Managing Life with High LDL Cholesterol: What You Need to Know

When 38-year-old Rajiv Mehta walked into his physician’s office for a routine checkup, he didn’t expect the results to change the way he lived his life. He had no symptoms, no discomfort, and no warning signs. It was surprising when the reports indicated that he had high LDL cholesterol.

This story is common among patients due to misconceptions such as cholesterol issues being something older people deal with, or it’s only related to lifestyle factors. An increase in prevalence reflects the lack of awareness, especially among younger people. A recent study highlighted that a significant 31% of people in India have high cholesterol.^[1]

High LDLC doesn’t show any symptoms; it starts accumulating in the arteries, creating blockages, leading to serious heart conditions. Even a few months’ delay can lead to risks that can never be fully treated by later intensifying the therapy.^[2] Elevated LDLC can accelerate plaque formation, especially in high-risk individuals, such as those with diabetes, hypertension, or a smoking history.

“One of the hardest things for me to grasp,” Rajiv shares, “was that I didn’t feel sick. I thought cholesterol issues were something older people or people who were visibly unhealthy dealt with. I had no idea I could have heart disease developing silently.”

Dr. Rajpal Singh, Director and Senior Interventional Cardiologist, Fortis Hospital, Bangalore, “Awareness about cholesterol has grown in recent years, but actual preventive behavior also must keep pace. Along with knowing high LDL is dangerous, yet most don’t prioritize screening unless they already have symptoms or a cardiac history in the family. The patients who come with LDLC complaints are generally between the ages of 30 to 50. The decision to treat should be guided by risk assessment.  A trial of lifestyle and dietary changes is mandatory prior to starting drug therapy. It shouldn’t be delayed in younger, asymptomatic patients. Therapy has to start early and has to be followed as per the doctor’s instructions. Replacing therapy with lifestyle modifications isn’t fruitful. Lifestyle modifications should continue in parallel to therapy.” 

There are more advanced therapies available when the traditional options aren’t giving the required results. Targeted treatments, such as PCSK9 therapy, siRNA therapy, or Inclisiran, show promise in helping patients reach target LDLC levels when standard options fall short.

Improving HDL cholesterol, known as good cholesterol, can be focused on simultaneously as it flushes excessive LDLC from the bloodstream.^[3] This requires several lifestyle changes, such as quitting a sedentary lifestyle and adopting mindful eating. It’s also important to note that having a healthy lifestyle isn’t a replacement for treatment.

Rajiv Mehta recalls, “I wanted to try everything naturally first.” “I thought, if I eat right, exercise more, maybe I can avoid taking pills.” While his efforts improved his overall fitness, his LDLC barely budged.

Lifestyle changes need to be coupled with therapy when managing LDLC to the target range. High LDL cholesterol can be effectively managed when all aspects are taken into account. Regular check-ups every 3–6 months are needed, depending on how the numbers are faring. Therapies don’t cure high cholesterol; they are used to control it. Therefore, they must be adhered to consistently, as pausing the medication can put you back to your older levels.^[4]

Rajiv Mehta “Eventually, I accepted that I needed medication. And within three months of taking them, my LDLC dropped significantly. That’s when I truly saw the value of medical therapy.”