Do you know what my HDL (high-density lipoprotein, often called “good cholesterol”) levels are? 64 mg/dL,” says K.K. Jain, a Delhi-based family physician. Most Indians would count themselves lucky if their HDL levels stay above the prescribed minimum of 40mg/dL. Yet experts now hold that the ratio of low-density lipoprotein (LDL) to HDL is a better indicator of health and cardiac risk than total cholesterol. The more the HDL, the better it is.
High HDL = healthy heart
Madhukar Shahi, interventional cardiologist, Artemis Healthcare, Gurgaon, says: “We don’t usually look at total cholesterol. We look at the ratio of HDL/LDL or ratio of total cholesterol/HDL, and also the level of non-LDL bad cholesterols. Third, we look at trigylcerides.” For men, a good total cholesterol/HDL ratio is 4.5 or less; for women, it’s 4 or less.
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The third report of the US National Cholesterol Education Program (NCEP) in 2001 noted: “The ability of HDL to predict the development of coronary atherosclerosis has been estimated to be four times greater than LDL and eight times greater than TC (total cholesterol). Treatment is recommended for those with a HDL level below 40 mg/dL.” Today, young people are increasingly falling prey to high triglycerides, high readings of “bad cholesterol”, too low HDL.
The gender difference
Illustration: Jayachandran/Mint
In 2007, Ravi Kasliwal, senior consultant, cardiology, Global Healthcare, New Delhi, conducted a survey of office executives (mean age 40) and found that 49.8% of the women had low HDL counts, as against 36.4% of men. At least 35% of all surveyed had high triglycerides. A 2006 study of urban Indians (in Delhi) by the Diabetic Foundation of India, found that over 68% of women had low HDL. The foundation’s science adviser, Anoop Misra, also director and head, department of diabetes and metabolic diseases, Fortis Hospitals, New Delhi, led the study.
This gender bender is why women should have HDL levels at least 10 units higher than men, that is, 50mg/dL or above, says nutritionist Ishi Khosla, who heads the Centre for Dietary Counselling, New Delhi.
Medicines, last recourse
“Medicines should be (a) last recourse,” she says. Many of her patients, she adds, have managed to perfect their lipid profile by eating right
Dr Jain attributes his own readings to the handful of almonds, walnuts and watermelon seeds he has every morning, plus a diet high in soluble fibre.
Case studies
Delhi-based clinical and rehabilitation psychologist Divya Parashar, 32, is a case in point. Overweight and suffering from high cholesterol, she was put on statins in December 2005. Weighing 94kg, her cholesterol readings then were: LDL 127 mg/dL; HDL 35.7 mg/dL, triglycerides 199 mg/dL.