How bad cholesterol causes heart attack: How much should you keep it down?

Why do Indians need to lower their LDL?

That’s because Indians are genetically prone to suffering a heart attack 10 years before other populations. Apart from this, the LDL type in Indians is oxidised faster, which means they harden the walls of the arteries more rapidly. Indians have lipoprotein (a) or Lp(a), a type of LDL which can clot more easily and is harder to break down. These can stick like scum in your arteries and form blockages called plaques. If a plaque breaks in the heart artery and tears the artery wall, more blood rushes in to form a clot. In effect, the blockage grows bigger and deprives the heart of blood supply, leading to heart attacks.

What’s the safest LDL number that is required?

Internationally, they prefer LDL levels to be less than 70 mg/dL but for Indians, I would say less than 50 mg/dL, preferably 30mg/dL. Otherwise, the risk gets compounded for Indians with additional risk factors like family history, smoking, stress, hypertension and diabetes. That’s why so many young Indians are getting a stent in early ages.

LDL levels need to be reworked for some people with high triglycerides and body weight. Triglycerides are blood fat, which along with cholesterol, cause plaque build-up. Therefore, both triglycerides and LDL levels need to be significantly lower. In fact, LDL can be risky for post-menopause women as their cholesterol levels tend to increase with age.

There is no scientific evidence of lower levels of LDL being harmful to your body, so one must keep it low.

How to lower LDL with diet and lifestyle?

Take the Lp(a) test, which is not part of routine medical checkups, so many people with high levels of Lp(a) don’t know they have it.

To lower LDL and triglycerides with diet, you must include more fibre which binds to the cholesterol and fat and pulls them out of your body. So beans, lentils, split peas, apples, blackberries, citrus fruits, oats, oat bran are recommended. Choose healthy fats like nuts and seeds, and fatty fish like salmon, mackerel or trout. You can also use olive oil instead of other fats.

Avoid trans fats, which are found in fried foods, baked goods and some animal products. Avoid bread and pasta made from refined white flour, or cornflakes. Limit sweets and drinks with added sugar, which can raise triglycerides.

Exercise as even a modest weight loss can reduce your triglycerides, cholesterol and heart disease risk. Give up smoking and drinking altogether if you are at risk.

What about medication?

Start lipid-lowering drug therapies like statins, which lower LDL production in the liver, or ezetimibe (Zetia), which stalls absorption of LDL from the intestine, or PCSK9 inhibitors, which remove LDL from the bloodstream into the liver.

(Dr Singh is Chairman, Cardiac Sciences, Cardiology, Max Hospital, Saket)