guidance on the patient choice conversation can be found here
This RoD form will be available for clinicians to download from this webpage. Once completed with the patient, it can be send to the lab with the corresponding test order form and sample.
Tests available to order will be listed in the National Genomic Test Directory. A test order form will soon be made available for clinicians on this webpage to download and complete. This form will include the address of the laboratory that the appropriate sample and completed form needs to be sent to.
Until the new Genomic Laboratory Service goes live, please continue to follow existing test order processes.
Later this year, the online test ordering tool for Whole Genome Sequencing will be integrated into the National Genomics Informatics System (NGIS) and clinicians will be able to search or filter to find a clinical indication, confirm eligibility criteria and start the test request process for their patient.