For a long time, we have been following US and European guidelines for cardiac care. But these standards are based on Western data, not Indian data. As a co-author of the first India-related guideline by the Indian Cardiology Society, I can tell you that Indians are genetically predisposed to premature heart attacks even if their lipid (compounds of fats and oils) levels are lower than what is considered normal. Hence, Indians need to lower their lipid levels further. And that can only be done if lipid testing is done early, precisely at the age of 18.
Many young Indians suffer early heart attacks due to dyslipidemia. Lipid (fat) levels Imbalances in the levels of cholesterol and triglycerides in the blood can increase the risk of heart disease and stroke.
What tests should I take when I turn 18?
Indians should get their first lipid profile at the age of 18, as this is the right age to understand cholesterol trends and get abnormal levels under control. The test maps total cholesterol levels, including high-density lipoprotein (HDL), the good cholesterol, as well as low-density lipoprotein (LDL), the bad cholesterol, triglycerides, and very-low-density lipoprotein (VLDL), which are often categorized together as non-HDL cholesterol, which causes plaque in the arteries and restricts blood flow.
People with a family history of heart attacks or high cholesterol should get a separate test for lipoprotein(a), the denser cholesterol, as it is not part of a lipid panel test. Levels above 50 mg/dl are associated with a higher risk of heart attack.
How do you read cholesterol levels?
At age 18, LDL cholesterol should not exceed 100 mg/dL for primary prevention. All non-HDL cholesterol combined should be less than 130 mg/dL (for people who have never had a heart attack or cardiac event). If an adult is in the moderate-risk category (having at least one risk factor, such as diabetes, high blood pressure, smoking, tobacco use, or a family history of heart attack), their LDL level should be less than 100 mg/dL. Young people in the high-risk category (diabetes and at least one risk factor) or people with chronic kidney disease (CKD) with an estimated glomerular filtration rate (eGFR) (a test that measures kidney function and determines the stage of kidney disease) between 30 and 60 years old should have an LDL level less than 70 mg/dL. For adults who have already had a cardiac event in their 20s, their LDL level should be less than 55 mg/dL. The same applies to people with high lipoprotein(a) levels.
What to do if high cholesterol is detected?
First, lifestyle changes are recommended, including dietary adjustments, weight loss, exercise, avoidance of smoking, and regular blood pressure monitoring. Second, diabetes and high blood pressure are tested and addressed with lifestyle adjustments and medication. If cholesterol levels do not decrease, statins should be taken. Contrary to misconception, statins are safe (no studies have demonstrated that they are harmful) and can be taken at a young age. Taking statins to lower cholesterol can prevent many heart attacks. Combining a statin with bempedoic acid or ezetimibe can lower cholesterol by up to 27 percent.
(Dr Mehta is a senior cardiologist at Ganga Ram Hospital, New Delhi)
© Indian Express Ltd.
First uploaded: September 7, 2024, 10:47 AM
