When 45-year-old Arjun Mishra* was brought to the emergency room after suffering a heart attack and requiring immediate stenting, he became distraught. Only a week earlier, his whole body test report revealed that his total cholesterol was less than 200mg/dL. But the reality is that optimal cholesterol levels do not always guarantee heart health because the proportion of bad cholesterol in the bloodstream can still be plaque buildup in the arteries,
“No cholesterol limit can be considered safe. One of the most common mistakes people make is that total cholesterol counts are considered a measure of good health. But the fact is that you don’t have to eat different components, especially LDL (bad cholesterol) count, HDL (good cholesterol) ratio and HDL:LDL ratio have to be seen. Indians have low HDL. They say 50mg/dL is ideal for neutralizing LDL, but in Indians, this level never crosses 45 mg/dL. So we should just focus on LDL levels and keep them low. In fact, over the past three decades, the safe limit for LDL has been pushed down and for Indians For those who are genetically predisposed to heart conditions, LDL levels are the only concern,” says Dr Balbir Singh, president, cardiac sciences, cardiology, Cardiac, Electrophysiology-Pacemaker, Max Hospital, Saket.
What should be the safest LDL number?
“Internationally, they prefer LDL levels to be less than 70 mg/dL, but for Indians, I would say less than 50 mg/dL. Indians have heart disease family history, smoking, stress, high blood pressure and diabetes. Many young Indians are getting stents at an early age,” he says.
The second worrying factor is triglycerides. “For some people the combination of co-morbidity, high triglycerides and body weight requires LDL levels to be reworked. Triglycerides are blood fats that, along with cholesterol, cause a buildup of plaque. Therefore The levels of both triglycerides and LDL need to be significantly reduced,” says Dr Singh.
In fact, the Johns Hopkins recommendations say that LDL may be even. more risky in women than men, “This is a problem because post-menopausal women’s cholesterol levels can fluctuate significantly and tend to rise with age, putting them at greater risk of heart disease and stroke. Knowing your cholesterol numbers and Knowing how to control them is a big step towards staying healthy.”
“LDL particles like to stick to the lining of your arteries, like soap scum in pipes. As soon as it sticks there, it triggers an inflammatory response and your body starts converting it into plaque. Plaque in your blood vessels causes them to harden and narrow, limiting blood flow to vital organs such as your brain and heart muscle, leading to high blood pressure. Additionally, the fragments can break off and cause a heart attack or stroke. what else? This build-up can start as early as your 20s,” the Johns Hopkins guidelines say.
Dr Singh says Indian guidelines differ for this exact reason. “Very low LDL levels can prevent cardio-vascular events. In extreme cases we should work towards a marker of less than 30 mg/dL. And we should recommend lipid-lowering, in addition to positive lifestyle changes for those at risk.” Drug treatment needs to be started early.”
What can be the preventive protocol?
“I have met many patients who have normal cholesterol levels but still have a high risk of heart disease. This is due to many reasons – they are smokers, lead stressful lives, lead a sedentary lifestyle, diabetes have high blood pressure, have a family history of heart disease. Usually in patients with low cholesterol, we look at all these risk factors together and then determine whether we need to do further testing. This includes heart may include a CT scan, treadmill test and carotid ultrasound. People think that just because their cholesterol is normal, they do not have a risk of heart disease. This is not true. This is a misconception and even Those who are fit but who smoke heavily and drink a lot of alcohol should also get tested every six months. People who are obese or do not exercise regularly are definitely at risk. Even if their To have normal cholesterol levels, they should walk religiously for 30 minutes, which can significantly reduce heart risk. Dr Manish Bansal, Director, Clinical and Preventive Cardiology, Heart Institute, Medanta Hospital, Gurgaon says.
(*Name changed to protect identity)