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Journalism of Courage
At 25, Aadya Waadiyar (name changed) had to undergo a pre-employment medical screening before she could settle into her new IT job. Her numbers were borderline high, her total cholesterol being 220 mg/dL, (the normal being less than 200 mg/dL). Total cholesterol is a sum of low-density lipoprotein (LDL) or bad cholesterol, high-density lipoprotein (HDL) or good cholesterol and triglycerides or blood fats from excess calories. “I didn’t know anything about why their single scores also mattered. Or why I couldn’t roll back the readings with a few extra runs. At 25, you are young and you think these slightly elevated figures won’t make much of a difference. Except it did, when I had a heart attack at 35, exactly a decade later,” she says.
“People can have high cholesterol for years, decades even and not experience any discomfort till it piles up as plaque in the heart vessels, blocks the blood flow and triggers a heart attack,” says Dr Ranjan Shetty, lead cardiologist and medical director at Sparsh Hospital, Bengaluru, who did an angioplasty (a medical procedure to open blocked arteries). “She was a fit person and had no other risk factor. So I asked her about her family history. Then she told me that her father had had a heart attack, that too at age 50. And suddenly everything became clear,” he adds.
When you have a family history of young heart attacks, it means you can inherit genes that lead to high cholesterol, high blood pressure, or other risk factors for heart disease. “Some patients have familial hypercholesterolemia, a hereditary disorder where your body can’t effectively remove LDL cholesterol from your blood, leading to its build-up in the bloodstream,” says Dr Shetty. “Aadya had a total cholesterol of 220 mg/dL at 25. Though she didn’t know it then, that figure in her early 20s was actually very indicative. Anything above 180 mg/dL in your early 20s usually means you have a family history of risk factors. It is a red flag to do follow-up tests and monitor your condition regularly to prevent a heart attack,” he adds.
Why cholesterol management needs to begin early
Cholesterol takes a long time to get to dangerous levels in the body. “Plaque formation typically begins from a person’s childhood. Then it takes a long time, usually a decade and actually gives you time to rectify yourself with lifestyle correction. Once it reaches high levels, then you would need medication to bring it down,” says Dr Shetty. “I wish I had known basic facts about cholesterol and my family history. Then perhaps I could have prevented my heart attack,” says Aadya.
When should young people do a cholesterol test?
Adolescents, says Dr Shetty, should have their cholesterol checked between ages 18 and 21. Children who have obesity or diabetes may need to be screened earlier and monitored more frequently. Those with family history and co-morbidities should go for annual check-ups. Those with normal readings and without co-morbidities should go for their next test within a four to six-year window.
What do the numbers in a cholesterol test mean?
“Since Indians are more prone to heart attacks a decade earlier than other populations and 31 per cent of them have high LDL (bad) cholesterol, while being genetically predisposed to low HDL (good) cholesterol, the checks and balances ought to be calibrated very well,” says Dr Shetty. So LDL, according to him, should ideally be under 70 mg/dL while the minimum HDL should be no less than 40 mg/dL. Triglycerides should be less than 150 mg/dL. Simultaneously, check and balance other components of heart health, like blood sugar and blood pressure.
Dr Shetty focusses on LDL and triglyceride levels to assess risk. “The two together are a potent combination. One must also measure lipoprotein-A or Lp(a), which carries cholesterol in the blood. About 25 per cent Indians have high levels, which should ideally be lower than 30 mg/dL. That’s why it should be tested at least once to eliminate risk factors,” he says.
What to do for preventive heart health?
Looking back, Aadya realises that long hours of sedentary work had limited her physical activity while work stress had fuelled her desire for convenience foods. “I didn’t realise that I was piling up new risk factors with diet and low exercise,” says the IT professional, who now has low-fat, low calorie food. She has more fruit and vegetable salads as the soluble fibres in them bind to the cholesterol in the digestive system and remove it from the body. She gets her Omega 3 fatty acids from almonds, walnuts and flaxseeds.
Dr Shetty has advised her strength training and she does them at least twice a week, doing five-minute squats and lunges at her workplace. Her cholesterol is now within range.
