Each 39 mg/dL reduction in serum LDL (low-density lipoprotein, commonly called bad cholesterol), maintained over a five-year period, reduces the risk of death from cardiovascular disease by 20%.
The Lipid Association of India, a team of physicians in the field of cardiovascular medicine, internal medicine and pharmacology, recommends that screening for high cholesterol should start right out of school. If Arpan Shah from Mumbai knew that, his life would have been different. The 36-year-old, who works at a diamond shop in Mumbai’s Bandra Kurla complex, saw a GP last year as he was suffering from chest pain. He was detected to have a heart attack. “One of my arteries was completely clogged,” he said.
Whether or not to place a stent is a dilemma that cardiologists often face. “The patient being young, we did not want to put a stent. Instead, we decided to treat him with blood thinners and injections and repeat his angiography after 5-7 days,” said Dr Ruchit Shah, Consultant Cardiologist at Masina Hospital, Mumbai. “The second angiogram showed that there were still some subtle blockages. Then we performed a fractional flow reserve procedure to see if the blocks were large or not and if the patient needed angioplasty and stenting. The blocks had largely dissolved and the patient did not require angioplasty. Shah was advised to lower his total cholesterol and LDL levels with high-dose statins, daily exercise, and diet control.
Heart disease appears to be on the rise among young Indians. “We develop coronary heart disease 10 years earlier than other ethnic groups. What is even worse is that about 40% of Indians with coronary heart disease are under 40 years old, and 25% of our cardiovascular deaths are also under 40 years old,’ said Dr CK Ponde, Cardiologist consultant at Hinduja Hospital. , Mumbai.
High LDL levels are a common culprit behind cardiovascular problems. LDL is responsible for depositing cholesterol and plaque inside arteries throughout the body. “Cholesterol travels through the blood on proteins called lipoproteins. Among the various lipoproteins, LDL is the bad guy that can stick inside arterial walls and create blocks to cause heart attacks and strokes,” said Dr. Vivek Jawali, Chief Cardiothoracic and Vascular Surgeon and President of Fortis Hospitals.
According to Dr. Rishi Gupta, Chairman, Cardiac Sciences, Accord Superspeciality Hospital, Faridabad, acceptable LDL levels are below 100. “In patients who already have the disease, the expected level is below 70.” Lowering the LDL level can reduce the risk of cardiovascular problems significantly. Statins are the main drugs used to control LDL, aimed at reducing the risk of heart problems and stroke. However, some patients do not respond to statins. “Despite high doses, 40-50% of patients do not reach the target LDL level, so additional medications are needed. Also, high dose of statins can cause severe muscle pain,” Gupta said.
Bempedoic acid medications offer hope for patients whose LDL levels cannot be managed with statins alone or for those who cannot tolerate statins. “It has been conclusively established that the drug can be used safely in these patients,” said Dr. S. Venkatesh, Senior Consultant, Interventional Cardiology, Aster RV Bengaluru. Zydus Lifesciences recently launched its bempedoic drug in India under the brand name Bemdac.
However, bempedoic acid drugs are not an alternative to statins, said Dr. Praveen Chandra, cardiologist and chair of interventional cardiology at Medanta-The Medicity, Gurugram. “These are not as potent or effective as statins and should only be given when statins are not effective. For example, some patients have high LDL levels even after taking 20mg of statins. For them , bempedoic acid medications can be given in addition to statins,” he said.
Statins lower LDL by inhibiting HMG-CoA reductase, an enzyme that produces cholesterol. Bempedoic acid medications slow down a different enzyme in the cholesterol-producing pathway known as ATP citrate lyase, but only in the liver. “Unlike statins, bempedoic acid only works in the liver, so it’s much less likely to cause muscle-affecting side effects, one of the main reasons some people can’t take statins.”
There are many studies on the bi-directional link between LDL infections and Covid-19. “It is a myth that low LDL causes severe symptoms of Covid infection,” said Dr Siddhant Jain, Director of Cardiac Sciences and Chief Interventional Cardiologist, Shalby Hospitals, Indore. “In fact, it’s the other way around. The severity of Covid causes LDL levels to drop and therefore low LDL is found in these cases. It is not a causal relationship but a correlation. People often misinterpret this and stop taking their cholesterol medications.”
LDL levels in the blood are mainly determined by genes and not diet, said Dr Ranjan Shetty, Head of Department and Consultant in Interventional Cardiology, Manipal Hospital, Old Airport Road, Bengaluru.
Albert Fernandes of Bengaluru would agree. The 34-year-old had a blood test a few months ago as he was suffering from allergic rhinitis. Much to his dismay, he discovered that his cholesterol level was higher than normal. His total cholesterol was 203 mg/dL and his LDL level was 122 mg/dL. Fernandes was advised to change his lifestyle and diet. “I was told to avoid red meat and shellfish and do regular cardio exercise,” he said. He took the doctor’s advice and repeated the tests three months later. “My cholesterol level was even higher. Sometimes my chest feels heavy,” said Fernandes, who has now been advised to take statins.
Gene mutations can also affect cholesterol levels. “A reading of 190 mg/dL is considered high. For diabetic patients, even a value of 70 mg/dL is considered high. People who are already struggling with heart disease should control their LDL level to less than 55 mg/dL,” Shetty said.
Low LDL is essential for everyone, including men and women of all ages, with or without heart disease. “Getting a full lipoprotein profile is essential if you are experiencing discomfort,” said Dr. Amit Pendharkar, Director, Cardiology, Aakash Healthcare, Dwarka. “If your cholesterol is not where it should be, see a dietitian right away and start adopting a heart-healthy lifestyle. In addition, people should avoid fatty foods and junk foods at all costs. Eat more high fiber foods and live a healthy lifestyle,” he said.
Researchers believe there is a link between stress and LDL. Stress leads to high levels of cortisol, the stress hormone which, in turn, leads to high LDL levels. Stress also lowers good cholesterol.
Music can help maintain better cholesterol levels. The ancient Greeks used music to soothe pain and reduce stress. Singing was part of Native American and African healing rituals. Participants in some of the recent scientific studies reported feeling significantly less anxiety and pain when listening to music for 30 minutes.
Listening to your favorite songs is one of the easiest ways to lower LDL levels. Dr. Sparsha S. Vasisht, a final-year resident in the Department of Anesthesiology at SDM Medical University in Dharwad, listens to music in her operating room. “Our OTs have built-in speakers,” she said.
But that may be a different story for performing musicians. It’s well documented that professional musicians and music students regularly encounter musculoskeletal and mental health issues, Jain said. “Playing music can lead to increased heart rate and blood pressure. Musicians can face major stress in creating music. Performing at concerts in high temperatures with large crowds can cause stress .
Low levels of HDL and high triglycerides along with high levels of LDL contribute to atherosclerotic coronary heart disease, said Dr. Lal Daga, Senior Interventional Cardiologist, Apollo Hospitals, Ahmedabad. He said high carbohydrate levels in the diet must contribute to high triglyceride levels.
Harsh Yadav from Indore had a slight increase in LDL with low HDL which made him susceptible to heart problems. The 33-year-old had a terrible lifestyle which included smoking, sedentary work and excessive stress and he didn’t bother to see a doctor even after facing extreme sweating and to chest discomfort.
Yadav ended up paying a huge price for ignoring the body’s call for help. One day he collapsed in his office and was taken to Shalby Hospitals by his colleagues. It turned out that he had suffered a massive heart attack. “He was immediately taken in for angioplasty and his blocked arteries were opened which saved his life. Now he will have to take medicine for the rest of his life with a weakened heart,” Jain said.
Considering the increasing prevalence of cardiovascular problems among young Indians, Dr Sudheer Koganti, consultant interventional cardiologist at Citizens Specialty Hospital, Hyderabad, said India needs to develop a mechanism to screen adults under the age of 30, especially those with a family history of cardiovascular disease. “A simple blood test can help you check and monitor cholesterol levels, especially triglycerides and LDL cholesterol,” Koganti said. “The test may be done more often if you have heart disease, diabetes, or high cholesterol in your family.”