Can high cholesterol levels lead to heart attack or stroke? Top cardiologist answers 9 such questions

Cholesterol is a waxy, fat-like substance found in your blood, essential for building healthy cells, making vitamins, and producing hormones. Your liver produces most of the cholesterol your body needs, while the rest comes from dietary sources like saturated fats found in animal products and processed foods. While cholesterol is necessary for the healthy functioning of the body, having too much of it can lead to dangerous health issues like heart disease and stroke. High cholesterol is responsible for 3.6 million deaths annually, according to the World Heart Federation, and is a major risk factor for cardiovascular disease.

Today we will explore some of the most common questions and misconceptions about cholesterol, with insights from Dr Swarup Swaraj Pal, Sr. Consultant Cardiovascular and Thoracic Surgeon.

Question 1: What is the ideal cholesterol level for a healthy heart?

Dr Swarup Swaraj Pal: Cholesterol levels are measured in milligrams per deciliter (mg/dL) through a blood test known as a lipid panel or lipid profile. Here are the recommended ranges for total cholesterol in adults:

• A healthy cholesterol level should be below 200 mg/dl.
• The borderline cholesterol levels range from 200 to 239 mg/dl.
• High cholesterol levels are 240 mg/dl or higher.
• Low cholesterol levels are less than 40 mg/dl for men and less than 50 mg/dl for women (HDL cholesterol).

The American Heart Association (AHA) recommends that adults get their cholesterol checked every 4-6 years starting at age 20, as cholesterol levels can begin to rise during this time. The Centers for Disease Control and Prevention recommends children have their cholesterol checked between ages 9–11 years and again between ages 17–21 years. Here are the recommended ranges for total cholesterol in children:

• Good cholesterol levels are 170 mg/dl or less.
• Borderline cholesterol levels are 170-199 mg/dl.
• High cholesterol levels are 200 or higher mg/dl.
• Low cholesterol levels less than 40 mg/dl (HDL cholesterol).

Question 2: What exactly are LDL and HDL, and how does high LDL impact your heart health?

Dr Swarup Swaraj Pal: Cholesterol is a waxy, fat-like substance in the body, transported through the bloodstream by two main types of lipoproteins:

• High-density lipoprotein (HDL) or ‘good’ cholesterol: HDL helps remove excess cholesterol from cells, including those in the arteries, which can reduce the risk of heart disease and stroke.
• Low-density lipoprotein (LDL) or ‘bad’ cholesterol: LDL carries the majority of cholesterol to cells throughout the body. When LDL levels are high, it can lead to plaque buildup in the arteries, causing blockages that restrict blood flow to the heart. High LDL levels increase the risk of heart disease and stroke, as per the Centers for Disease Control and Prevention.

Question 3: Beyond obesity, what are the risk factors of high cholesterol?

Dr Swarup Swaraj Pal: Many things contribute to high cholesterol, some of which you can control and others you cannot. Risk factors like poor dietary choices, sedentary lifestyles, smoking cigarettes, drinking alcohol, genetic makeup, diabetes, high blood pressure, thyroid disorders, kidney diseases, and certain medications can contribute to high cholesterol levels. Apart from this, women after menopause and a family history of heart disease may also increase your risk of high cholesterol, suggests the Centers for Disease Control and Prevention (CDC). These factors altogether can not only increase bad cholesterol levels but also impact your heart health.

Question 4: With obesity becoming a growing issue in kids and teens as per the World Health Organization, could this affect their cholesterol levels too?

Dr Swarup Swaraj Pal: Overweight is a condition of excessive fat deposits. It is now increasingly prevalent among children and teenagers due to their sedentary lifestyle or unhealthy choices. According to the World Health Organization, over 390 million children and adolescents aged 5–19 years were overweight in 2022, including 160 million who were living with obesity. It not only increases the risk of high LDL and low HDL cholesterol in children but can also put you at risk of type 2 diabetes and heart disease.

Question 5: At what age is the risk of bad cholesterol high? And what can we do to reduce its risk?

The risk of developing high cholesterol rises after the age of 20, which is why it is important to have your cholesterol checked every 4 to 6 years until the age of 40. For those with high cholesterol, testing should occur every 1 to 2 years. After the age of 40, it is important to begin getting cholesterol checks annually. Patients with heart disease or who take cholesterol-lowering medications may need checks more frequently. Following a healthy lifestyle—eating a balanced diet, exercising regularly, and avoiding smoking or excessive drinking—can help reduce the risk. Regular health check-ups and screenings are also crucial for early detection and timely treatment.

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Question 6: If high cholesterol runs in my family, does that mean I am more likely to develop it?

Dr Swarup Swaraj Pal: Some people are more prone to experiencing high LDL due to a family history of high cholesterol. This is because you may have inherited a genetic condition called familial hypercholesterolemia (FH). If someone from your family has high cholesterol levels or other heart health issues, then going for regular checkups and making necessary changes in your lifestyle is crucial, explains the Centers for Disease Control and Prevention (CDC).

Question 7: With heart attacks on the rise among young adults, what role does cholesterol have to play here?

Dr Swarup Swaraj Pal: High cholesterol levels can increase the risk of cardiovascular problems, including heart attacks. This is because high cholesterol levels can lead to a buildup of plaque in the arteries while increasing the risk of heart attacks even in younger adults. Other factors like unhealthy dietary choices, smoking, and too much stress can also worsen the condition. Managing your cholesterol levels early on can help prevent heart problems in later life.

Question 8: We know that high triglyceride levels are risky for heart disease, stroke, and heart attack—how does this relate to cholesterol?

Dr Swarup Swaraj Pal: Both triglycerides and cholesterol are lipids found in the blood but they serve different functions. Excess calories, alcohol, and sugar are converted into triglycerides, which primarily store energy as fat. In contrast, cholesterol helps build cells and produce certain hormones. High levels of triglycerides, along with high LDL (bad) cholesterol and low HDL (good) cholesterol, can significantly increase the risk of heart disease, including heart attacks and strokes as well as vascular (blood vessel) problems.

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Question 9: Statins are commonly prescribed to lower cholesterol—are there any side effects I should be aware of?

Dr Swarup Swaraj Pal: To manage heart health and cholesterol levels, staying physically active, eating a healthy diet packed with greens, whole grains, and fruits, and regular checkups are recommended. If lifestyle changes don’t lower a patient’s cholesterol, or if the levels are consistently high, doctors prescribe statins to decrease cholesterol levels. Statins are medications that help lower LDL cholesterol in the body. The medication prevents an enzyme that the liver needs for the production of LDL cholesterol from affecting your heart health. However, there can be various side effects when one takes statins the wrong way. Follow the dosage as recommended by the doctor to avoid any problems. Unmonitored dosage can lead to muscle pain, liver damage, digestive issues, headaches, dizziness, and nausea.