Jun 07 2016 : The Times of India (Delhi)
Now, teens have cholesterol problems
Shobita Dhar


Start lipid screening for growing children as young as 17, says new recommendation by cardiologists
If you thought that cholesterol troubles afflicted only middle-aged or older folks, consider this: the Lipid Association of India has recommended that lipid screen ing should start at the age of 17, around the time of college admission. Traditionally , screening was advised to those in their 40s.This recommendation, drafted in collaboration with 150 cardiologists from across India, will be published next month.
There's reason for alarm, say experts. A study by senior cardiologist Dr Raman Puri on 2,500 school students (14-18 years) in Delhi last year found that 23% of them had high cholesterol levels, an indicator of heart disease. In a more worrying trend, 10% of the surveyed children had alarming levels of low-density lipoprotein or LDL (also known as bad cholesterol).Their triglycerides too were on the higher side.Though a small study , its findings match what cardiologists across India are observing -a large number of children reporting symptoms of dyslipidemia or high lipid levels.

Dharminder, a 10-year-old based in Delhi, is as careful of his lipid cut-offs as his school grades. On March 15, he had a by-pass surgery after an angiography revealed three blocked arteries. His plaque-choked arteries had left him with reduced stamina and appetite as well as chest pain. His grandfather, Shankar Lal, was the first to raise an alarm. “I saw skin tags on his hands, feet and elbows...these are a symptom of high lipid levels,“ says Lal, who is in his 60s and has also undergone a by-pass procedure a few years ago.

While genetics were primarily responsible for Dharminder's poor heart health, doctors are raising a red flag over lifestyle factors. Lack of playing space in cities is pushing children indoors, reducing physical activity . Nutritionally inadequate packaged food is replacing fresh options. “These factors are putting our children at risk,“ says cardiologist Dr Nilesh Gautam.He reports some teenagers reporting triglycerides as high as 300 to 500 when they should not be higher than 150mg dl. “A decade ago I would see one or two such cases in a year, now I see one or two in a month,“ says Dr Gautam, head of preventive cardiology and rehabilitation, Asian Heart Institute, Mumbai. “These days boys start smoking and drinking in their teens. This pushes up their risk for dyslipidemia. It is essential to identify it early in order to prevent a serious cardiac event later in life,“ says Dr Shreesha Maiya, paediatric cardiologist at Narayana Health, Bengaluru. He suggests lipid screenings should be done between ages 9 and 11 and then later between 17 and 21 as has also been recommended by the American Association of Pediatrics.

“There are two reasons for this shift in thinking. One, some children have genetically determined, severely elevated cholesterol levels that predispose them to heart attacks in their 30s or 40s, rather than 50s or 60s. Second, obesity and type-2 diabetes mellitus due to lifestyle-related factors are increasingly being associated with cholesterol level elevation in children and adolescents,“ explains Dr Peeyush Jain, head of preventive cardiology , Fortis Escorts Heart Institute & Research Centre, Delhi.

There's no official estimate on the genetic incidence of the disease in India. However, globally it is said to be 1 in 200. There is also no concrete figure to quantify incidence of dyslipidemia due to lifestyle factors. What is clear, though, is that it is a ticking time bomb.“WHO has predicted that by 2020, 40% of all deaths in India will be because of coronary artery disease. If we don't implement the new screening guidelines, the predictions may turn rue,“ says Dr Puri