Source:
https://indianexpress.com/article/health-wellness
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.
