Cholesterol is a waxy, fat-like substance present in the bloodstream, playing a crucial role in the formation of healthy cells, the synthesis of vitamins, and the production of hormones. The majority of cholesterol required by the body is synthesized by the liver, while the remainder is obtained from dietary sources, particularly saturated fats found in animal products and processed foods. Although cholesterol is vital for the body's proper functioning, excessive levels can result in serious health complications, including heart disease and stroke. According to the World Heart Federation, high cholesterol contributes to approximately 3.6 million deaths each year and is a significant risk factor for cardiovascular diseases.

In this discussion, we will address some prevalent questions and misconceptions regarding cholesterol, featuring insights from Dr Swarup Swaraj Pal, Senior Consultant Cardiovascular and Thoracic Surgeon.

Question 1: What is the ideal cholesterol level for a healthy heart?

Dr Swarup Swaraj Pal: Cholesterol levels are measured in milligrams per deciliter (mg/dL) through a blood test known as a lipid panel or lipid profile. Here are the recommended ranges for total cholesterol in adults:

• A healthy cholesterol level should be below 200 mg/dl.
• The borderline cholesterol levels range from 200 to 239 mg/dl.
• High cholesterol levels are 240 mg/dl or higher.
• Low cholesterol levels are less than 40 mg/dl for men and less than 50 mg/dl for women (HDL cholesterol).

The American Heart Association (AHA) recommends that adults get their cholesterol checked every 4-6 years starting at age 20, as cholesterol levels can begin to rise during this time. The Centers for Disease Control and Prevention recommends children have their cholesterol checked between ages 9–11 years and again between ages 17–21 years. Here are the recommended ranges for total cholesterol in children:

• Good cholesterol levels are 170 mg/dl or less.
• Borderline cholesterol levels are 170-199 mg/dl.
• High cholesterol levels are 200 or higher mg/dl.
• Low cholesterol levels less than 40 mg/dl (HDL cholesterol).

Question 2: What exactly are LDL and HDL, and how does high LDL impact your heart health?

Dr Swarup Swaraj Pal: Cholesterol is a waxy, fat-like substance in the body, transported through the bloodstream by two main types of lipoproteins:

• High-density lipoprotein (HDL) or 'good' cholesterol: HDL helps remove excess cholesterol from cells, including those in the arteries, which can reduce the risk of heart disease and stroke.
• Low-density lipoprotein (LDL) or 'bad' cholesterol: LDL carries the majority of cholesterol to cells throughout the body. When LDL levels are high, it can lead to plaque buildup in the arteries, causing blockages that restrict blood flow to the heart. High LDL levels increase the risk of heart disease and stroke, as per the Centers for Disease Control and Prevention.

Question 3: Beyond obesity, what are the risk factors of high cholesterol?

Dr Swarup Swaraj Pal: Many things contribute to high cholesterol, some of which you can control and others you cannot. Risk factors like poor dietary choices, sedentary lifestyles, smoking cigarettes, drinking alcohol, genetic makeup, diabetes, high blood pressure, thyroid disorders, kidney diseases, and certain medications can contribute to high cholesterol levels. Apart from this, women after menopause and a family history of heart disease may also increase your risk of high cholesterol, suggests the Centers for Disease Control and Prevention (CDC). These factors altogether can not only increase bad cholesterol levels but also impact your heart health.

Question 4: With obesity becoming a growing issue in kids and teens as per the World Health Organization, could this affect their cholesterol levels too?

Dr. Swarup Swaraj Pal: Overweight refers to an accumulation of excess fat in the body. This condition is becoming more common among children and adolescents, largely as a result of sedentary habits and poor dietary choices. The World Health Organization reported that in 2022, more than 390 million children and teenagers aged 5 to 19 were classified as overweight, with 160 million of them suffering from obesity. This situation not only elevates the likelihood of high LDL and low HDL cholesterol levels in young individuals but also increases the risk of developing type 2 diabetes and cardiovascular diseases.

Question 5: At what age is the risk of bad cholesterol high? And what can we do to reduce its risk?

The likelihood of developing elevated cholesterol levels increases after the age of 20, making it essential to have cholesterol levels assessed every 4 to 6 years until reaching 40. Individuals with high cholesterol should undergo testing every 1 to 2 years. Once a person turns 40, it becomes vital to have cholesterol screenings conducted annually. Those with heart disease or who are on cholesterol-lowering medications may require more frequent evaluations. Adopting a healthy lifestyle—consisting of a balanced diet, regular physical activity, and the avoidance of smoking and excessive alcohol consumption—can significantly mitigate this risk. Additionally, routine health check-ups and screenings play a critical role in the early identification and prompt management of health issues.

Question 6: If high cholesterol runs in my family, does that mean I am more likely to develop it?

Dr Swarup Swaraj Pal: Certain individuals may have a greater susceptibility to elevated LDL levels as a result of a familial history of high cholesterol. This predisposition may stem from a genetic disorder known as familial hypercholesterolemia (FH). If a family member has been diagnosed with high cholesterol or related cardiovascular conditions, it is essential to undergo regular medical evaluations and implement appropriate lifestyle modifications, as emphasized by the Centers for Disease Control and Prevention (CDC).

Question 7: With heart attacks on the rise among young adults, what role does cholesterol have to play here?

Dr Swarup Swaraj Pal: Elevated cholesterol levels can heighten the likelihood of cardiovascular issues, such as heart attacks. This occurs due to the accumulation of plaque in the arteries, which raises the risk of heart attacks, even among younger individuals. Additional contributors, including poor dietary habits, smoking, and excessive stress, can further exacerbate the situation. Proactively managing cholesterol levels at an early stage can aid in the prevention of heart-related complications in the future.

Question 8: We know that high triglyceride levels are risky for heart disease, stroke, and heart attack—how does this relate to cholesterol?

Dr Swarup Swaraj Pal: Triglycerides and cholesterol are both types of lipids present in the bloodstream, yet they fulfil distinct roles. When the body consumes excess calories, alcohol, and sugar, these substances are transformed into triglycerides, which mainly function as a means of energy storage in the form of fat. On the other hand, cholesterol plays a crucial role in the formation of cells and the synthesis of specific hormones. Elevated levels of triglycerides, in conjunction with high levels of LDL (low-density lipoprotein) cholesterol and low levels of HDL (high-density lipoprotein) cholesterol, can considerably heighten the risk of cardiovascular diseases, including heart attacks, strokes, and various vascular complications.

Question 9: Statins are commonly prescribed to lower cholesterol—are there any side effects I should be aware of?

Dr Swarup Swaraj Pal: To maintain optimal heart health and regulate cholesterol levels, it is advisable to engage in regular physical activity, consume a nutritious diet rich in vegetables, whole grains, and fruits, and attend routine medical checkups. In cases where lifestyle modifications do not effectively reduce a patient's cholesterol levels, or if these levels remain persistently elevated, healthcare providers may prescribe statins to assist in lowering cholesterol. Statins are pharmaceutical agents designed to reduce LDL cholesterol in the bloodstream by inhibiting an enzyme that the liver requires for LDL cholesterol production, thereby supporting heart health. However, improper use of statins can result in a range of side effects. It is crucial to adhere to the prescribed dosage to mitigate potential complications. Failure to monitor dosage may lead to adverse effects such as muscle pain, liver damage, gastrointestinal disturbances, headaches, dizziness, and nausea.

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