Fake News: High Cholesterol Only Affects Older People!

By Dr Tay Hui Sian, Consultant Physician in Geriatric and General Medicine at Pantai Hospital Ayer Keroh

Cardiovascular disease is on the rise in Malaysia, with patients presenting this problem eight years earlier than the global average[i]. The reason for this could be due to the common misperception that “heart attacks only happen in older people”.

In truth, there is a large number of younger people today who have cholesterol levels that are too high, putting their health at risk.

The World Health Organization (WHO) estimates that over 15 million people die from Atherosclerotic Cardiovascular Disease (ASCVD) every year, accounting for 85% of global cardiovascular deaths[ii]. In Malaysia, 4 out of 10 Malaysian adults, including those below the age of 40, suffer from high cholesterol levels [iii] and this disease has contributed to 71% of premature deaths.

High Cholesterol and ASCVD

High cholesterol is a key contributor of ASCVD. High cholesterol levels could lead to a condition known as hyperlipidaemia (excessive lipids in the blood), which can cause cardiovascular problems such as chest pain or heart attacks.

Cholesterol is a waxy substance that is found in the body’s cells and has several useful functions, including helping to build cells and produce hormones [iv]. The liver produces 70-80% of the body’s cholesterol, while the remainder comes from diet, primarily from the consumption of animal products [v].

Cholesterol comes in two forms. Low-density lipoprotein cholesterol (LDL-c), also known as bad cholesterol and high-density lipoprotein cholesterol (HDL-c), which is beneficial to the body. The term high cholesterol is often used to describe a condition where too much LDL-c circulating in the blood may lead to the clogging-up of arteries, which in turn, may cause heart disease or stroke[vi].

By understanding the facts about cholesterol, a person can take effective measures to manage cholesterol levels and reduce the risk of heart disease and stroke. Here are some key points one should know about cholesterol:

By Dr Tay Hui Sian, Consultant Physician in Geriatric and General Medicine at Pantai Hospital Ayer Keroh

High cholesterol does not just affect the elderly

Cholesterol levels are not related to age, sex or weight of a person. Total cholesterol levels may steadily increase with age but cholesterol-related problems such as heart attacks or stroke can strike at any age [viiii].

Cases of people suffering from heart attacks in their 20s or early 30s are becoming more and more common. In fact, one in five heart attack patients today is younger than 40 years old[x]. As such, young adults must take early and effective action by going for regular health check-ups, while maintaining a healthy lifestyle to mitigate high cholesterol levels.

Being thin and active does not equate to low cholesterol

It is common to hear people saying, “I am thin and active and as such, I don’t think I have high cholesterol.” While studies have shown that overweight people are more likely to have high cholesterol, cholesterol levels are also determined by several factors such as diet or the type of food one consumes, stress, genetics and lifestyle.

It is best not to leave one’s health to assumptions. All adults are advised to have their cholesterol checked yearly as long as the risk remains low. Detecting high cholesterol levels early is critical towards reducing the risk of cardiovascular disease and stroke.

Pay attention to the family factor

If a person has family members who have heart disease or high cholesterol, it is quite likely that the person may inherit the same issues. Familial hypercholesterolemia (FH), which is a genetic disorder that affects 1 in 250 people, can increase one’s likelihood of having coronary heart disease at a young age[xii]. FH is caused by an inherited mutated gene that affects the way the body regulates and removes cholesterol from the blood.

Anyone with a family history of high cholesterol and heart disease is recommended to undergo screening from as young as 9 years old[xi].

Know your LDL-C number

High cholesterol is a ‘symptomless’ and invisible condition, there are no obvious signs or symptoms of cholesterol. Many of us don’t even realise it. No matter how fit and healthy you feel, it’s a good idea to find out your cholesterol numbers.

As a general principle, it is advised to maintain an ideal LDL-c level range between 1.4 – 2.6mmol/L. If one’s cholesterol level goes beyond that range, seek medical help to mitigate the risk of a heart event or stroke.

Holistic measures to manage high cholesterol levels

If a person is found to have high cholesterol, he or she should immediately take measures to bring cholesterol levels down following a thorough assessment and consultation with a doctor. A doctor may recommend a holistic approach that can include newer breakthrough treatments that can effectively lower low-density lipoprotein cholesterol (LDL-c) to optimal levels.

Simultaneously, positive lifestyle changes that can bring long-term benefits from both a health and mental perspective should also be made as soon as possible. These include:

Eating a healthy diet low in saturated fats, trans fats and salt (sodium) as well as staying away from drinks with added sugar. Foods that are high in fiber, like fresh fruits and vegetables are ideal!
Being physically active, try to get at least 150 minutes of light aerobic activity a week.
Limiting alcohol intake and quit smoking.
Being diligent in taking medications that are meant to manage cholesterol, blood pressure, and blood sugar levels in a timely and consistent manner.