Cholesterol & Lipids

LDL (low-density lipoprotein) is the 'bad' cholesterol that deposits in artery walls — target under 100 mg/dL for most adults, under 70 if you have diabetes or established heart disease, under 55 if very high risk. HDL is 'good' cholesterol that removes deposits — higher is better, target above 40 (men) or 50 (women). Triglycerides are blood fats — target under 150. Total cholesterol matters less than the components. Ask for a full lipid profile, not just total cholesterol.

Statins reduce heart attacks and strokes in high-risk people — that's the well-established benefit backed by dozens of trials. They're recommended for: established heart disease or prior stroke, LDL above 190 mg/dL (very high), age 40-75 with diabetes and LDL above 70, and adults with high 10-year cardiovascular risk on validated risk calculators. In lower-risk people, benefit is smaller — the decision depends on personal risk versus preferences. A good cardiologist calculates your specific risk before prescribing.

Muscle aches occur in 5-10% of patients but are usually mild; severe muscle damage is very rare. Small increases in blood sugar can occur but the cardiovascular benefit outweighs this in patients who need statins. Liver enzyme elevations are rare and reversible on stopping. Most fears are exaggerated by media stories. If you have muscle pain on statin, try a different statin, a lower dose, or every-other-day dosing before giving up — many patients tolerate an alternative even when one specific statin causes problems.

Diet reduces LDL modestly (5-15%) — replacing saturated fats (ghee, butter, red meat, fried snacks, coconut oil in excess) with unsaturated fats (mustard oil, olive oil, nuts, fatty fish), adding soluble fiber (oats, beans, apples), and losing weight all help. Exercise improves HDL and lowers triglycerides more than LDL. For most people with mildly elevated cholesterol, lifestyle alone can meet targets. For high-risk patients or very high LDL, medication does what diet cannot.

Yes — high triglycerides (over 150 mg/dL) are common in Indians and often reflect insulin resistance, high refined-carb intake, alcohol, or genetic factors. Very high triglycerides (over 500) can cause acute pancreatitis. Lifestyle interventions work well for triglycerides: less refined carbs and sugar, less alcohol, weight loss, more omega-3 fatty acids (fish, flaxseed) or supplements, and regular exercise. Medications (fenofibrate, omega-3 prescription doses) are used when levels stay high despite lifestyle changes.