What is cholesterol?
Cholesterol is a waxy fat that the body needs to build cells, make vitamin D and produce hormones. The liver makes most of the cholesterol we need, and the rest comes from food, mainly animal products. It travels in the blood in small packages called lipoproteins, which carry it to and from the tissues.
LDL, often called bad cholesterol, can settle in the walls of arteries and form plaques that narrow them. HDL, the good cholesterol, helps carry extra cholesterol back to the liver. Triglycerides are another blood fat that rises with sugar, refined carbohydrates and alcohol. Indians often have high triglycerides and low HDL together.
Why it matters
High cholesterol causes no pain or symptoms. Over years, plaques in the arteries can block blood flow or break open and form a clot. When this happens in the heart it causes a heart attack; in the brain it causes a stroke. The risk is higher when high cholesterol comes with diabetes, high blood pressure, smoking or a family history of early heart disease.
The damage builds up silently over decades, which is why heart attacks can seem to come from nowhere. Bringing LDL down lowers this risk, even in people who already have heart disease. The earlier high cholesterol is found and managed, the more protection you get for your heart and brain.
High cholesterol: causes and risk factors
Diet and lifestyle play a large role, but genes matter too. Some families have inherited high cholesterol, called familial hypercholesterolaemia, that starts in childhood and can cause heart attacks at a young age. Children in such families need early testing and treatment. Common contributing factors include:
- Food high in saturated and trans fats: vanaspati, deep-fried snacks, bakery items, red meat, full-fat dairy in excess
- Too much sugar, sweets, maida and white rice, which raise triglycerides
- Being overweight and inactive
- Smoking and alcohol
- Diabetes, hypothyroidism, kidney or liver disease
- Family history of high cholesterol or early heart attack
The lipid profile test
A lipid profile is a simple blood test that measures total cholesterol, LDL, HDL and triglycerides. Many labs advise fasting overnight, but some doctors accept a non-fasting sample; follow the instruction you are given. Adults should get their first lipid profile by their twenties or thirties, and earlier if there is a family history. If your result is normal and you are low risk, repeating it every few years is usually enough.
Your target LDL is not the same as everyone else's. It depends on your overall heart risk, including age, diabetes, BP, smoking and past heart problems. Your doctor may also check sugar, thyroid, liver and kidney function, as these can affect cholesterol and treatment choices.
Food and lifestyle changes
Replace vanaspati, butter and repeated deep frying with small amounts of vegetable oils such as groundnut, mustard, rice bran or sunflower oil, and rotate them. Eat more fibre from whole grains, millets, oats, dal, rajma, chana, vegetables and fruits. A handful of unsalted nuts is a good snack. Limit sweets, bakery items and sugary drinks to lower triglycerides. Grill, steam or roast more often instead of deep frying.
Aim for 30 minutes of brisk walking, cycling, swimming or other activity on most days, and lose weight if you are overweight. Stop smoking in every form and avoid alcohol, which raises triglycerides. These changes also help lower blood pressure and sugar, so they protect your heart in more than one way.
Medicines and follow-up
When lifestyle changes are not enough, or your heart risk is high, your doctor may prescribe a statin. Cholesterol medicines are taken only on a doctor's prescription and usually long term. Stopping them makes cholesterol rise again. Doctors sometimes add a second medicine when LDL does not reach the target.
Statins are not used in pregnancy or breastfeeding, so tell your doctor if you are planning a baby. A repeat lipid profile is usually done a few weeks after starting or changing treatment, and then regularly. Discuss any concerns about side effects with your doctor or pharmacist instead of stopping on your own.
Children and teenagers are usually treated with diet and activity first, unless they have an inherited form. People with liver disease need careful monitoring before and during treatment. Older adults also benefit from statins, and your doctor will balance the benefits against any other medicines you take. If you have questions about your cholesterol results or medicines, talk to your doctor or pharmacist.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Statins such as atorvastatin or rosuvastatinReduce the liver's production of cholesterol and lower LDL, cutting the risk of heart attack and stroke.Report unexplained muscle pain or weakness to your doctor; not used in pregnancy.
- EzetimibeReduces cholesterol absorption from the gut and is often added to a statin.Only on a doctor's prescription; usually well tolerated.
- Fibrates such as fenofibrateMainly lower very high triglycerides.Doctors monitor kidney function and use extra care when combined with statins.
- Omega-3 fatty acid preparationsSometimes prescribed to help lower high triglycerides.Use only if your doctor advises; tell them if you take blood thinners.
See a doctor urgently if
- Chest pain, pressure or tightness, especially on exertion or spreading to the arm, jaw or back
- Sudden weakness of one side of the body, slurred speech or drooping face
- Pain in the calves when walking that goes away on rest
- Severe belly pain with very high triglycerides, which can signal pancreatitis
- Yellowish fatty lumps on the eyelids, elbows or tendons, especially in young people
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.