Heart disease and diagnosis; New Zealand's housing crisis; end-of-life wishes; and water pollution.
HEART DISEASE AND DIAGNOSIS
“Changes of heart” (September 17) devoted much of its space to discussing population-based assessment of risk for heart disease. However, as the article also pointed out, and as Professor Rob Doughty exemplifies (1% risk and still had a heart attack), population-based risk and individual risk are quite different things.
In actuality, most people have their risk determined by having their fasting lipids measured, with most attention being paid to their LDL-C “bad cholesterol” level. Unfortunately, the LDL-C level is an inadequate determinant of risk. One can have normal LDL levels but still be at high risk of heart disease, and one can also have higher levels of LDL-C and not have a high risk.
A better risk predictor is something known as LDL-P – the LDL particle number – which is determined by the size of the LDL particles. For a given level of LDL-C, if your particles are small, you will have a high particle number; and if your particles are large, you will have a low particle number. Small LDL particles cause most of the damage to coronary arteries. Because of their size, they pass easily into arterial walls, where they undergo oxidation and cause inflammation and progressive damage to the vessels.
A higher particle number, which can occur in the presence of a normal LDL-C, is associated with higher risk of disease. LDL-P can be decreased and particle size increased by well-recognised dietary changes and drug therapies.
Unfortunately, because LDL-P is not routinely measured in New Zealand, many people who have their misnamed “bad cholesterol” lowered to normal levels by statins are still at increased risk. There are number of ways to measure LDL-P, both direct and indirect, but these are not routinely used here, nor do they appear to be recommended by the Heart Foundation. This seems a pity because the routine measurement of LDL-P might pick up people such as Rob Doughty, who have normal “cholesterol” but are at high risk of heart disease.
Dr Andrew Logan
(Mt Victoria, Wellington)
Letter of the week
The state houses built by the first Labour Government were rental housing and never put up for sale. The rents were set at 25% of the tenants’ income. If their wages went up, the rent went up. Tenants who started off with large families were moved to smaller state houses, still on 25% of their income, once the children had moved out.
Today, the talk is about helping first-home buyers, but there’s little about the state providing reasonable accommodation for the people who will never be in a position to own their own homes.
Concentrating on these people first would surely deal with poverty and homelessness. People who have security of tenure can take pride in their homes, knowing they are there for the long term.
(Onetangi, Waiheke Island)
A “do not resuscitate” order only comes into effect if the heart stops (Letters, September 10). It will not stop treatable symptoms being treated.
New Zealand has a fantastic range of fiction, with talented authors working in all sorts of genres. I agree with Paula Morris that there is a general lack of information about our books and writing (“Disturbing reading”, September 17).
We hear plenty about international titles, but who is promoting our books? Radio NZ could go a long way with this. Where once we had designated New Zealand book slots on RNZ National, now there is maybe one book featured each week in the magazine programme Standing Room Only. The book reviews on Nine to Noon also rarely feature New Zealand books. This would be a great place to start putting out the good word about our national literature.
On a positive note, one place that quietly promotes our literature is the Book Discussion Scheme. It supports more than 1000 book groups, and its catalogue features plenty of New Zealand books.
I am a small, independent publisher and trade associate of Booksellers NZ and support the findings of the NZ Book Council. Over the past four years, I have published nearly 300 New Zealand authors’ work in anthologies, novels and non-fiction.
Many of these writers have won awards, but still most of them have been rejected by the big publishing houses not because they are poor writers, but because they are unknown. I work hard to get their books reviewed and sales are satisfactory. However, it appears that unless you are a celebrity, a TV chef, a sports star or possibly an academic, it is virtually impossible to get interest from a large publisher.
All my books are available on Amazon and sell well overseas, proving they are marketable and widely read. New Zealand’s two largest book retailers have a very closed-shop attitude to small publishers. My local Paper Plus owner says she can’t sell New Zealand authors, and that attitude seems common among book distributors, too. Thank goodness for the independent book stores and online booksellers who see the value of our treasure trove of amazing authors.
When I was a young man, my children played and swam in lowland rivers and we fished and drank the water. I would not have envisaged that 40 years later, all our lowland rivers would be unsafe for my grandchildren.
In a First World country, I am ashamed that we have contributed to this tragic state. We sit on our hands and meekly let business interest, ignorance and greed destroy our streams and rivers. The water we are losing is a commons. We are told that no one owns it, and yet everyone owns it. Why is it that commercial land use can take it clean and return it in a state that will eventually poison a nation?
“Water woes” (September 10) is not just about testing and finding ways to treat all domestic waters. It is not just about the inability of district and regional councils to protect us from pathogen poisoning. It is about theft, poor farming practice and the inability of the Government, and previous governments, to promulgate rules and safeguards around our natural aquatic environment.
It is also about poor leaders, especially those who make such statements as “we need more research”, when a blind fool can see the dirty water running off crop and feedlots into rivers, obviously into our previously pure aquifers.
We ignore the warnings of freshwater scientists and even ridicule them. We pander to leaders in the farming, scientific and political communities who tell us there will be some loss of water quality if the country is to succeed economically.
We have bought a crock. We need to vote for continuance (of fresh water) at the next election. We need to act now. Get a stencil that reads “Dirty Farming” and paint it onto the highways and byways where you see dirty runoff. But also have another stencil that reads “Clean Farming”. There are ways to save water. Wider fenced setbacks from waterways and a few new swamps would help. Take back your commons. The water is yours, so stop the theft now.
Reading between the lines of Danyl McLauchlan’s review of Ed Yong’s book I Contain Multitudes (Books & Culture, September 3), I glean that the author waxes enthusiastically about the role bacteria play in maintaining the human condition. So, why is the reviewer so squeamish and disparaging about the subject? The hyena’s stink has evolved with bacterial help. So has ours.
If McLauchlan had any scientific nous, he would be intrigued by the mostly symbiotic relationship complex organisms have with their single-celled companions, notwithstanding the kind of mechanisms facilitated and the odd bacterial renegade.
In the controversy over the Ruataniwha dam, a caption in the “Water war” story (August 20) described the Makaroro River as “a small stream”. Anyone who has tramped down this waterway, wading chest high through deep pools, scrambling down banks and over waterfalls, as I have, knows the Makaroro is a substantial back-country river. A DoC notice at the Upper Makaroro Hut warns: “River route recommended for experienced trampers only.”
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