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Excessive lipids invite sudden cardiac arrests, ET HealthWorld


New Delhi: Considered the most important atherosclerotic risk factor, dyslipidemia is a global public health issue. Evolving living habits have an impact on both industrialised and developing countries. The prevalence of dyslipidemia is rising worldwide due to factors like sedentary lifestyles, poor diets, and rising obesity rates.

Due to the presence of abnormal levels of lipids such as cholesterol and triglycerides in the blood, chronic conditions can increase the risk of cardiovascular diseases, including clogged arteries, stroke, and heart attacks. Recent studies in India have shed light on the elevated levels of cholesterol being present (around 25–30 per cent) in urban and rural populations (15–20 per cent). Borderline high low-density lipoprotein (LDL cholesterol), low high-density lipoprotein (HDL cholesterol), and high triglycerides are the most prominent dyslipidemias in India. According to studies, urban populations’ total cholesterol, LDL cholesterol, and triglyceride levels have risen over the last two decades.

Despite its high prevalence, dyslipidemia remains underdiagnosed and undertreated in many cases, primarily due to a lack of awareness, limited access to healthcare, and insufficient screening programmes. ETHealthworld, on the occasion of National Lipid Day, spoke to cardiologists who explained the factors causing excessive lipid production and its impact on cardiovascular health. Experts elucidated various aspects of dyslipidemia, including its role as a trigger behind increasing instances of sudden heart attacks in the country, especially among the younger population.

Risk factors for developing dyslipidemia

Experts suggest a clear demarcation of risk factors that contribute to the formation of excessive lipids in the bloodstream, namely modifiable and non-modifiable risk factors. Genetically having higher cholesterol levels, or the chances of men developing cardiovascular disease are higher than those of women due to slightly higher cholesterol presence in non-amendable and there is nothing much an individual can do about it.

Apart from excessive alcohol and smoking, poor dietary habits such as consuming processed food, fatty meals, and foods rich in oil and sugar content can act as catalysts in the formation of lipids, which can further advance cardiovascular diseases. Doctors also say that a sedentary lifestyle, lack of sleep, poor work-life balance, and stress can also contribute to the development of dyslipidemia.

Dr Rahul Gupta, Cardiologist, Apollo Hospitals CBD Belapur, Mumbai, explained that there are three components that doctors look for — low-density lipoprotein (LDL), sometimes called ‘bad’ cholesterol; high-density lipoprotein (HDL), or ‘good’ cholesterol; and triglycerides. Lipid profiling is done with a combination of all these things.

“When we say high cholesterol, it could be high LDL or high triglyceride, and both of these can get elevated because of multiple factors,” voiced Dr Gupta, including a poor dietary lifestyle—junk food, oily stuff, and a lot of sugary drinks are classified as cholesterol-rich foods.

Doctors suggest managing such a disease is a continuous process because it is chronic in nature, and stress and lack of sleep can also produce inflammation, which can cause cholesterol to rise again. The disease can resurface once an individual stops paying attention to following a good lifestyle and dietary habits. Furthermore, patients with dyslipidemia are first treated with natural methods, and if it is unmanageable naturally, patients are put on medications.

Treatment modalities used in the management of LDL-C

Bad cholesterol is considered instrumental in developing atherosclerosis, the main underlying cause of cardiovascular disease (CVD). Emphasising that treatment modalities used for dyslipidemia are primarily focused on decreasing the load but not lipoproteins and that the focus is not much on reducing total cholesterol levels, Dr Subhendu Mohanty, Interventional Cardiologist, Sharda Hospital, Noida, suggested, “The perception in the general public that the total cholesterol level is important is not the case. The reason behind a rise in total cholesterol level can be an individual’s high good cholesterol level. Statin drugs are most commonly used and are widely proven to be beneficial in the studies involving lakhs of patients with high LDL.”

Patients whose LDLs are not controlled by statins have to go for a second line of treatment. Apart from controlling high blood sugar levels, blood pressure is also recommended.

“There is another new component that has come to be known as bempedoic acid and is part of the LDL-reducing medications. People with excessively high cholesterol/LDL levels and those with multiple blockages are given the monoclonal antibody evolocumab injection, which is very costly right now and is given once every 15 days to aid in reducing the LDL,” Dr Gupta elaborated further.

Early identification and treatment to potentially reduce cardiovascular risk due to dyslipidemia

Experts suggest that being exposed to high cholesterol for several years could lead to further complications. That is why earlier control is better. Dr Gupta elucidated this with an example, he stated, “Suppose somebody has had mildly elevated cholesterol for 30 years versus somebody with very high cholesterol for 10 years. The one with 30 years will have a greater impact on health because of the cumulative effect.” In other words, it is the number of years of elevated cholesterol. Therefore, controlling cholesterol with an early diagnosis is extremely important to reduce the burden of heart disease at later stages in life.

The international guideline suggests that after 20 years of age, an individual should get their cholesterol checked. “Even if you don’t have any symptoms, a checkup is a must. We are seeing a rising incidence of heart disease in our country. People are developing heart disease in their 20s and 30s, especially males. Therefore, we might resort to checking the children at 15 years of age,” added Dr Gupta.

What do people need to keep in mind to keep their cholesterol levels in check, and how important is it?

In our population, especially in the context of India, the most important advice for anybody is to maintain a work-life balance, said Dr Mohanty. “Unfortunately, we are totally oblivious to the fact that working 12-14 hours a day is not normal and shouldn’t be considered normal. They are so into work that they don’t maintain a work-life balance, which leads to stress. Furthermore, that leads to increased consumption of cigarettes, and the diet goes haywire. Looking at all of these things, ultimately it all boils down to maintaining a work-life balance,” he added.

Dr Gupta suggests that high LDL can impact the arteries and musculature to cause blockages. Terming it a silent killer, cholesterol elevation doesn’t show any symptoms. He said, “When the blockages become 70-80 per cent, then symptoms are predominantly visible. A lot of the disease will go undetected, so it becomes very important that people check their blood cholesterol levels. In clinical practise also, we are seeing a lot of people, apparently looking healthy, who come for health checkups in urban areas who have mild dyslipidemia in some form or another.”

Challenges in treating dyslipidemia

Experts see many people whose lipid formation is not controlled even after giving them a high dose of statins. In those cases, they have to rely on multiple drug combinations. Two to three per cent of patients using statins may develop side effects involving muscle pain, and sometimes it can also lead to the involvement of the liver with a rise in the liver enzymes.

“The present urban lifestyle is something that is very difficult to modify because people have fixed hours as per their job profile, which is usually stressful. These things become non-modifiable, because of which the statins, even though we are using them, we have to use them in higher doses,” said Dr Mohanty.

Dyslipidemia’s role in rising instances of sudden cardiovascular deaths

Young people, who are very active otherwise, one fine day experience heart attacks. This has been dominating the headlines for the past few years. “The reason behind this is the existence of lipid-rich blocks, which are not severe. 50 per cent heart blockage will not cause any kind of symptoms even if one runs a marathon, but with the presence of lipid-rich blocks, that means if the cholesterol content is high in these blocks, then they can rupture. And once they rupture, the 50 per cent blockage suddenly becomes 100 per cent because the rupture might form a clot within the blood vessels and suddenly occlude the blood supply,” explained Dr Gupta.

According to Dr Gupta, young individuals working out in the gym or running marathons might be collapsing because of the lipid-rich plaques, which are not severe until they rupture. Controlling lipids is extremely important to reduce the vulnerability of the plaque to rupture because it may cause heart attacks. 50 per cent of heart attacks occur in patients who don’t have very severe blockages (lesser than 70 per cent). Until the time of a heart attack, they may be very active, but it’s a vulnerable plaque. And vulnerable plaques are usually lipid-rich. Controlling lipids is extremely important in any age group.

  • Published On May 10, 2023 at 07:27 PM IST

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