Take a cholesterol check: What should young people do to reduce levels?

Dr Kumar Kenchappa, Consultant, Interventional Cardiologist, Manipal Hospital, Bengaluru, on the benefits of early tracking and lifestyle changes

High LDL cholesterol in young adults increases the risk of heart attacks in later life, when the cholesterol buildup is high enough to form plaques and blockages in the vessels of the heart. That’s why it is important to reduce cholesterol early. (File)

Written by: Dr Kumar Kenchappa

4 min readApr 24, 2024 07:28 AM IST First published on: Apr 23, 2024 at 02:50 PM IST

Of late, I have been seeing a lot of young executives with high cholesterol. They found they had these high levels quite by chance, mostly after availing corporate full body packages. Most of them say they never felt any discomfort or unease and hence were shocked by the results. That’s the bad part about cholesterol, it goes up and up without you knowing you have breached the barrier.

In fact, a large US study in 2021 found that roughly 27 per cent of young adults had elevated levels of low density lipoprotein (LDL) or bad cholesterol of 130 milligrams per decilitre (mg/dL) or above and nine per cent reported 160 mg/dL or above. High LDL cholesterol in young adults increases the risk of heart attacks in later life, when the cholesterol buildup is high enough to form plaques and blockages in the vessels of the heart. That’s why it is important to reduce cholesterol early.

BEGIN SCREENING EARLY

Nowadays, we recommend that anybody above 25 must get tested for cholesterol. If your readings are normal, then you can test after five years. If your readings are above the normal range, then go in for corrective measures as advised by your doctor but take the cholesterol test every year. If your readings are in range but you still have a family history of high cholesterol, heart attack, or stroke, then you must go for annual screening too. Sometimes, cholesterol levels rise because of hypothyroidism and diabetes, so get tested for these conditions as well.

START LIFESTYLE MODIFICATION IMMEDIATELY

If the readings are borderline high, then we first advise lifestyle modification. Begin with the two easiest interventions of controlling your diet and weight. Limit intake of saturated fats, sugary, salty, processed and ultra-processed packaged foods. The 20s are when you tend to get addicted to these foods easily. So focus on fruits, vegetables, wholegrains, nuts, seeds, lean meats and fish. Include plant proteins, too, as they make for flavourful options these days. Have freshly prepared food and junk the pre-mixed or marinated easy-to-prepare instant meal pouches.

Reducing and maintaining moderate weight can also help you reduce LDL cholesterol. Studies have shown that losing even 3 to 5 per cent of your body weight may help lower LDL cholesterol and increase high-density lipoprotein (HDL) or the good cholesterol.

LIMIT SMOKING AND ALCOHOL USE

Smoking damages the blood vessels and increases the rate at which the arteries harden, narrowing them and triggering blockages and heart attacks. Similarly alcohol breaks down in your body and gets converted to triglycerides and cholesterol in the liver. If your triglyceride levels become too high, they can build up in the liver, causing fatty liver disease. The liver can’t work as well as it should and can’t remove cholesterol from your blood, so your cholesterol levels rise. Men should not cross two drinks per day, women should not have more than a drink. Also avoid drinking more than six units in six hours, which counts as binge drinking.

BUILD AN EXERCISE PLAN YOU CAN STICK TO

Physical activity can play an important role in managing cholesterol levels by lowering LDL cholesterol, triglycerides and increasing HDL. A daily 45-minutes of walking is the bare minimum. Build in moderate intensity routines like jogging, swimming, strength and resistance training. Rest and sleep adequately.

MEDICINES FOR CHOLESTEROL

Statins: These are the most common type of cholesterol-lowering drugs and target cholesterol production in the liver.

Bile acid sequestrants: Doctors may prescribe these if statins are unsuitable or ineffective as they prevent cholesterol from circulating in the blood.

PCSK9 inhibitors: People inject this underneath the skin every 2–4 weeks.

ARE THESE SAFE FOR EVERYBODY?

Except for pregnant women, statins can be given to everybody. In fact, different drugs are given to different people depending on their threshold and body conditions.

WHAT ABOUT THOSE WITH A GENETIC HISTORY OF CHOLESTEROL?

Familiar hypercholesterolemia is an inherited disorder where people are born with high LDL levels, which continue to increase over time. Without treatment, it increases the risk of heart disease by 20 times, with a heart attack a possibility by your 30s. In such cases diet and exercise can help but are not enough to reduce LDL cholesterol on their own. Drugs are needed to reduce LDL levels by 50 per cent or more.