Why young people need to worry about that sneaky cholesterol

Why are more and more young people having heart attacks? Since cardiac disease is caused by multiple factors, it is difficult to pin-point one specific cause. But one factor that is common in most such cases is abnormal or high levels of cholesterol — a fat-like substance made by the liver or found in certain foods. Dr Mohit Gupta, professor of cardiology at Delhi’s G B Pant hospital, says nearly 70% of patients aged 40 or below who come with a history of heart attack have abnormal cholesterol levels which are undetected. “The percentage of people with a history of heart attack having abnormal cholesterol levels in the 40 to 60 years age group is almost 40%, and almost 30% in the age group of 60 to 80 years have abnormal cholesterol,” says Dr Gupta.THE GOOD, THE BADThere are two main types of cholesterol. LDL (low-density lipoprotein) is considered to be ‘bad’ cholesterol because it clogs up arteries with plaque or fat deposits, while HDL (high-density lipoprotein) is called ‘good’ cholesterol because it acts like a scavenger, filtering the blood of excess fat and bad cholesterol thus providing some protection against heart disease. medium nocaption113636637Contrary to what people believe, eating high-cholesterol foods often has only a modest impact on cholesterol in the blood. The bigger culprits are foods with saturated and trans fats. Saturated fats are easy to recognize as they are typically solids at room temperature. Trans fats (or trans fatty acids) are created in a process that adds hydrogen to liquid vegetable oils to make them more solid. Another name for trans fats is partially hydrogenated oils. Both increase levels of bad cholesterol. According to the US Centre for Disease Control and Prevention (CDC), if we take in more cholesterol than the body can use, the extra cholesterol can build up in the walls of arteries, including those of the heart. This leads to narrowing of the arteries and can decrease the blood flow to the heart, brain, kidneys and other parts of the body, the CDC says.TEST YOUR LIPIDSResearchers have found that the longer a person has high levels of LDL, the greater the risk for coronary heart disease (CHD). However, it often goes undiagnosed because high blood cholesterol usually has no signs or symptoms. The only way to know whether you have it is to get your lipid profile done.The Cardiological Society of India recently shared guidelines that highlight the importance of lipid management, with context to the Indian population. According to these guidelines, LDL-C levels should be reduced to below 70 mg/dL and non-HDL-C, below 100 mg/dL. Cholesterol screenings starting at the age of 18, alongside medication adherence and healthy lifestyle modifications, can dramatically lower LDL cholesterol and reduce the risk of heart disease, says Dr Preeti Gupta, professor, Safdarjung Hospital, Delhi.THE THIRD GOOGLYDoctors are recognising the importance of a third type of cholesterol — lipoprotein (a). A recent study published in Current Medical Research and Opinion suggests that increased levels of lipoprotein (a) also plays a significant role in increasing the risk of recurrent CHD in people aged 60 or above. “This finding adds to growing evidence of a relationship between increased Lp(a) and the risk of recurrent CHD,” notes Leon Simmons, lead author and associate professor at the University of New South Wales, Sydney. “It is well established that people who have already experienced CHD are at a very high risk of another event. Our new results indicate that new therapeutics in development that aim to reduce elevated Lp(a) might help prevent recurrent heart disease. However, the potential clinical benefit of therapy to reduce elevated Lp(a) is yet to be confirmed.” medium nocaption113636675Dr Ashok Seth, chairman of Fortis Escorts Heart Institute, New Delhi, says clinical therapy for Lp(a) management is available in some parts of the world but it is very expensive. “It may be more prudent to ensure optimum utilisation of available drugs and lifestyle interventions to reduce the other known risk factors till novel therapies are made widely available at affordable prices,” he adds.Dr Mukesh Goel, senior cardiology consultant, Indraprastha Apollo Hospitals, New Delhi, says controlling cholesterol levels is a multi-level approach beyond the use of medications alone. “While statins and other pharmacologic treatments are critical, long-term cholesterol management needs lifestyle interventions. A diet rich in soluble fibre such as oats, beans and fruits, coupled with the healthy fats from sources like avocados, nuts and olive oil can improve lipid profiles. Regular physical activity — aiming for at least 150 minutes of moderate exercise per week — plays a crucial role in raising HDL and lowering LDL,” he says.Dr Goel stresses that giving up smoking leads to significant improvements in lipid levels and overall heart health. These lifestyle strategies not only help in managing cholesterol levels but also have broader implications for cardiovascular health, including the reduction of arterial plaque and prevention of heart disease.