There are new directives to screen for cholesterol early in life. But some studies say cholesterol is not so bad. Just how adversely does high cholesterol affect the body? Dr Mukesh Goel, senior consultant, cardiothoracic and vascular surgery, heart and lung transplant surgery, Indraprastha Apollo Hospitals, says: “Cholesterol itself is not ‘bad’. It is an essential fat-like substance used by the body to build cells and hormones. The concern arises when levels of low-density lipoprotein (LDL), often called bad cholesterol, become elevated.
Excess LDL can deposit in the walls of arteries, forming plaques over time. This process, known as atherosclerosis, gradually narrows and stiffens blood vessels, reducing blood flow. It can silently progress for years without symptoms until it leads to serious events like heart attack, stroke, or peripheral artery disease. High cholesterol is also linked to inflammation within blood vessels, further increasing cardiovascular risk. While some studies suggest cholesterol alone is not the sole culprit, it remains a major modifiable risk factor, especially when combined with smoking, diabetes, obesity, or hypertension. So, the real issue is not cholesterol itself, but persistently high and unmanaged levels.
Why is screening early so important?
Early screening is important because cholesterol-related damage begins much earlier than most people realise. Atherosclerosis can start in childhood or early adulthood, long before symptoms appear. By the time someone experiences a cardiac event, significant arterial damage may already have occurred.
Screening helps identify individuals with elevated cholesterol or inherited conditions like familial hypercholesterolemia, which can lead to very high levels from a young age. Early detection allows for timely lifestyle changes such as improving diet, increasing physical activity, and managing weight, which can significantly reduce long-term risk. It also helps establish a baseline and track trends over time. In countries like India, where heart disease tends to occur at a younger age, early screening becomes even more relevant. It shifts the approach from reactive treatment to prevention, helping reduce the overall burden of cardiovascular disease.
Would you advise medication or lifestyle changes to lower cholesterol?
The approach depends on an individual’s overall risk profile rather than cholesterol numbers alone. For people with mildly elevated cholesterol and no additional risk factors, lifestyle changes are usually the first and most important step. This includes a diet low in saturated and trans fats, increased intake of fibre, regular physical activity, weight management, and avoiding tobacco. These measures can significantly improve cholesterol levels and overall heart health.
However, if someone has very high LDL levels, existing cardiovascular disease, diabetes, or multiple risk factors, medication may be recommended alongside lifestyle changes. Drugs such as statins are well-studied and help reduce both cholesterol levels and the risk of heart events. The key is a personalised approach, where treatment decisions are based on total cardiovascular risk rather than a single lab value.
At what stage should medication be started, and does age have something to do with it?
Medication is typically started when the risk of cardiovascular disease is considered moderate to high, rather than based on age alone. Factors such as LDL levels, presence of diabetes, hypertension, smoking status, family history, and overall risk scores guide this decision. For instance, individuals with very high LDL levels or known heart disease may require medication regardless of age.
In younger individuals, lifestyle changes are often prioritised unless there is a genetic condition or significantly elevated cholesterol. Age does play a role because cardiovascular risk increases over time, so older adults are more likely to benefit from medication. However, early treatment may be necessary in younger people with high lifetime risk. The goal is to prevent long-term damage, so decisions are made by balancing immediate risk with future risk, rather than relying on age alone.
Disclaimer: The information in this article is for educational and informational purposes only and is not intended as medical advice. While the author has incorporated expert medical guidance while producing the story and ensured full authentic information is provided to the reader, you should always seek the advice of a qualified healthcare provider regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.