10/26/2024
Dr. Gupta’s health tip # 5 CHOLESTEROL
For Indians, total cholesterol should be less than 150 (less than 200 is not enough). However, we now focus more on the bad cholesterol, LDL.
For Indians, “bad” cholesterol LDL should be under 70 (under 100 is not sufficient).
The “good” cholesterol, HDL, should be more than 40 in men and more than 50 in women. The higher the HDL, the better, as it helps protect against heart attacks and strokes. If your HDL is over 60, you can subtract one risk factor from your overall risk count. Exercise boosts HDL, and contrary to past beliefs, recent studies show that no alcohol is good for your health. Quitting smoking can also increase HDL.
Triglycerides, or the “ugly” cholesterol, should be under 150. If you have diabetes, it’s essential to first control your blood sugar. Cutting down on carbohydrates and alcohol can also help manage triglycerides.
Now, let’s talk about Lipoprotein(a) or Lp(a)—the “deadly” cholesterol. While only 5% of Caucasians have high Lp(a), a staggering 45% of Indians do. Lp(a) not only causes blockages but also increases the risk of blood clots. It’s genetic, and treatment options are currently limited, though new drugs are in development. Lp(a) is a major marker for PREMATURE and SEVERE coronary artery disease (CAD), so it’s crucial to be aggressive in controlling other risk factors.
Just like facing multiple enemies at once increases your risk of harm, having multiple risk factors can significantly elevate your cardiovascular risk. Therefore, it’s vital to manage the risk factors we can control.
It’s important to note that 50% of heart attacks happen in people with “normal” cholesterol levels. In such cases, to better assess risk, we should do “advanced lipid testing” to evaluate cholesterol particle size and particle number. The more particles and the smaller they are, the greater the risk. I like to use the analogy of traffic: if 10 people are in 10 cars, there’s more traffic and more risk, but if they all get on one bus, there’s less traffic and less risk. Similarly, small, dense LDL particles are much more dangerous than large, fluffy ones. This condition, called atherogenic dyslipidemia (small dense LDL, low HDL, and high triglycerides), is especially common in diabetics and people of Indian descent. No surprise that 75% of Indians die from heart attacks or strokes.
Even “normal” cholesterol levels should be treated if Lp(a), hsCRP (C-reactive protein), or homocysteine levels are high, or if someone has known CAD, diabetes, CAD risk equivalents, or small and numerous LDL particles. And yes, special attention is needed if they are of Indian descent.
Regular monitoring is crucial. If you experience any side effects, inform your doctor right away—they always have a backup plan in mind to adjust your treatment.
