Cholesterol

Cholesterol is a waxy, fat-like substance in your blood. Your body needs some cholesterol to build cells and make hormones, but too much — particularly the wrong kind — builds up in artery walls and raises the risk of heart attack and stroke. High cholesterol is very common in Indians and often shows up at younger ages than in Western populations.

Types of cholesterol

• LDL ("bad") cholesterol — carries cholesterol to artery walls; higher levels raise heart-disease risk
• HDL ("good") cholesterol — carries cholesterol away; higher levels are protective
• Triglycerides — a different type of blood fat; high levels also raise heart-disease risk (see Triglycerides page)
• Non-HDL cholesterol — total minus HDL; a useful overall measure
• Lipoprotein (a) — Lp(a) — a specific lipid particle, tends to run in families; South Asians often have higher Lp(a) and an independent heart-disease risk

Why it matters

High LDL cholesterol over years contributes to atherosclerosis — hardening and narrowing of arteries — which underlies most heart attacks and many strokes. South Asians often develop cholesterol problems earlier, at lower BMI, and with less dramatic numbers than Western populations — so the usual "normal range" may not fully reflect risk. Indian cardiology societies often recommend lower LDL targets for South Asians.

Risk factors for high cholesterol

• Diet high in saturated fat (ghee, butter, fatty meats, full-fat dairy), trans fats (vanaspati, many commercial fried foods), and refined carbs
• Physical inactivity
• Overweight and central obesity
• Smoking (raises LDL and lowers HDL)
• Family history — genetic causes (familial hypercholesterolaemia) are under-diagnosed in India
• Diabetes
• Hypothyroidism, kidney disease
• Some medicines

Symptoms

High cholesterol has no symptoms by itself — it's found on a blood test. Some people with very high levels have yellow cholesterol deposits on the skin (xanthomas) or around the eyes (xanthelasma). Most people find out after a routine check, or — too often — after a heart attack.

Testing

A lipid profile is a simple blood test. Indian cardiology societies recommend lipid screening from age 20 onwards, and more often with family history of early heart disease, diabetes, high blood pressure, or obesity.

Treatment

• Lifestyle changes are the foundation — work whether or not you need medicines
• Diet — more whole grains, pulses, vegetables, fruits, nuts; less ghee, butter, vanaspati, fried foods, sweets, refined flour; prefer unsaturated oils in rotation; limit egg yolks if LDL is very high
• Physical activity — at least 150 minutes of moderate activity a week; walking, yoga with movement, cycling
• Weight — losing 5-10% of body weight meaningfully helps
• Stop smoking
• Treat underlying conditions — diabetes, hypothyroidism
• Cholesterol-lowering medicines — several classes are available. Statins are the most common and well-studied. Your doctor decides based on your overall heart-disease risk, not just cholesterol numbers alone.
• Take medicines consistently — don't stop on your own when numbers improve; the medicine is keeping them improved