HDL and LDL Cholesterol Levels |How High Cholesterol Affects Heart - Dr.R.Muralidhar|Doctors' Circle

Registration No. 24907 Karnataka Medical Council, 1986
Dr. R. Muralidhar | Phone ????:+91 9341220446 and 9611525626 (Online & in-person appointment can be booked online or by call) | Consultant Vascular & Endovascular Surgeon | Jupiter Hospitals, Nelamangala Bengaluru, India
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As all of you know, there are different types of fat in our bodies. So the blood contains various types of fat, which we otherwise call cholesterol. Cholesterol is not a single entity. There are various types of cholesterol, like high-density lipoproteins, low-density lipoproteins, very low-density lipoproteins, and triglycerides. Among these, we should know which one is bad cholesterol and which one is good cholesterol. The total cholesterol or triglycerides are considered bad cholesterol because they tend to stick to the inside of the blood vessels and slowly cause blockages. On the other hand, high-density cholesterol, or HDL cholesterol, is referred to as good cholesterol. So when we test our blood, we should evaluate which values are high and which are low. Triglycerides should always be controlled. The normal level is between 150 to 160 mg per deciliter, and it should always be less than this. We've seen patients with triglyceride levels as high as 1,000 or even 3,000 mg per deciliter, which puts them at very high risk for heart attacks. Good cholesterol, like HDL, should be more than 40 mg per deciliter, but unfortunately, many people don’t reach that level. So we all should maintain healthy cholesterol levels. Bad cholesterol, such as triglycerides, should be less than 150, and good cholesterol, like HDL, should be more than 40 or 45 mg per deciliter. Now, what happens inside the blood vessel? As we age, and depending on the levels of triglycerides, layers of cholesterol get deposited. This reduces the diameter of the blood vessel. For instance, in the heart, coronary arteries may be only 3 to 4 mm in diameter. Over time, these vessels age, and layers of cholesterol build up, gradually narrowing the diameter. At a certain point, these blockages can worsen due to sudden blood clotting. This condition is known as Acute Coronary Syndrome (ACS). It happens when a plaque inside the artery ruptures and triggers clot formation. This clot suddenly blocks the vessel, cutting off blood flow beyond that point. As a result, the heart muscle doesn’t receive blood, causing a medical emergency. A large portion of the heart muscle may die, leading to a drop in blood pressure. Sometimes, blood pressure can fall so drastically that the heart stops beating altogether. This is one of the causes of sudden cardiac arrest. We should all be aware of this. When coronary angiography reveals blockages, there are several treatment methods. One such method is atherectomy, where atherosclerotic clots are removed. While this was traditionally a major surgery involving direct access to the heart and arteries, modern techniques allow us to perform it using instruments passed through blood vessels from the thigh or hand. For example, we can use a catheter to perform atherectomies. There are tools like the rotablator, which work by rotating to remove the blockages. These rotators spin at a very high speed — 1.5 to 2 lakh revolutions per minute (RPM) — and with their rough edge, they clean out the arteries. This is especially useful in diabetic patients, where the blood vessels become hard due to calcium deposits, making it difficult to open them using balloons. In such cases, rotators are very helpful. Another method is the classical angioplasty, which uses a balloon and a stent. A stent helps keep the artery open after dilation and prevents it from collapsing, maintaining proper blood flow over time. There are various types of stents available now. In the past, we used steel nitinol stents, but they had limitations. If the patient’s condition worsened later and required surgery, these stents made it difficult to open the artery for bypass surgery.
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