Do you have high cholesterol too? Do you need to take medication? (High Cholesterol) Let's talk!

Did your blood test show that you have high cholesterol? You must have been a little scared when you saw it. You might have thought, 'Oh, now I have to take medication for the rest of my life?' But don't worry. Not everyone who is diagnosed with high cholesterol needs to start taking medication right away. Sometimes, the condition can be controlled with just a healthy diet and exercise. Whether you need medication or not depends on your overall health and your risk of heart disease.

What exactly is cholesterol?

Simply put, cholesterol is a waxy, oily substance found in our blood. It is essential for many things in our bodies, including building cells and producing hormones. But the problem starts when this cholesterol level becomes too high.

When this happens, this extra cholesterol starts to build up inside the walls of our blood vessels. It's like rust building up inside a water pipe. Over time, these deposits (we call them `plaque`) cause the inside of the blood vessels to become narrow and stiff. This then restricts blood flow to the heart and brain. Sometimes, blood clots form on these deposits, which can break off and cause a heart attack or stroke.

Are there types of cholesterol?

Yes, there are mainly two types of cholesterol that we are talking about and another important type of fat.

• LDL (Low-Density Lipoprotein): This is what we call "bad cholesterol." When these levels increase, they can build up in the blood vessels and cause the aforementioned risks.
• HDL (High-Density Lipoprotein): We call this "good cholesterol." This is because these HDL particles remove bad LDL cholesterol from the arteries and take it back to the liver. Therefore, the higher the HDL level, the better for us.
• Triglycerides: This is another type of fat found in the blood. This is how we store the extra calories we eat as energy. Increased levels of these are also not good for blood vessels.

What are healthy cholesterol levels?

Compare these with the values ​​in your blood report (`Lipid Profile` report). These are levels that are generally considered healthy.

What are the main causes of high cholesterol?

High cholesterol conditions can be divided into two main types based on their cause.

1. Familial Hypercholesterolemia (FH)

This is a genetic condition. That is, it is inherited from parents to children. These people may have very high LDL cholesterol levels from an early age . This puts them at risk of developing heart disease at a young age.

Treatment: Although lifestyle changes (low-fat diet, exercise) are essential for people with this condition, medications are often required . The most commonly used class of drugs is `Statins`.

2. High cholesterol caused by lifestyle and other diseases (Secondary High Cholesterol)

This is the most common type. It is caused by:

• Consuming more processed foods that are high in saturated fats and trans fats.
• Lack of exercise and a sedentary lifestyle.
• Diabetes.
• Excessive alcohol consumption.
• Chronic Kidney Disease.
• Decreased thyroid function (Hypothyroidism).
• Some medications (e.g. steroids).

Treatment: Doctors first advise people like this to try to control their cholesterol without using medication by making lifestyle changes . This means switching to a heart-healthy diet, getting regular exercise, quitting smoking if you are overweight, and losing weight if you are overweight. If these things don't bring your cholesterol levels under control, medication is the next step.

How does the doctor decide whether or not to prescribe medication?

Here's the important thing. Your doctor doesn't just look at the numbers on your cholesterol report and make a decision. He or she will do a complete assessment of your overall cardiac risk . To calculate this risk, they will consider many factors, including:

• Your total cholesterol, LDL, and HDL levels
• Blood Pressure
• Age
• Femininity/masculinity
• Whether you smoke or not
• Whether you have diabetes
• Whether anyone in your family has had heart disease at a young age (Family History)

All of this is added together to calculate your risk of having something like a heart attack within the next 10 years. The decision to start medication or not depends largely on this risk level.

For example, if your LDL level is slightly elevated, but everything else is in good shape (you don't smoke, you're at a healthy weight, and you don't have high blood pressure), you may be advised to make lifestyle changes without medication.

What if you're not sure about the risk?

Sometimes your risk level may be somewhere in between. That means your risk is neither too low nor too high. In such cases, there are several other tests that can help you decide whether to start medication or not. Your doctor may recommend these if necessary.

• Coronary Calcium Scan: This is a special CT scan. It looks for calcium deposits in the coronary arteries that supply blood to the heart. Such deposits mean that the blood vessels are slightly narrowed, and the risk of heart disease is higher than expected.
• High-sensitivity CRP (hs-CRP): This is a blood test. It measures a very subtle level of inflammation in the body. If this value is high, it is also an indication of an increased risk of heart disease.

With the results of these tests, you can more accurately determine whether you would benefit more from starting medication, or whether lifestyle changes are sufficient.