Can heart attacks in young people be prevented with a simple cholesterol test at 18?
FOR a long time, we have been following US and European guidelines on heart care. But these norms are based on data in the West and not India. As a co-author of the first India-relevant guidelines by the Cardiologist Society of India, let me tell you that Indians are genetically predisposed to early heart attacks even if their levels of lipids (fat and oil compounds) are lower than what is accepted as normal. So Indians have to push their levels further down. And that can happen only if we do a lipid test early, at age 18 to be precise.
Why lipids need to be watched early?
Many young Indians have an early heart attack because of dyslipidemia, a condition characterised by abnormal levels of lipids (fats) in the blood, such as high cholesterol and triglycerides. This imbalance can increase the risk of heart disease and strokes.
What test should you take at 18?
Indians should get their first lipid profile at 18 as that’s a good age to understand cholesterol tendencies and control errant levels.
The test maps your total cholesterol levels, including high density lipoprotein (HDL) or good cholesterol besides low density lipoprotein (LDL) or bad cholesterol, triglycerides and very low density lipoproteins (VLDL), often classified together as non-HDL cholesterol, the kind that triggers plaques in arteries and restrict blood flow.
Those with a family history of either heart attacks or high cholesterol should get tested for lipoprotein (a), which is a denser cholesterol, separately as it is not part of the lipid panel test. If its levels are higher than 50 mg/ dl, then the risk of heart attack is high.
How to read cholesterol levels?
At 18, LDL cholesterol should not cross 100 mg/dL for primary prevention. If you factor all forms of non-HDL cholesterol together, it should be less than 130 mg/dL (for those who have not had a heart attack or any heart event).
If an adult is in the moderate risk category — where they also have one risk factor like diabetes, hypertension, smoking, tobacco use or family history of heart attacks — their LDL level should be less than 100 mg/dL. Young people in the high risk category (diabetes plus one or more risk factors) or those suffering from chronic kidney disease (CKD) with an estimated glomerular filtration rate (eGFR) — a test that measures kidney function and determines the stage of kidney disease — between 30 and 60, should have LDL levels lesser than 70 mg/dL.
For adults who have already had a heart event in their 20s, the LDL level should be less than 55 mg/dL. Same for people with elevated lipoprotein (a).
What to do if high cholesterol is detected?
We first recommend lifestyle correction, which includes diet control, weight loss, exercise, avoiding smoking and monitoring blood pressure (BP) regularly. Then get yourself screened for diabetes and hypertension and address them through lifestyle tweaks and medication. If cholesterol levels are stubborn, then one must take statins.
Contrary to myths, statins are safe (no trial has shown they are harmful) and can be administered at a younger age. If people take statins to get cholesterol down, a lot of heart attacks would be prevented. A combination of statin with bempedoic acid or ezetimibe may lower cholesterol by up to 27 percent.