Normal cholesterol report does not rule out heart risk, says Pune cardiologist on World Heart Day
Blood pressure, blood sugar, family history, sleep and inflammation can raise the risk of heart disease even when cholesterol is normal, a doctor says.
While looking after their heart health, most people focus only on keeping cholesterol under control. But a normal cholesterol report does not mean everything is fine. Blood pressure, blood sugar, family history, sleep, inflammation in the body and other metabolic factors can also raise the risk of heart disease. This was highlighted on the occasion of World Heart Day.
The situation in India is worrying. According to ICMR-INDIAB research, among adults tested, 11.4 per cent had diabetes, 15.3 per cent had pre-diabetes, 35.5 per cent had high blood pressure and 81.2 per cent had dyslipidaemia. The figures show that greater care of the heart is needed.
Dr Rajeev Sethi, director and senior consultant, interventional cardiology, at Aditya Birla Memorial Hospital, Pune, said: "Many things other than cholesterol affect heart health. Family history, blood pressure, blood sugar, sleep, inflammation in the body and other metabolic factors can raise the risk of heart disease, and there may be no symptoms."
On family history, it was said that if parents or siblings have had a heart attack or stroke at a young age, it is important to speak to a doctor. Even when routine tests come back normal, family history can raise the risk. Genes can also affect the level of lipoprotein(a), or Lp(a). This is a cholesterol-related factor that is mostly inherited and can raise the risk of heart disease. Unlike other lifestyle factors, Lp(a) levels do not change much with diet or exercise. The test is described as necessary for those with a strong family history of heart disease or those at higher risk.
Heart disease can develop even without clear symptoms. Plaque begins to build up in the arteries long before symptoms appear, which is why the disease often progresses slowly. If further testing is needed, doctors may order certain imaging tests. These include coronary artery calcium (CAC) scoring, to detect calcified plaque, and CT coronary angiography (CCTA), to look at narrowing of the arteries. These tests are not the same for everyone, so doctors recommend them only after considering the patient's age, risk factors, symptoms and medical conditions.
Factors such as blood pressure, blood sugar and triglycerides can also worsen without showing any symptoms. High blood pressure in particular stays well hidden. According to WHO estimates, 220 million people in India have high blood pressure, but only about 12 per cent of them have it under control. Heart risk begins to rise even before blood sugar reaches diabetic levels. Regular tests such as fasting glucose and HbA1c, along with other factors, can therefore help detect problems early.
Many overlooked everyday things also affect the heart. Too little sleep raises the likelihood of high blood pressure, metabolic problems, obesity and heart disease. Long-term inflammation damages blood vessels and speeds up atherosclerosis, the process of plaque build-up in the arteries. Long-term exposure to urban air pollution and fine dust particles also increases heart and metabolic risks.
A full heart check-up is not limited to cholesterol. It looks at blood pressure, blood sugar, weight, waist circumference, smoking habits, sleep habits, family history and existing illnesses. Depending on the patient's own level of risk, doctors may recommend specialised tests such as Lp(a), ApoB, CAC scoring or CCTA in place of standard screening. If the overall risk of heart disease is assessed without relying on a single factor, problems are detected in time and the right treatment can be given.
