The Link Between Age And Cholesterol: Navigating Cholesterol Levels Throughout Life

Key takeaways

• While genetics and family history may influence cholesterol levels, lifestyle choices such as diet, exercise, and smoking cessation play a significant role in managing cholesterol levels and reducing the risk of heart disease.
• By adopting a heart-healthy diet, engaging in regular physical activity, and avoiding smoking, individuals can positively influence their cholesterol levels.
• Indians as an ethnic group are at increased risk of elevated levels of bad cholesterol, underscoring the importance of regular check-ups to mitigate the risk of coronary artery diseases.
• Regular cholesterol check-ups and discussions with a healthcare provider are essential for monitoring cholesterol levels and assessing cardiovascular risk.  

Cholesterol, a type of lipid, is essential for various bodily functions, such as forming cell membranes, synthesizing hormones, and aiding in bile production for digestion. While your liver produces sufficient cholesterol to meet your body's needs, you also acquire it from the foods you eat. Excess cholesterol circulating in your blood can lead to health complications, particularly an increased risk of coronary artery disease. Understanding the distinction between good (HDL) and bad cholesterol (LDL) is key to taking charge of your heart health. Let's delve deeper into this essential topic together.  

The Good And the Bad Cholesterol

Lipoproteins are complex particles composed of lipids (fats) and proteins. They serve as carriers for transporting cholesterol and other lipids through the bloodstream. Cholesterol exists in various forms, primarily low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and high-density lipoprotein (HDL).  

1. LDL cholesterol

Often referred to as bad cholesterol, LDL carries cholesterol from the liver to cells throughout the body. If the levels of LDL become elevated, it can lead to the buildup of cholesterol in the blood vessels, contributing to atherosclerosis and increasing the risk of heart disease and stroke.

2. HDL cholesterol

Known as good cholesterol, HDL scavenges excess cholesterol from the bloodstream and tissues, transporting it back to the liver for processing and excretion. High levels of HDL are associated with a reduced risk of heart disease.

3. Triglycerides and VLDL cholesterol

Triglyceride is a type of lipid derived from the fats in our diet. VLDL carries triglycerides from the liver to the cells. Like LDL, elevated levels of VLDL can contribute to the development of atherosclerosis and cardiovascular disease.

4. Total cholesterol

Total cholesterol is the sum of HDL, LDL, and 20% of triglycerides in your blood.

Factors influencing cholesterol levels

1. Diet

A diet high in saturated and trans fats can raise LDL cholesterol levels. Foods like red meat, full-fat dairy products, fried foods and bakery items raise bad cholesterol levels.  

2. Genetics

Family history and genetics can play a significant role in determining cholesterol levels. Some individuals may inherit conditions that lead to high cholesterol levels (familial hypercholesterolemia), even with a healthy lifestyle.

3. Age, gender and ethnicity

Cholesterol levels tend to increase with age. Between the ages of 20 and 39, men are more likely than women to have high cholesterol levels. However, a woman's risk increases after menopause.  

As an ethnic group, Indians have a higher risk of having elevated levels of bad cholesterol and lower levels of good cholesterol compared to other ethnicities.

4. Weight

Being overweight or obese can elevate LDL cholesterol and triglyceride levels while lowering HDL cholesterol levels.

5. Sedentary lifestyle

A sedentary lifestyle can promote obesity and increase LDL cholesterol levels.

6. Smoking

Smoking can lower HDL cholesterol levels.

7. Stress

Stress can elevate levels of specific hormones, like corticosteroids, which may prompt your body to produce increased amounts of cholesterol.

8. Medical conditions

Certain medical conditions, such as diabetes, hypothyroidism, and kidney disease, can affect cholesterol levels.

9. Medications

Certain medications used for various health conditions can either elevate LDL cholesterol or lower HDL cholesterol levels. Examples include arrhythmia drugs, beta-blockers for angina and hypertension, chemotherapy agents and diuretics.

Maintaining Healthy Cholesterol Levels

1. Diet

Following the DASH eating plan can effectively lower LDL cholesterol by reducing intake of saturated and trans fats. The American Heart Association recommends limiting saturated fat to less than 6% of daily calories and avoiding trans fats altogether. This involves opting for low-fat dairy products, choosing lean cuts of meat, and cooking with liquid vegetable oils. Additionally, a heart-healthy diet emphasizes fruits, vegetables, whole grains, poultry, fish, and nuts, while limiting red and processed meats, sodium, and sugar-sweetened foods and beverages. Incorporating oily fish high in omega-3 fatty acids further supports heart health.

2. Exercise

Research indicates that engaging in physical activity can effectively reduce LDL cholesterol and triglyceride levels while increasing HDL cholesterol. Aim for at least 150 minutes of moderate-intensity aerobic exercise weekly. High-intensity aerobic workouts are particularly effective, as they help clear LDL cholesterol and triglycerides from your blood. When doing resistance training, focusing on more sets and repetitions, rather than just intensity, can have a bigger impact on your cholesterol levels.

3. Weight management

Research indicates that patients who lost 5–10% of their weight experienced notable reductions in triglycerides, total cholesterol, and LDL cholesterol. Those who lost more than 10% of their weight saw even greater improvements compared to those with smaller weight loss.

4. Smoking cessation

Quitting smoking can lead to improvements in HDL cholesterol levels. This increase happens quickly, often within less than three weeks.

5. Medications

Medication may be necessary when lifestyle changes alone aren't sufficient to achieve target cholesterol levels or when there's a high risk of cardiovascular disease. This includes individuals with significantly elevated LDL cholesterol levels despite dietary and exercise interventions or those with a history of heart disease.

Ideal Cholesterol Levels

Dyslipidemia refers to an abnormal level of lipids in the blood, including elevated levels of LDL cholesterol, triglycerides, or total cholesterol, and/or decreased levels of HDL cholesterol. For Indians, the risk of heart disease is twice as high compared to other ethnic groups, even at similar cholesterol levels. Consequently, the recommended target levels for total and LDL cholesterol are lower. Moreover, Indians often have lower levels of HDL. Low HDL is three times more prevalent than high LDL in individuals with premature heart disease. For every 10-point rise in HDL on your cholesterol test, the risk of heart disease is reduced by 50%.  

The Indian Heart Association cholesterol target levels recommendations in adults:

LDL

Target goal: less than 70 mg/dL

Average risk: 100 mg/dL or less

Near-optimal: 100-129 mg/dL

Borderline high: 130-159 mg/dL

High risk: 160 mg/dL and above

HDL

50-60 mg/dL

Triglycerides

Optimal: Less than 150 mg/dL  

Borderline risk: 151-199 mg/dL

High risk: over 200 mg/dL

The American Heart Association suggests that adults should undergo cholesterol screening every 4–6 years, beginning at the age of 20. This is the period when cholesterol levels may begin to elevate.

The Lipid Association of India recommends regular lipid profile screenings starting at age 20 for all individuals, and as early as age two for those with a family history of high cholesterol or premature coronary heart disease in men under 55 years and women under 65 years.  

Conclusion

In conclusion, while factors like genetics and family history may influence cholesterol levels beyond our control, adopting a healthy lifestyle plays a crucial role in managing cholesterol and reducing the risk of heart disease. Regular cholesterol check-ups and discussions with a healthcare provider are essential for understanding one's risk and taking proactive measures to prevent heart attacks and strokes.  

Additionally, I encourage readers to download the Aware Health Rewards app, which helps you to manage cholesterol levels through health insights, delivered as daily action steps. Get a FREE 90-day diet and care plan to reduce your cholesterol naturally.

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About the Author
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Dr. Satish Madiraju, a renowned cardiologist is passionate about consumer heart health and is on a mission to prevent a million heart attacks. He shares his expertise not only on heart health but also on leadership, digital health, and improving patient experience.