High Cholesterol in South Asians and What Statins Do

High cholesterol means too much fatty material is circulating in your blood, especially LDL cholesterol. Over years it builds plaque inside artery walls and narrows them. It causes no symptoms and no pain. It is found on a blood test, or discovered after it has already caused a heart attack or a stroke.

What are the symptoms of high cholesterol?

In most people there are none, and that is the difficulty. A few patients show visible signs: soft yellowish patches on the eyelids, a white or grey ring around the coloured part of the eye at a young age, or thickened lumps over the ankle and hand tendons in the inherited forms.

By the time symptoms do appear, they belong to the damage already done:

• Chest tightness or heaviness walking uphill, which is angina
• Sudden severe chest pain with sweating, which is a heart attack
• Cramping pain in the calves after walking a set distance, easing with rest
• Sudden weakness or slurred speech, which is a stroke

Patients often say khoon gaarha ho gaya hai, the blood has thickened. Cholesterol does not thicken blood in that way. It deposits in artery walls. The correction is worth making, because it explains how you can feel entirely well while the process runs.

What do the numbers on a lipid profile mean?

A lipid profile reports several different fats, and they do not all mean the same thing. Treatment is guided mainly by your LDL level and your overall risk rather than by the total cholesterol figure on its own, which is why two people with the same total can need very different advice.

Target numbers are not the same for everybody. European Society of Cardiology guidelines set lower LDL targets for people at higher risk, meaning those with diabetes, existing coronary disease, or a previous heart attack or stent, than for otherwise healthy adults.

Why do South Asians have a riskier cholesterol pattern?

Because the pattern is not the textbook one. The American Heart Association describes people of South Asian origin as carrying higher cardiovascular risk at lower body weight, with a lipid pattern that tends toward lower HDL and higher triglycerides rather than a dramatically raised total cholesterol.

Three practical consequences follow:

1. A normal-looking total cholesterol can be falsely reassuring. Read LDL, HDL and triglycerides separately.
2. Slim people are not exempt. Central weight around the abdomen, with insulin resistance, produces this pattern at what looks like a perfectly normal body weight.
3. Testing should start earlier. Since coronary artery disease appears earlier in South Asians, waiting until 50 for a first lipid profile wastes the years when prevention works best.

What causes high cholesterol, and who is at risk?

Most high cholesterol comes from a mix of diet, weight, activity level and inherited tendency, and the liver's own production matters at least as much as what you eat. A smaller group has a strong inherited condition called familial hypercholesterolaemia, where LDL is very high from childhood.

Risk factors that matter locally:

• Cooking fat. Ghee and vanaspati in salan, parathas, halwa and deep-fried snacks, and oil reused for frying again and again.
• Bakery and packaged items made with hydrogenated fat, plus mithai, biscuits, rusk and namkeen eaten daily rather than occasionally.
• Refined carbohydrate and sugar, which push triglycerides up. Sugary chai several times a day counts.
• Physical inactivity and long sitting hours.
• Diabetes and insulin resistance, which lower HDL and raise triglycerides.
• High blood pressure, which usually travels in the same company.
• Smoking and naswar, which lower HDL and damage artery walls.
• An underactive thyroid, kidney disease and some medicines, which raise lipids as a secondary effect.
• Family history of heart disease before 55 in men or 65 in women, or of very high cholesterol.

When should you go to the Emergency?

High cholesterol itself is never an emergency. There is no such thing as a cholesterol crisis. Its complications are another matter. Call 1122 or go straight to DHQ Hospital Abbottabad Emergency if you have chest pain or pressure lasting more than a few minutes, particularly with sweating, breathlessness or nausea.

Do the same for sudden weakness or numbness on one side of the body, facial drooping, slurred speech or sudden loss of vision, all of which suggest a stroke. Both are time-critical. A raised cholesterol report is the opposite situation. It needs a clinic appointment and a risk assessment, never an emergency visit and never a medicine you start yourself.

How is high cholesterol diagnosed?

With a simple blood test called a lipid profile, read alongside your other risk factors rather than in isolation. Most routine testing no longer requires fasting, though your laboratory may ask you to fast if triglycerides are very high or if a specific diagnosis is being investigated.

The full assessment usually includes:

• A lipid profile, plus blood sugar or HbA1c, kidney function and thyroid tests to catch secondary causes.
• A preventive cardiology and risk assessment visit, where your numbers, blood pressure, weight, family history and habits are combined into one overall risk picture.
• An ETT (Exercise Tolerance Test) if you have symptoms suggesting angina.
• Echocardiography where the heart's structure and pumping need checking.
• Angiography when non-invasive tests point to significant coronary narrowing.

NICE guidance recommends using a formal risk assessment rather than the cholesterol number alone when deciding who benefits from treatment. Dr. Muhammad Ali Khan, Consultant Cardiologist, provides this kind of structured lipid and risk assessment in Abbottabad, including advice for families where heart disease has appeared early.

What are the common myths about statins?

Statins attract more rumours than any other heart medicine, and unanswered rumours are a leading reason patients quietly stop taking them. Most of the worries reduce to six familiar questions, and each has a straightforward answer. Here they are as patients actually put them in clinic, with what the evidence supports.

If a statin genuinely does not suit you, there are alternatives. What does not work is stopping quietly and saying nothing at the next visit.

How is high cholesterol treated?

Treatment starts with food and movement, and adds medicine according to your risk level. Diet alone may be enough for a young person at low risk. It is rarely enough for someone with diabetes, established coronary disease or a very high LDL.

• Reduce added fat: less ghee and vanaspati, less deep frying, no reused frying oil, fewer bakery items.
• Change the oil. Liquid vegetable oils such as canola, sunflower or olive for daily cooking.
• Cut sugar and refined carbohydrate if your triglycerides are raised.
• Move daily. Brisk walking most days raises HDL and improves triglycerides.
• Statins lower LDL substantially and stabilise existing plaque. Their real benefit is preventing heart attacks, not tidying up a report.
• Ezetimibe or additional agents are added when LDL stays above target on a statin alone.
• Treat what drives the lipids: diabetes, thyroid disease, weight and smoking.

How do you live with high cholesterol?

Live with it the way you would live with a slow leak. Fix it steadily and check it periodically. Cholesterol control asks for durable household habits rather than a month of strict dieting followed by a return to the old cooking.

Practical steps that hold:

• Cook once for the whole family in a heart-friendly way instead of making a separate diet plate.
• Grill, bake or pressure-cook more often, and deep-fry rarely.
• Fill half the plate with vegetables, daal and salad, and keep fruit as the routine sweet.
• Walk 30 minutes most days, and take the stairs once your doctor has cleared you for effort.
• Stop smoking and naswar, both of which lower HDL directly.
• Repeat the lipid profile as advised, usually after starting or changing a medicine, then periodically.
• Get first-degree relatives tested if your cholesterol is very high or if heart disease has struck early in the family.
• Take the medicine daily, and bring any side effect to your doctor rather than to the internet.