Dr. Uthra S, Senior Consultant, Dr. Mohan’s Diabetes Specialties Centre
Most people think high cholesterol is something that happens later in life—or only to people who are overweight, have diabetes, or eat unhealthy food. But a recent nationwide study suggests that this belief may be putting millions of Indians at risk.
The ICMR-INDIAB study, one of the largest health surveys conducted in the country, found that nearly 9 out of 10 Indian adults have at least one abnormal blood lipid level. In other words, around 355 million Indians could be living with unhealthy cholesterol levels, many without having any symptoms or even knowing they are at risk.
What makes this finding even more surprising is that many of these individuals appeared perfectly healthy. They had no diabetes, no high blood pressure, and were not necessarily overweight. Yet, their cholesterol levels silently increased their risk of heart disease.
This is exactly why cholesterol is often called a “silent risk factor.” You may feel completely well while damage is slowly building up inside your blood vessels.
What exactly is cholesterol?
Cholesterol is often spoken about as though it is entirely harmful, but that isn’t true. Our bodies actually need cholesterol to make hormones, vitamin D, and build healthy cells. Problems arise only when the balance between different types of cholesterol is disturbed.
There are three important components of a lipid profile.
LDL cholesterol, often called the “bad” cholesterol, can build up inside the walls of arteries. Over time, these deposits narrow the blood vessels, making it harder for blood to flow. If a blockage suddenly forms, it can lead to a heart attack or stroke.
HDL cholesterol, known as the “good” cholesterol, works differently. It helps remove excess cholesterol from the bloodstream and carries it back to the liver, where it is broken down. Higher HDL levels generally protect the heart.
The third component is triglycerides, another type of fat in the blood. High triglyceride levels, especially when combined with low HDL, further increase the risk of cardiovascular disease.
Interestingly, the ICMR study found that low HDL cholesterol was the most common abnormality, affecting almost two-thirds of adults. This pattern is commonly seen in Indians and is influenced by both genetics and lifestyle factors such as physical inactivity and diets rich in refined carbohydrates and sugary foods.
The problem starts much earlier than most people think
Many people assume cholesterol becomes a concern only after the age of 50. However, the study found that abnormal lipid levels were common even among adults in their 30s.
That’s worrying because cholesterol doesn’t cause symptoms while it’s damaging blood vessels. The first sign may be chest pain, a heart attack, or even a stroke. By then, the disease has often been developing silently for years.
This is why waiting until symptoms appear is simply too late.
Why early screening makes all the difference
One of the biggest lessons from this study is that cholesterol should not be checked only after someone develops diabetes or high blood pressure.
A simple fasting lipid profile is inexpensive, widely available, and takes only one blood sample. Yet it can reveal risks long before complications develop.
For most adults, especially those aged 30 years and above, and anyone with a family history of heart disease, regular cholesterol screening is a sensible step—even if they feel perfectly healthy.
Finding abnormal cholesterol early creates an opportunity to act before irreversible damage occurs.
Small lifestyle changes can have a big impact
The encouraging news is that cholesterol levels often respond well to healthy lifestyle changes.
Simple habits such as eating more vegetables, fruits, whole grains, pulses, nuts, and healthy fats while cutting back on sugary drinks, refined carbohydrates, fried foods, and processed snacks can make a noticeable difference.
Regular physical activity is equally important. Brisk walking, cycling, swimming, or any moderate exercise for at least 150 minutes each week helps improve HDL cholesterol and lower triglycerides.
Avoiding tobacco in all forms and limiting alcohol intake also reduce cardiovascular risk.
These changes may seem small individually, but together they can significantly improve heart health over time.
Where do statins fit in?
Lifestyle changes are the foundation of cholesterol management, but they may not be enough for everyone.
For people with high LDL cholesterol or those who already have heart disease, diabetes, chronic kidney disease, or a high risk of cardiovascular disease, doctors may recommend statins.
Statins are among the most extensively studied medicines in cardiovascular care. They lower LDL cholesterol and have been shown to reduce the risk of heart attacks, strokes, and premature death.
Importantly, statins are not medicines that everyone should start on their own. The decision depends on an individual’s overall cardiovascular risk, cholesterol levels, age, and other health conditions. A healthcare professional can determine whether medication is necessary and which treatment is most appropriate.
The bigger picture
Heart disease remains one of the leading causes of death in India. What this study reminds us is that the process often begins quietly, years before symptoms appear.
The good news is that we have the tools to detect and manage cholesterol early. A simple blood test, healthier food choices, regular physical activity, and appropriate treatment when needed can dramatically reduce the risk of future heart disease.
Take-home messages
Nearly 9 in 10 Indian adults have at least one abnormal cholesterol level.
High cholesterol usually causes no symptoms, making regular screening essential.
Adults aged 30 years and above should consider a lipid profile, especially if there is a family history of heart disease.
Healthy eating, regular exercise, maintaining a healthy weight, and avoiding tobacco remain the first line of defence.
Statins are highly effective for people who need them and should be taken only under medical guidance.
Early screening and timely treatment can prevent heart attacks, strokes, and other serious cardiovascular complications.