Understanding bad and good cholesterol
It is vital to understand the effects of cholesterol. In fact, cholesterol is just one of the many substances created and used by our body to keep us healthy. It promotes synthesis of cell membranes and hormones. Unfortunately, cholesterol does not get processed in a beneficial way every time. In other words, elevated levels of bad cholesterol is a major risk factor for the rising epidemic of heart attack, brain attack, etc in our country. Covid-19 is prothrombotic, pro-inflammatory and pro-immunogenic. These factors are responsible for severity and mortality, more so for those with underlying comorbidities.
The theme of World Heart Day this year is ‘Use your heart to connect to healthy choices digitally to improve awareness, prevention and treatment’. Healthy heart is not by chance, it is by choice.
What is cholesterol? What are the types and risks?
Cholesterol is a waxy, soft, fat-like substance found in all body cells, and is essential for life. However, high levels of bad cholesterol such as total cholesterol (CH), triglycerides (TG), low density lipoproteins (LDL) LPa, remnants cholesterol, Apolipoprotein A1, Apolipoprotein B, may lead to premature hardening of the arteries in the heart, brain, peripheral arteries, aorta, kidney arteries, etc. Narrowing of the arteries reduces blood supply to the tissues. High levels of bad cholesterol and low levels of good cholesterol HDL (high density lipoproteins) may be responsible for premature heart attack in the younger population, especially those who are obese with pot belly (>90cm in men and >80cm in women), in hypertensives, diabetics and smokers.
What are the normal and risk levels of cholesterol?
Normal range of blood cholesterol is 150-250 mg/dl. Ideally, blood cholesterol in an adult should be < 130 mg/dL, LDL cholesterol levels
< 70 mg/dL, triglyceride level < 130mg/dl, VLDL level < 30 mg/ dl, HDL cholesterol levels > 40 mg/dl in males and > 50 mg/dl in females. The cholesterol/ HDL ratio should be < 4, LDL/ HDL ratio should be < 3. LPa level should be < 30 mg/dL, non-HDL < 130 mg/dL, Apolipoprotein A1 .89 -.1.86,g/l Apolipoprotein B .45 -.1.69 g/l (>LDLC-Non HDLC) Apolipoprotein < 90 mg/dL, Remnant Cholesterol .4-.5 mmol/L (total cholesterolLDL-HDL). Increase in levels of these lipoproteins may increase risk of heart attacks.
How is high triglyceride level harmful to the body?
The source of triglycerides is diet. If high, it may be an independent risk factor for heart attack and brain attack. Individuals with high levels of triglycerides (> 200 mg/dl) are
two times more vulnerable to atherosclerosis than those with lower levels. Regular exercise, healthy diet, reduced alcohol intake, fenofibrate may be recommended to reduce triglyceride levels.
What about fats?
Saturated fats are solid at room temperature. They are found in fats of animal origin such as beef, butter, cream. Coconut oil, though of plant origin, is solid at room temperature and has high saturated fat content. High intake of saturated fat spikes cholesterol. On the contrary, unsaturated fats are liquid at room temperature. Sources of polyunsaturated fats are plants such as sunflower, corn and soyabean. Consumption of polyunsaturated fat oils lowers cholesterol level. Monounsaturated fats are in olive, peanut, avocado oil, and lowers cholesterol levels.
What is the relationship between cholesterol and alcohol/smoking?
Excessive alcohol intake can raise bad cholesterol, triglycerides and may cause high blood pressure or heart attack. Also, tobacco consumption in any form raises bad cholesterol, even LDL and triglycerides, lowers the level of HDL. HDL level decline is greater in women smokers, as compared to men.
How are age and stress related to cholesterol?
Any kind of stress may raise bad cholesterol. Also, as age advances, it enhance vascular age and raises bad cholesterol. And after menopause, bad cholesterol level becomes high and good cholesterol low.
What is the recommended protocol for lipid profile check after the age of 30?
Lipid profile should be checked on a yearly basis after 30 and every six months after 55. It can be individualised on doctor’s advise and an individual’s comorbidities.
What is the role of diet in reducing cholesterol?
Reduce fat intake, so that less than 10% of total calories comes from saturated fat and 10% from polyunsaturated fats. Eat more nuts, vegetables and. One can have chicken and fish, no red meat. Avoid egg yolk, opt for egg white. Ditch junk, deep-fried food such as samosa, cutlets, etc.
How can regular exercise influence cholesterol ?
Regular walking, wogging, jogging, swimming, etc are excellent for a healthy heart and to reduce the level of bad cholesterol and increase the level of good cholesterol. Follow these points for good heart health and to keep your cholesterol levels in check: Say no to stress, smoking, l sedentary lifestyle, saturated fat, excess alcohol, salt, sugar Practice heart-friendly l exercises for 30 minutes daily Do not eat junk or fried food; l include more nuts, fruits and vegetables in your diet
To be cholesterol fit, ensure l you are adequately hydrated Manage anger to enhance l heart health. Also, cope with stress by practising all eight limbs of yoga and meditation. Eat the right food at the right l time, place, in the right dose and the right environment Get annual health check-up l done after the age of 30 Optimise your heart-mind l connection for a more healthy heart
Follow 3Ms (mindfulness, l meditation and medication) Please take statins with your l doctor’s advise
The author of the article is Dr HK Chopra, senior consultant cardiologist, Medanta Moolchand Heart Institute, chairman CME, Moolchand Medcity, Delhi, chairman, World Wellness Foundation, WHA, country head, AHA, former national president, CSI and IAE, former national editor-in-chief, IHJ, JIAE, editor-in-chief, Top 10 Textbooks of Cardiology, chief advisor, heath committee, SCOPE; Email: drhkchopra@gmail.com