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 the blood, essential for building healthy cells, producing vitamins and producing hormones. Your liver produces most of the cholesterol your body needs, but the rest comes from dietary sources like saturated fats found in animal products and processed foods. Cholesterol is necessary for the body’s healthy functioning, but too much of it can lead to dangerous health issues such as heart disease and stroke. According to the World Heart Federation, high cholesterol is the cause of 3.6 million deaths per year and is a major risk factor for cardiovascular disease.

Today we explore some of the most common questions and misconceptions about cholesterol. Dr. SwarupSwarajPal, a senior consultant cardiovascular and thoracic surgeon, gains insights from Dr. SwarupSwarajPal.

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

Dr. Swarap Swarajpal: Cholesterol levels are measured in milligrams per decilitor (mg/dl) via blood tests known as lipid panels or lipid profiles. The recommended range of total cholesterol for adults is as follows:

• Healthy cholesterol levels must be below 200 mg/dL.
• Border cholesterol levels range from 200 to 239 mg/dL.
• High cholesterol levels are above 240 mg/dL.
• Low cholesterol levels are below 40 mg/dL in men and below 50 mg/dL in women (HDL cholesterol).

The American Heart Association (AHA) recommends that adults check for cholesterol every 4-6 years from the age of 20, as cholesterol levels may begin to rise during this period. The Centers for Disease Control and Prevention recommends that children check for cholesterol between the ages of 9-11 and 17-21. The recommended ranges for total cholesterol in children are as follows:

• Good cholesterol levels are below 170 mg/dL.
• Border cholesterol levels are 170-199 mg/dL.
• High cholesterol levels are above 200 mg/dl.
• Cholesterol levels below 40 mg/dL (HDL cholesterol).

Question 2: What exactly are LDL and HDL?

Dr. Swarap Swarajpal: Cholesterol is a waxy fat-like substance in the body, transported through the bloodstream by two major lipoproteins.

• High density lipoprotein (HDL) or “good” cholesterol: HDL helps to remove excess cholesterol from cells containing cells, including those in arteries, which can reduce the risk of heart disease and stroke.
• Low density lipoprotein (LDL) or “bad” cholesterol: LDL carries most of the cholesterol throughout the body to cells. High LDL levels can lead to plaque accumulation within the arteries, causing blockages that limit blood flow to the heart. The higher your LDL level, the higher your risk of heart disease and stroke, according to the Centers for Disease Control and Prevention.

Question 3: What are the risk factors for high cholesterol beyond obesity?

Dr. Swarap Swarajpal: Many things contribute to high cholesterol. Risk factors such as poor dietary choices, sedentary lifestyles, smoking, alcohol, genetic structure, diabetes, hypertension, thyroid disorders, kidney disease, and certain medications can contribute to high cholesterol levels. Separately, the family history of postmenopausal women and heart disease can also increase the risk of high cholesterol, suggesting the Centers for Disease Control and Prevention (CDC). These factors not only increase poor cholesterol levels, but also affect heart health.

Question 4: According to the World Health Organization, obesity has become a problem for children and teens, so could this also affect cholesterol levels?

Dr. Swarap Swarajpal: Overweight is a condition of excess fat deposits. Nowadays, sedentary lifestyles and unhealthy choices make them more prevalent among children and teenagers. According to the World Health Organization, over 390 million children and adolescents aged 5-19 were overweight and included 160 million people living with obesity in 2022. Not only does LDL in children increase the risk of high and low HDL cholesterol, it can also be at risk for type 2 diabetes and heart disease.

Question 5: How old is the risk of high cholesterol? And what can we do to reduce that risk?

The risk of developing high cholesterol increases after age 20, so it is important to have your cholesterol checked every 4-6 years until age 40. For people with high cholesterol, tests should be conducted every 1 to 2 years. It is important to start cholesterol checks every year after age 40. Patients with heart disease or taking cholesterol-lowering medications may require more frequent checks. Following a healthy lifestyle, you can reduce your risk by eating a balanced diet, exercising regularly, and avoiding smoking and excessive drinking. Regular health checks and screenings are also important for early detection and timely treatment.

Question 6: If I have high cholesterol running in my family, does that mean I’m more likely to develop it?

Dr. Swarap Swarajpal: Some people tend to experience high LDL due to family history of high cholesterol. This is because you may have inherited a genetic condition called familial hypercholesterolemia (FH). If someone in your family has high cholesterol levels or other heart health issues, it is important to go for regular tests and make the necessary changes to your lifestyle, explains the Centers for Disease Control and Prevention (CDC).

Question 7: What role should cholesterol play here due to increased heart attacks among young adults?

Dr. Swarap Swarajpal: High cholesterol levels can increase the risk of cardiovascular problems, including heart attacks. This is because high cholesterol levels cause plaque buildup in arteries, which can increase the risk of heart attacks even in young adults. Other factors can also worsen the condition, such as unhealthy diet choices, smoking, and being too stressed. Early management of cholesterol levels can help prevent heart problems in later years.

Question 8: We know that high triglyceride levels are dangerous for heart disease, stroke, and heart attacks. How is this related to cholesterol?

Dr. Swarap Swarajpal: Triglycerides and cholesterol are both lipids found in the blood, but offer different functions. Excess calories, alcohol and sugar are converted to triglycerides, primarily storing energy as fat. In contrast, cholesterol helps build cells and produce specific hormones. High levels of triglycerides, along with high LDL (bad) and low HDL (good) cholesterol, can significantly increase the risk of heart disease, such as heart attacks and strokes, including heart attacks, strokes, and vascular problems.

Question 9: Statins are commonly prescribed to lower cholesterol. Are there any side effects I should know?

Dr. Swarap Swarajpal: To manage heart health and cholesterol levels, we recommend getting physically active, eating healthy food packed with greens, whole grains and fruits, and regular health checks are recommended. If lifestyle changes do not lower the patient’s cholesterol or the level is consistently high, doctors will prescribe statins to lower cholesterol levels. Statins are a drug that helps lower LDL cholesterol in the body. This drug prevents the enzymes needed to affect heart health by the liver for the production of LDL cholesterol. However, taking statins in the wrong way can cause a variety of side effects. Follow the dosage recommended by your doctor to avoid any problems. Unsupervised dosages can lead to muscle pain, liver damage, digestive problems, headaches, dizziness and nausea.