Overview#
High cholesterol, or dyslipidemia, refers to abnormal levels of lipids (fats) in the blood – elevated LDL ("bad") cholesterol, triglycerides, or low HDL ("good") cholesterol. Indians have a unique lipid pattern often called the "atherogenic triad": high triglycerides, low HDL, and small dense LDL particles, which significantly increases cardiovascular risk even at younger ages. Heart disease is the leading cause of death in India, and dyslipidemia is one of its most modifiable risk factors.
Causes & Risk Factors#
- Diet high in saturated and trans fats – ghee in excess, fried snacks (samosa, pakora), bakery products, and vanaspati (hydrogenated oils).
- Sedentary lifestyle – physical inactivity lowers HDL and raises triglycerides.
- Genetic factors (familial hypercholesterolemia) – affects about 1 in 250 people; causes very high LDL from birth.
- Obesity and metabolic syndrome – central adiposity drives the atherogenic lipid pattern.
- Associated conditions – hypothyroidism, diabetes, chronic kidney disease, and certain medications (steroids, beta-blockers) can worsen lipids.
Signs & Symptoms#
- High cholesterol itself causes no symptoms – it is a "silent" condition
- Xanthomas – yellowish fatty deposits on tendons (knuckles, elbows, Achilles)
- Xanthelasma – yellow patches around the eyelids
- Corneal arcus – white/grey ring around the cornea (in younger patients suggests familial type)
- Symptoms appear only when complications develop: chest pain (angina), leg pain on walking (peripheral artery disease)
- Heart attack or stroke may be the first manifestation
Diagnosis#
- Lipid Profile (fasting) – the standard test measuring Total Cholesterol, LDL, HDL, Triglycerides, and VLDL. Book Lipid Profile
- Non-HDL Cholesterol – calculated as Total Cholesterol minus HDL; a better predictor of risk in Indians with high triglycerides.
- Apolipoprotein B (ApoB) – optional; reflects the actual number of atherogenic particles.
- Thyroid Profile – rule out hypothyroidism as a reversible cause. Book Thyroid Profile
- Liver Function Test – baseline before starting statins. Book LFT
Target values for Indians (higher risk population):
- LDL < 100 mg/dL (< 70 if diabetic or with heart disease)
- HDL > 40 mg/dL (men), > 50 mg/dL (women)
- Triglycerides < 150 mg/dL
Treatment Options#
Statins (atorvastatin, rosuvastatin) are first-line for elevated LDL. They reduce LDL by 30-50 % and are proven to lower heart attack and stroke risk. Common Indian practice starts with moderate-intensity statins.
Other medications: Ezetimibe (add-on to statins), fibrates (for high triglycerides), PCSK9 inhibitors (for familial hypercholesterolemia or statin-intolerant patients).
Dietary changes:
- Replace vanaspati and excess ghee with mustard oil, groundnut oil, or rice bran oil.
- Increase soluble fibre: oats, barley, rajma, chana, flaxseeds (alsi), and isabgol.
- Eat fatty fish (mackerel, sardines) 2-3 times per week for omega-3 fatty acids.
- Include walnuts, almonds, and methi (fenugreek) seeds – all shown to improve lipid profiles.
Prevention#
- Get a lipid profile done by age 20, then every 5 years (annually if risk factors exist).
- Maintain a healthy weight and exercise for at least 30 minutes daily.
- Avoid trans fats completely – check labels for "partially hydrogenated" oils.
- Limit deep-fried foods and processed bakery items.
- Quit smoking – it lowers HDL and damages blood vessels.
When to See a Doctor#
Get tested if you have a family history of heart disease or high cholesterol, diabetes, hypertension, or obesity. Seek emergency care for sudden chest pain, jaw pain, breathlessness, or arm pain – these may indicate a heart attack from blocked arteries.