High cholesterol has no symptoms — it silently builds plaque in arteries for decades before causing a heart attack or stroke. Dr. Anand Karnam explains what the numbers mean, which matters most, and how to lower it.
Key Points
- High LDL cholesterol causes atherosclerosis — narrowing of arteries supplying the brain, heart, and limbs.
- Target LDL below 100 mg/dL for most adults; below 70 mg/dL for those with existing cardiovascular disease.
- Statins are the most effective medication — reducing LDL by 30–50% and cardiovascular events by 25–35%.
- Dietary changes: reduce saturated fat, increase soluble fibre (oats, legumes), and add plant sterols (fortified foods).
- Familial hypercholesterolaemia (genetic high cholesterol) requires early, aggressive treatment — even in children.
30–50%
LDL reduction achievable with standard statin doses
Source: AHA
25–35%
reduction in major cardiovascular events with statin therapy
Source: Lancet
1 in 250
people have familial hypercholesterolaemia — greatly underdiagnosed in India
Source: ICMR
"I tell patients: the vessel damage from high cholesterol starts in your 30s and takes 20 years to manifest as a stroke or heart attack. The patient who controls cholesterol at 35 is preventing the stroke at 55. Statins are among the most evidence-based preventive medicines we have."
Dyslipidaemia — abnormal blood cholesterol and fat levels — is present in approximately 25–30% of Indian adults and is a major, modifiable risk factor for heart attack and stroke. High cholesterol has no symptoms — it does not cause headaches, fatigue, or any detectable feeling. The only way to know is to check. Yet most Indians do not have a lipid profile done until after a cardiac event.
Understanding Your Lipid Report
Total cholesterol: Less than 200 mg/dL is desirable; 200–239 borderline high; 240+ high. But total cholesterol alone is a poor predictor of cardiovascular risk.
LDL cholesterol ("bad cholesterol"): The primary driver of atherosclerosis. LDL particles deposit in artery walls, triggering inflammatory plaque formation. Target depends on individual risk: below 130 for low-risk adults; below 100 if you have diabetes, hypertension, or smoking; below 70 if you have had a heart attack or stroke (secondary prevention).
HDL cholesterol ("good cholesterol"): Higher is better. HDL removes cholesterol from artery walls. Below 40 in men and below 50 in women increases cardiovascular risk. Regular exercise is the most effective way to raise HDL.
Triglycerides: Below 150 is normal; 150–499 is elevated; above 500 risks pancreatitis. High triglycerides in India are strongly associated with refined carbohydrate excess, sugary drinks, and alcohol.
Dietary Changes That Lower LDL
- Reduce saturated fat: ghee, coconut oil, full-fat dairy, red meat, vanaspati. Replace with unsaturated fats: olive oil, mustard oil, groundnut oil
- Eliminate trans fats: partially hydrogenated vanaspati, commercially fried foods, many Indian snacks (namkeen, pakoras from commercial oil repeatedly used)
- Increase soluble fibre: oats, psyllium husk (isabgol), legumes, apples, guava — soluble fibre binds cholesterol in the intestine and prevents reabsorption
- Reduce dietary cholesterol: egg yolks, organ meats (liver, kidney) — moderate restriction helps in some individuals
- Plant sterols: present in vegetable oils, nuts, seeds — block cholesterol absorption. Some fortified foods available
When Statins Are Needed
Statins (atorvastatin, rosuvastatin) are among the most evidence-backed medications in medicine — they reduce LDL by 40–55% and significantly reduce cardiovascular events independent of baseline cholesterol level. They are indicated for: all patients with established cardiovascular disease; patients with diabetes plus any additional risk factor; patients with very high LDL despite lifestyle changes. Lifestyle changes reduce the dose needed — they do not replace statins in high-risk patients.
For lipid management and cardiovascular risk assessment: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.
Dr. Anand Karnam
DrNB Neurology · Sri Anand CNC, Chanda Nagar Hyderabad · Sri Anand Child and Neuro Center
DrNB-qualified Neurologist, Fellow of the World Headache Society (FWHS), and Headache Specialist with 12+ years of experience treating epilepsy, stroke, migraine, and movement disorders. Practices at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad.
References & Sources
- 1.Cardiovascular Diseases — WHO Fact Sheet — World Health Organization
- 2.High Cholesterol — NIH MedlinePlus — NIH MedlinePlus
- 3.High Cholesterol — NHS — NHS UK
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All health tips and medical content on this website are written by qualified specialist doctors (DrNB / MD / MPT), follow the above guidelines, and are intended for general health education only. This content is original and evidence-based — not a substitute for professional medical advice. Always consult your doctor before making any health decisions.
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