High cholesterol in slim people and what to do about it?

High cholesterol (especially LDL cholesterol, which affects blood vessel health) is often associated with an unhealthy lifestyle , high intake of animal fats in the diet, and being overweight . In most cases, these factors do indeed cause cholesterol levels to increase. However, there is a group of slim individuals , often also athletic, who have unexpectedly high cholesterol values in their blood tests. The measured values are usually greater than 5 mmol/l for total cholesterol and greater than 3 mmol/l for LDL cholesterol. ¹

What affects high cholesterol in thin people?

Because every body is unique, cholesterol levels can be significantly influenced by genetic predispositions , which should always be taken into account. The same goes for eating habits, which typically correlate with changes in cholesterol levels . Some people lower their cholesterol on a keto or carnivore diet, others are more suitable for veganism or vegetarianism, others benefit most from a balanced diet , and some thrive most on fasting, for example. ^{3, 4}

Always ask your doctor for a comprehensive approach

When assessing a patient's condition, the doctor should not just blindly focus on elevated cholesterol levels and immediately start pharmacological treatment (for example, with a statin). It is necessary to analyze each specific case comprehensively . First of all, it is necessary to monitor whether the patient looks and feels healthy . Next, the doctor should determine whether there are in the patient's family , close relatives have had strokes, heart attacks or angina pectoris. The doctor should also be interested in what his eating and exercise habits are, whether he smokes and often drinks alcohol . All this needs to be compared with the values of cholesterol and blood sugar and measured blood pressure .

If cholesterol levels are elevated in a slim, athletic person with a good diet and are truly isolated, i.e. without the presence of other risk factors described above, it is most likely a genetic variant that is usually not a problem. However, the condition of such an individual must not indicate accelerated progression of atherosclerosis . ^{2, 3}

What can you take from this?

Although high cholesterol in thin people can be a concern, it is important to consider their overall health , genetic predisposition , and lifestyle . Cholesterol levels can be effectively reduced by changing their diet, especially by limiting their intake of animal fats , and by increasing their physical activity , especially by including aerobic activities such as running , cycling , and swimming . ^{1, 2, 3, 4}

If your doctor wants to put you on medication, they should have a justifiable reason for doing so - always ask for a clear explanation before prescribing medication (we also recommend getting examined at another facility for a second opinion). The key to preventing cardiovascular disease is to prioritize an individual approach and maintain a healthy lifestyle.

Resources:

1. Carr, Samantha. "Epidemiology and management of hyperlipidemia." The American journal of managed care vol. 23.9 Suppl (2017): S139-S148.
2. Fernandez, Antonio B et al. "Coronary Atherosclerosis in Masters Athletes: Mechanisms and Implications for Cardiovascular Disease Risk." Current treatment options in cardiovascular medicine vol. 21,12 87. 10 Dec. 2019, doi:10.1007/s11936-019-0798-0
3. Eisenmann, Joey C. “Blood lipids and lipoproteins in child and adolescent athletes.” Sports medicine (Auckland, NZ) vol 32.5 (2002): 297-307. doi:10.2165/00007256-200232050-00002
4. https://www-uptodate-com.ezproxy.is.cuni.cz/contents/dyslipidemia-in-children-and-adolescents-definition-screening-and-diagnosis?search=cholesterol&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=2