Gujarat, Ahmedabad 19 March 2025: We oftenassociate high cholesterolas a concern for those with poor dietary habits or a sedentary lifestyle. Commonly, people who look leaner, are younger, or without any health conditions are often thought to be safe from cholesterol issues. But the fact is even the otherwise healthy individuals are not savedfrom risks associated with elevated cholesterol.[1][2]About 25% of people with a normal BMI have cardiac problems such as high blood pressure, high sugar levels, and high cholesterol levels.[3][4]
In India, 31% of people have high cholesterol,[5]which is also one of the leading causes of mortality worldwide[6].In India the prevalence of abnormal level of cholesterol exceeds high blood pressure and diabetes.[7] LDL cholesterol, commonly known as bad cholesterol, silently accumulates in the bloodstream and forms plaque which causes blockage, leading to heart attacks or strokes. This condition is known as atherosclerosis, which often shows no symptoms and thus is a grave concern.This symptom-less naturemakes LDLC “a silent killer.”
Regular exercise helps increase HDL cholesterol,which is considered good cholesterol,and improves overall cardiovascular health. [8]However, it does not fully prevent LDLC accumulation in all individuals. Even elite athletes have been found to exhibit high LDL levels.[9]Cardiac death (SCD) is the most common medical cause of sudden death in athletes. [10]
Dr. Sameer Dani, Director, Cardiology Services, Apollo Hospital, Ahmedabad, says“One false belief I often hear is that 30-40% of patients assume only extremely high cholesterol levels are dangerous, disregarding the cumulative effects of even moderate elevations. Any degree of rise in LDLC levels can massively affect heart health. If minor rises in LDLC are underestimated or ignored, the levels may rise even further if the proper routine of medication and lifestyle measures is not followed. Even if the buildup is slow, reducing LDLC once it has risen is difficult. Therefore, frequent testing and setting treatment plans to maintain LDLC levels are crucial.”
Genetics plays an important role in cholesterol metabolism.Some individuals have inherently low HDL cholesterol or inefficient cholesterol clearance mechanisms, puttingthem at riskof LDLC buildup despite optimal lifestyle choices. [11]Stress levels, sleep quality, and overall metabolic health also play an important rolein how cholesterol is processed in the body. When these aspects are ignored, theycause chronic inflammation. [12]Due to inflammation, the body produces more LDL cholesterol as a response mechanism.[13]
Age and hormonal changes also play a crucial role in impacting LDLC levels over time. As individuals age, their cholesterol levels tend to rise naturally due to reduced low-density lipoprotein receptor (LDLR) activity and metabolic shifts. [14]Men generally have higher cholesterol over the course of life. Womenexperience fluctuations in cholesterol levels due to hormonal changes associated with menopause. Estrogenregulates cholesterol levels, and when it declines post-menopause,it can lead to increased LDL cholesterol and heightened cardiovascular risk. Sometimes post menopause the LDLC levels in women do exceedeven more than men.[15]
Incorporating lifestyle modifications beyond diet and exercise can help optimize cholesterol levels. Stress management techniques, such as mindfulness meditation, yoga, and having a good sleep cycle, can be made part of life. But all these factors are not a replacement for medication. Medicines are crucial for individuals with persistently high LDLC levels or those at high cardiovascular risk.
High LDLC cannot be ignoredeven by healthy individuals. Taking precautions by getting regular checkups and getting treatments when necessary is the only way to keep the heart healthy.
