Ask the Doctor: ‘I’m in my mid-20s and my GP has just diagnosed me with high cholesterol — how can I avoid medication for life?’

“I have recently been diagnosed with high cholesterol by my GP. They say that if it doesn’t decrease with lifestyle changes, medication may have to be considered. I am worried about this as I feel I’m very young (mid-20s) to have cholesterol issues. My BMI is in the normal range, but my mother’s side of the family also has cholesterol issues. Beyond lifestyle changes, what else can I do to avoid being on medication for life?”

Answer from Dr David Barton, Consultant Cardiologist at the Beacon Hospital

Cholesterol is a type of fat, produced by the body that is essential for the normal functioning of the body. Unfortunately, when there is too much cholesterol in the body it gets deposited into the arteries of the heart and other organs leading to a myriad of diseases, including heart disease – which remains the leading cause of death in Ireland each year.

High cholesterol is common. It is estimated that at least 40% of the Irish population have high cholesterol and it is one of the leading causes of preventable heart attacks and strokes. Traditionally, it was thought that only people aged 50 and above with high cholesterol were predisposed, but we now understand that cholesterol plaque can start forming in the arteries from teenage years.

Lifestyle changes to reduce cholesterol are the single most important thing folks in their mid-twenties need to undertake. A healthy diet comprising fruits, vegetables, unsalted nuts, wholegrains, fibre, fish and vegetable oils instead of butters and animal fats, is essential. Moderate intensity exercise for at least 3 hours a week is also strongly recommended. Stress management, quitting smoking and losing weight are all other undertakings to reduce high cholesterol.

Non-medicinal options are also available. They include plant phytosterols (over the counter supplements), red yeast rice, fibre supplements, and soy protein. It is however important to understand that while these dietary supplements have been shown to modestly reduce cholesterol, they have not been shown to reduce strokes and heart attacks.

When should someone start taking a statin for high cholesterol? This question is a complex one, and for someone in their mid twenties the answer is: a lot of the time, we don’t really know. If you have a family member (parent or sibling), that has very high cholesterol or who has had a heart attack or stroke at a young age and your cholesterol is high, we may recommend additional blood tests to see if there is an inherited component at play. If there is, then regardless of someone’s age and because of the very high risk of heart disease if left untreated, we generally recommend a statin, in addition to adopting lifestyle measures.

If there is no genetic or familial component to your high cholesterol, the situation is more uncertain, as most people previously studied on statins were at least in their 40s. However, if your bad cholesterol (LDL) is very high (greater than 4.9) despite your best efforts, then we classify you as being high risk, and usually recommend starting a statin.

If your cholesterol is moderately elevated despite lifestyle changes, then we usually recommend additional measures and testing to guide our recommendation. We can obtain additional blood tests to further assess your individual risk and an ultrasound of the artery of your neck or leg to see if cholesterol has begun to be deposited in your arteries.

Have a question for the professionals you’d like answered? Get in touch with [email protected] with the subject headline ‘Ask The Doctor’.