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

High cholesterol (especially LDL cholesterol, which affects vascular health) is often associated with an unhealthy lifestyle, a high intake of animal fats in the diet and excess weight. In most cases these factors really do cause cholesterol levels to rise. However, there is a group of lean individuals, often sporty ones, whose blood tests come back with unexpectedly high cholesterol values. The measured values tend to be higher than 5 mmol/l for total cholesterol and higher than 3 mmol/l for LDL cholesterol.¹

What influences high cholesterol in lean people?

Because every body is unique, cholesterol levels can be significantly influenced by genetic predispositions, which always need to be taken into account in these cases. The same applies to eating habits, which typically correlate with changes in cholesterol levels. Some people see their cholesterol drop on a keto or carnivore diet, for others veganism or vegetarianism is more suitable, others get the most out of a balanced diet and some do best when they include, for example, intermittent fasting.^{3, 4}

Always ask your doctor for a comprehensive approach

When assessing a patient's condition, a doctor should not focus blindly on elevated cholesterol levels alone and immediately start pharmacological treatment (with a statin, for example). Every individual case needs to be analysed comprehensively. First of all it is necessary to look at whether the patient looks and feels healthy. The doctor should then find out whether there are any close relatives who have had strokes, heart attacks or angina pectoris in the patient's family. The doctor should also take an interest in the patient's eating and exercise habits, whether they smoke and often drink alcohol. All of this needs to be compared with cholesterol and blood sugar values and the measured blood pressure.

If cholesterol levels in lean and physically active people with a good lifestyle are elevated in genuine isolation, i.e. without the presence of the other risk factors described above, it is most likely a genetic variant that is usually not a problem. The condition of such an individual must not, however, point to accelerated progression of atherosclerosis.^{2, 3}

What to take away from this

Although high cholesterol in lean people can be worrying, it is important to take their overall state of health, genetic predispositions and lifestyle into account. Cholesterol levels can be effectively lowered by changing the diet, especially by reducing the intake of animal fats and by increasing physical activity, in particular by including aerobic activities such as running, cycling, swimming and so on.^{1, 2, 3, 4}

If your doctor wants to put you on medication, they should have a defensible reason for it - before starting medication, always ask for a clear explanation (we also recommend getting examined at another practice for a second opinion). For the prevention of cardiovascular disease it is essential to prioritise an individual approach and maintain a healthy lifestyle.

References:

1. Karr, 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, N.Z.) 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