World Heart Day is an important annual event that aims to raise awareness about cardiovascular diseases and the importance of taking care of your heart. This day is also used as an opportunity to highlight various modifiable and non-modifiable risk factors for heart disease. High cholesterol is a significant risk factor for heart disease because it can lead to the buildup of plaques in the arteries, a condition known as atherosclerosis. This can restrict blood flow, increasing the likelihood of heart attacks and strokes. When cholesterol levels are elevated, particularly low-density lipoprotein (LDL) or "bad" cholesterol, the chances of developing cardiovascular issues escalate.
Additionally, an entire family may have high LDL levels, without any symptoms, and no one is aware of it. As LDL cholesterol in most cases doesn't show any symptoms, the external appearance of someone being healthy or fit could be misleading. The young ones from the family who generally can be considered safe from any chronic conditions aren't exempt.
What are the causes?
Genetic factors like familial hypercholesterolemia (FH) can cause dangerously high LDL levels from childhood, regardless of diet or lifestyle. Cholesterol and heart risk don't skip generations; FH is an autosomal dominant trait, and each child of an affected parent has a 50 percent chance of inheriting it. Inherited high cholesterol (especially FH) is passed down in families due to genetic mutations.
A study in The Lancet Diabetes & Endocrinology, backed by the Indian Council of Medical Research (ICMR), found that 81.2 percent of people in India have abnormal cholesterol levels. Anyone with a parent, sibling, or grandparent who had early heart attacks or high LDL should be especially vigilant.
Early screening can reveal inheritable risks and enable timely treatment for all affected relatives. Routine cholesterol screening allows healthcare providers to monitor lipid profiles and tailor treatment plans.
"LDL Cholesterol) plays a major role in the development of atherosclerosis (Plaque accumulation in vital arteries of the body). Blood LDL levels are mostly genetically determined, and only a minor contribution comes from diet and exercise patterns. There are accepted LDL target levels for each individual according to their Risk Class. LDL cholesterol starts accumulating in the arteries, creating blockages and restricting the blood flow, including the Coronary and Cerebral arteries," said Dr. Anand Kumar V, Senior Consultant & HOD Cardiology, VPS Lakeshore Hospital, Kochi.
The more concerning aspect about high LDL cholesterol is that it does not show symptoms till a complication like a heart attack or stroke happens. By the time there is any indication, it can be too late for successful treatment. The longer the body is exposed to high LDL cholesterol, the higher the incidence of cardiac events.
The Cardiological Society of India (CSI) guidelines highlight lipid management as a priority, positioning LDL cholesterol reduction as a fundamental pillar in cardiovascular disease prevention.
"In today's fast-paced lifestyle, stress, lack of sleep, smoking, and poor eating habits are major contributors to high LDL cholesterol. Even people who are not overweight or obese can have cholesterol problems due to genetics or underlying conditions such as diabetes and hypothyroidism. The worrying fact is that 40-50 percent of patients don't know they are at risk until an event like a heart attack or stroke occurs. Early detection is the best defence. Around 65 percent of our cholesterol is dependent on our genes and 35 percent can be modified with diet control. Even thin and lean patients who have those genes that predispose them to hyperlipidemia can have very high cholesterol levels. So one should get checked if they have a family history of premature heart disease," said Dr. Sandeep Chopra, Director Cardiology, Fortis Hospital, Ludhiana.
Symptoms, if they appear, include chest pain, shortness of breath, or leg cramps during exertion, but by then, damage is already significant. Most people are unaware of their LDL cholesterol levels, or they don't know the desired levels. Patients might equate a good lifestyle with appropriate cholesterol levels, but high cholesterol is not only related to a poor lifestyle but is more often genetically determined and hereditary, and even seemingly healthy individuals can have high LDL cholesterol.
"It's important to get the levels checked, starting at age 18 years, but should be done even at 2 years of age if both parents have very high lipids (familial hypercholesterolemia) or already have an established heart disease. Along with a healthy lifestyle, it's important to seek therapy if a healthy lifestyle alone does not give the desired level in 3 to 6 months. Studies show that cardiac events are reduced by 30-50 percent by taking statin group of drugs to achieve the target LDL levels," explains Dr. Milan Chag, Interventional and Heart Transplant Cardiologist, Lipidologist and Preventive Cardiologist, Marengo CIMS Hospital, Ahmedabad.
When traditional medicine doesn't show the desired result, advanced therapies in injectable form can be added; these are usually indicated in those who cannot achieve target LDL goals, have side effects of the first-line oral medication or those who have familial dyslipidemia. Like vaccines, Inclisiran has the advantage of just having two doses every year to keep LDL at the desired level," Dr. Chag added.
As many as 90 percent of LDL-related cases can be avoided through effective risk management, which involves routine cholesterol checks along with monitoring for diabetes and hypertension. Once the targets are achieved, it's equally important to maintain the levels over time. Consistency in therapy is essential and must be maintained throughout life for sustained health and to prevent future heart-related events and stroke.
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