If my cholesterol is below 200 mg/dl, within normal limits, should I be concerned about heart disease?

When 45-year-old Arjun Mishra* was rushed to the emergency room with a heart attack that required an immediate stent, he was distraught. For just a week before, full body checkup reports had shown that his total cholesterol was below 200 mg/dL. But the reality is that optimal cholesterol levels do not always guarantee heart health because the ratio of bad cholesterol in the bloodstream can still lead to plaque buildup in the arteries.

“No cholesterol limit can be considered safe. The most common mistake people make is to consider the total cholesterol count as a measure of good health. But the fact is that you need to look at individual components, especially the LDL count (cholesterol bad), the ratio of HDL (good cholesterol) and the HDL:LDL ratio. Indians have low HDL. They say 50 mg/dL is ideal for neutralizing LDL, but in Indians, this level never exceeds 45 mg /dL That’s why we just need to focus on LDL levels and keep them low. In fact, over the last three decades, the safe limit of LDL has come down and for Indians, who are genetically prone to heart conditions, LDL levels are the only concern,” says Dr. Balbir Singh, president of Cardiac Sciences, Cardiology. , Cardiac, Electrophysiology-Marpassos, Max Hospital, Saket.

What is the safest LDL number required?

“Internationally, they prefer LDL levels below 70 mg/dL, but for Indians, I would say below 50 mg/dL. Heart disease among Indians is compounded by additional risk factors such as family history , smoking, stress, hypertension and diabetes. So many young Indians are getting a stent at an early age,” he says.

The other factor of concern is triglycerides. “LDL levels need to be reworked for some people in combination with comorbidities, elevated triglycerides, and body weight. Triglycerides are blood fats that, along with cholesterol, cause plaque to build up. So both both triglyceride and LDL levels should be significantly lower,” says Dr. Singh.

In fact, the Johns Hopkins recommendations say that LDL can be even riskier in women than in men. “This is a problem because women’s cholesterol levels can fluctuate quite a bit after menopause and tend to rise with age, putting them at greater risk for heart disease and stroke. Knowing your numbers cholesterol and how to control it is a big step in staying healthy,” he says.

“LDL particles like to stick to the lining of the arteries, like soap scum on pipes. As it sticks there, it creates an inflammatory response and your body starts turning it into plaque Plaque in blood vessels makes them stiffer and narrower, restricting blood flow to vital organs such as the brain and heart muscle, leading to high blood pressure. In addition, pieces can break off and cause a heart attack. heart or stroke. And guess what? That build-up can start as early as age 20,” the Johns Hopkins guidelines say.

Dr Singh says the Indian guidelines are different for this precise reason. “Very low levels of LDL can prevent a lot of cardiovascular events. In extreme cases we should work towards the marker of less than 30 mg/dL. And we should start therapies with lipid-lowering drugs early, in addition to positive changes in lifestyle for people at risk”.

What can be the preventive protocol?

“I see many patients who have normal cholesterol levels, but are still at high risk for heart disease. This is for many reasons: they are smokers, they have a stressful life, they lead a sedentary lifestyle, they are diabetic, have high blood pressure, have a family history of heart disease. Usually, in patients with lower cholesterol, we look at all of these risk factors together and then determine whether we need to do further testing. This could include a CT scan of the heart, a treadmill test and a carotid ultrasound. People think that just because their cholesterol is normal, they are not at risk for heart disease. This is not correct. It is a misconception and even those who are fit but smoke and drink excessively too should get checked every six months. Those who are obese or don’t exercise regularly are definitely at risk. Even if their cholesterol levels are normal, they should walk religiously for 30 minutes, which can significantly reduce the risk of heart disease,” says Dr Manish Bansal, Director, Clinical and Preventive Cardiology, Heart Institute, Medanta Hospital, Gurgaon.

(*Name has been changed to protect identity)

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