KOCHI: George (name changed), from Cherthala in Kerala, was 41 when he found out he has high cholesterol during a routine health checkup. He was working in Dubai. Being the youngest member in a family with a strong history of cardiac disease - his father and two elder brothers had heart attacks - he was started on medicines to lower his cholesterol.
“He was not obese but slightly overweight, so I suggested he take lifelong statin therapy as there is a dominant genetic risk besides dyslipidemia. However, he stopped taking his medicines as he found that his cholesterol levels came down after a few months of treatment and didn’t check his cholesterol thereafter,” said Dr Blesson Varghese, senior consultant in cardiology at Rajagiri Hospital, Ernakulam.
The shocker came three years later when he went to the doctor for a checkup - he was diagnosed with coronary artery disease. As he had stopped taking the medicine after a few months of treatment, it led to a cardiac disease and underwent angioplasty recently.
"We started the cholesterol-lowering medicine on a high dose to bring down the cholesterol level, so that we can prevent or advance the occurrence of a heart attack at a later time. However, when patients find that cholesterol levels have lowered, they stop medications inadvertently and don't test further.
It is a common mistake people make," he said, adding that the levels may come down immediately after taking high dose statins in a few days but it does not mean that dyslipidemia has been cured and they should continue the medication to keep the cholesterol under control.
Diet and exercise have been found to be the best way to control cholesterol when anyone is diagnosed with high levels. Also, the number of people who ignore treatment and control of cholesterol is not miniscule. "Recent studies have reported that high cholesterol is present in 25%–30% of urban and 15%–20% of rural subjects.
This prevalence is lower than in high-income countries. The most common dyslipidemia in India are borderline high LDL cholesterol, low HDL cholesterol and high triglycerides," state the study 'Recent trends in the epidemiology of dyslipidemias in India', published in 2017.
According to health experts, untreated and uncontrolled cholesterol can lead to cardiovascular diseases. "If we look from an epidemiological perspective, the incidence of acute coronary syndrome is proportionate to the average cholesterol levels in the country. There is a strong epidemiological association between cholesterol levels and coronary events," said Dr Blesson.
"Reducing the cholesterol levels of people in society even by 2-5 ml can reflect in almost 5%-10% reduction in coronary events," he added. Atherosclerosis refers to the development of blocks in different arteries in the body, including heart. “It can also affect arteries supplying (blood to) the brain, legs, etc.
Depending on the location, it can lead to heart attack, stroke, leg gangrene and damage etc. Atherosclerosis is the leading cause of death in the world contributing to one third of all human deaths,” said Dr Anand Kumar, head of the department of Cardiology at VPS Lakeshore, Kochi.
Many factors control the way cholesterol is deposited. On average - the total levels of cholesterol should be less than 200 and LDL level should be less than 100, and HDL should be above 40 in males and above 50 in females. In patients with risk factors - diabetes, heart attack, angioplasty - targets are even lower," said Dr Blesson, adding that, it is recommended, if the patient has a coronary or vascular disease, cholesterol value should be reduced by 50% from the baseline.
Dr Anand added that an important component of atherosclerotic plaque leading to blocks is LDL cholesterol, which is referred to as ‘bad cholesterol’. “80-85% of LDL levels are genetically determined, and 15-20% is related to diet, exercising, and other external factors. LDL levels slowly increase with age also. Studies have shown that in the south Asian (Indian) populations, LDL levels are high, at least by 40%. This, along with other factors like lack of exercise, diabetes, diet, high carbohydrates, etc, leads to atherosclerotic cardiac diseases," he said.
The liver produces 50-70% of cholesterol, while diet contributes 30-40%. "When we control dietary cholesterol we are working on only this 30-40%. If the cholesterol levels are high we need to follow a healthy diet. But sometimes we have to take medication to prevent and control cholesterol formation in the liver," Dr Blesson emphasised. He added that exercising to spend more energy can help increase good cholesterol levels.
Periodical checkups and tests, along with medications, can help in controlling cholesterol levels. “We need to test and understand the target level and try to control it through diet and exercise. If it is not working, we can control the levels through medicines after consulting a physician. Also, other risk factors should be considered before starting medication. Once the treatment is started, the LDL level will be controlled. After it is brought under control, we need to test only once a year as there won't be many fluctuations in LDL levels," added Dr Anand.