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Cholesterol and Heart Disease: What You Need to Know Earlier
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High cholesterol can start damaging your arteries long before you feel anything — and your total cholesterol number does not tell the whole story. So when should you start checking it, what do LDL and other cholesterol particles really mean, and when are lifestyle changes no longer enough?
In this episode of Baptist Health Talk, host Dr. Anthony Gonzalez speaks with Dr. Sanjeev Gulati about how cholesterol contributes to heart attacks and heart failure, why screening should begin earlier than many people think, and the treatment options available today.
- Why high cholesterol is directly linked to heart attack risk
- Common cholesterol myths, including the idea that diet is the only cause
- How LDL and lipoprotein(a) contribute to plaque buildup and inflammation
- How uncontrolled cholesterol can ultimately contribute to heart failure
- Why cholesterol screening may need to begin in your 20s
- How family history and familial hypercholesterolemia change cardiovascular risk
- Lifestyle steps that can help lower cholesterol
- When cholesterol-lowering medication may be needed
- Why cholesterol control remains critical even after a heart attack
- How advanced lipid testing can provide a clearer picture of individual risk
Host:
Anthony Gonzalez, M.D.
Chief of Surgery, Baptist Health Baptist Hospital
Medical Director of Bariatric Surgery, Baptist Health
Guest:
Sanjeev Kumar Gulati, M.D.,
Executive Deputy Director
System Chief of Cardiovascular Medicine
Baptist Health Heart & Vascular Care
If you found this episode helpful, we also recommend:
What Your Blood Pressure and Cholesterol Numbers Really Mean
Calcium Scores Explained: What Your Heart Rick Really Looks Like
Heart Disease in Young Adults: Why It's Rising (And What to Watch For)
Yeah, so in the adult population, I would say in your 20s, we should start looking at that. And that's for a couple of reasons. One, you may be surprised that your cholesterol is higher than you think, even though you're very young and you're healthy. The other thing is it helps us to sort out if there's a genetic component for your for your cholesterol. Like familiar hypercholesterolemia actually has a almost a 20-time chance of having early cornearity disease.
SPEAKER_00Welcome to Baptist Health Talk, a podcast on all things healthcare powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness.
SPEAKER_01Hello, everyone. I'm your host, Dr. Anthony Gonzalez. Welcome back to a new episode of Baptist Health Talk, where we answer your most searched questions on trending health topics. Today we're talking about cholesterol, but probably not in the way you've heard before. For years, the message has been simple: watch your cholesterol to prevent a heart attack. But what we've learned is that its impact goes far beyond that. We are joined today by Dr. Sanjeev Gulati, Executive Deputy Director of Baptist Health, Heart and Vascular Care, and System Chief of Cardiovascular Medicine. Thank you for being here, Dr. Gulati. Thank you for having me. Wow, that's a mouthful. So let's start with what people hear about cholesterol, high cholesterol and heart attack. You know, what do we need to know about that?
SPEAKER_02Well, so one thing you need to know is that high cholesterol and heart attacks are clearly linked. And the issue really is it starts a lot earlier before you have your heart attack. And I think what people don't realize, there's more to cholesterol than just that total cholesterol number. There's multiple different parts of it. We all hear about the bad cholesterol, which is LDL. There's another one, lipoprotein little A, and there's HDL, which is considered the good cholesterol. What we really want to understand is how that cholesterol affects the arteries of the heart.
SPEAKER_01And so over the years, a lot of information has changed, just like you mentioned. And so what are some of the misconceptions that you still hear from patients today that you think we should be bringing to our attention?
SPEAKER_02So I think the one thing is people still think cholesterol is related only to diet. And that's a big problem. It does affect your cholesterol, but there are other factors that we can talk about that actually affect your cholesterol even more. The other big myth is people think that, oh, I'm healthy, I'm exercising, I'm doing these things, my I should be doing well. And actually, cholesterol is a silent part of the problem that leads to disease later on. And so we need to be looking at that early on. And I think the other part that people don't understand or don't think about is that we should be getting our cholesterol checked a lot earlier, not when you're 50 or 60, but more in your early adulthood. And what about even youngsters with obesity? Should we be checking that as well? That's a great question. And I think the answer is yes. And we're starting to see pediatricians and you know, people who take care of teenagers starting to check that cholesterol early on. Because to your point, there's other factors besides medicines that can actually help those children early on.
SPEAKER_01All right. So cholesterol and heart failure? You know, I've heard about cholesterol and heart attacks, but you know, how can cholesterol lead to heart failure?
SPEAKER_02Great question. So, you know, if you think about this, heart failure in the United States is probably one of the largest problems and it's growing. The number one cause for heart failure is what we call ischemic heart disease, which is really heart attacks. So, what is up ends up happening is over the years you have high cholesterol and the particles like LDL, which is that bad cholesterol, and this other one that we're talking about, like little lipoprotein little A, both of those are actually not markers. They actually get into the artery walls, start to cause inflammation, start to cause plaques, and those plaques cause narrowing. Eventually you have a heart attack, damage the heart muscle, heart muscle then gets weaker, and you develop heart failure.
SPEAKER_01Wow. Okay, so you spent your career, we talked about this, you spent your career dealing with heart failure and heart transplants. So, how often does like uncontrolled cholesterol lead to heart failure and eventually somebody needing a heart transplant?
SPEAKER_02Very often. So, number one cause of heart failure in the United States is heart attacks. And we're talking about eight million people in the United States having heart failure. So you can do the math, that's a big number. And the problem is the cholesterol starts a lot earlier. And then by the time you find out you have a heart attack and heart failure, we're actually now behind the eight ball.
SPEAKER_01Okay. So obviously you're seeing the patients way further in advance when they have the heart failure and they need the transplant. So, how do you address this much early on in a preventive manner to kind of prevent that cholesterol from getting out of control?
SPEAKER_02Yeah. And I think really what we as physicians need to do, and this is primary care physicians, general cardiologists. I do this in my practice, but it's a lot later in the spectrum of disease, is to remind people that we should check your cholesterol. We should talk about what we should do about your cholesterol, and we should monitor it over those years. But the earlier we can start, the better off we can get those diseases under control.
SPEAKER_01All right. So I've heard it. Check my cholesterol. All right, so Doc, I've checked my cholesterol. My doctor says it's a little high. He doesn't want to put me on medication. What can I start doing today to kind of curb that cholesterol problem?
SPEAKER_02Yeah. So the first thing we tell people, especially when it's early on and they're younger, is lifestyle management. So the first thing is to control your diet. You hear about the Mediterranean diet, which is very healthy, unsaturated fats, avoid processed foods. In addition to that, exercise. So we want people exercising about 150 minutes a week, excuse me. Um, and we want them to be doing that at a moderate level. And then the third part of that is really managing your weight, getting your weight under control. Those three things can really impact your cholesterol and your cardiovascular health as a whole over several years.
SPEAKER_01Okay. And you we mentioned, you know, the specific group of kids when they have obesity, they may need their cholesterol check. But, you know, the everyday person in our community, how early should we be thinking about this? Is you mentioned it's not really adult or older uh disease in the older people. Should we be thinking this in our 20s and 30s?
SPEAKER_02Yeah. So in the adult population, I would say in your 20s, we should start looking at that. And that's for a couple of reasons. One, you may be surprised that your cholesterol is higher than you think, even though you're very young and you're healthy. The other thing is it helps us to sort out if there's a genetic component for your for your cholesterol, like familial hypercholesterolemia actually has a almost a 20-time chance of having early cornearity disease. So we want to get to those people even faster.
SPEAKER_01And is it important what your parents or siblings had? Is family history very important in that when should you be checked?
SPEAKER_02100%. So if you have a strong family history of cardiovascular disease, particularly at an early age, we should be doing everything to help you modify your disease, lifestyle, medications, but cholesterol is a big part of that. And checking it and then deciding on how to treat you is really important at that age.
SPEAKER_01Okay. So I've done all the things you said. I I'm controlling my diet, I'm controlling my weight, I'm doing that exercise 150 minutes a week, and it's really not working. My cholesterol is still high. What's next?
SPEAKER_02Yeah. So the first thing is that's not failure. We want to think about lifestyle modification plus pharmacologic therapy medications. So when we see patients who've done those things, we always like to give that a chance and see where we land. Now remember, you have to have a really strict diet to control your cholesterol. And we're talking about a 10 to 15% reduction in your bad cholesterol at LDL. So most people are going to need some pharmacologic therapy. So that next conversation that I would have with you is let's talk about what medications we have and let's talk about the risks and the benefits. People get pretty nervous about medications. So we want to talk about the benefits of those medications and how we can use them.
SPEAKER_01Yeah. And those medications, some of those medications have gotten kind of a lot of bad press. I hear that, you know, more socially with among friends and people that are prescribed and then they have issues with them. So let's talk about that. How do you walk a patient through, you know, taking the medication, balancing the benefits versus, you know, what the negatives are of these medications?
SPEAKER_02That's that's really a great question. And that's probably the most frequent question I get from patients and their families when we start talking about cholesterol. The first thing is to understand there has been a lot of studies, and a lot of patients have gone through those studies. So we have robust data that says it's very beneficial to reduce your cholesterol, but more importantly, to reduce those bad outcomes such as heart attacks. Second thing is what we look at is how to tailor that medication for you as an individual. Now there's much more options in terms of cholesterol management besides the statins that everybody knows about. So we can try those medications. If you have side effects, we can adjust the medications or try a different one or a different combination. What I will tell you in our experience, the side effects are actually overrated. And I think to your point about the bad press, they're actually relatively infrequent and we can manage around them. And we have a lot more options nowadays.
SPEAKER_01All right. So we've talked about already managing the cholesterol, preventing the heart attack, and leading to the heart failure. But I've come to you now. I've already had a heart attack at a young age. Uh do I still have to manage my cholesterol? What's the big picture? Is that, you know, now doing something even after a heart attack is going to prevent me from leading to heart failure and ending ending up in your office?
SPEAKER_02Yeah. So there's two kinds of prevention that we talk about in medicine. One is primary prevention. What that means is you've not had an event. So that young person that we find has high cholesterol, we're going to try to do a primary event prevention, which means try to prevent the first event that you have. Secondary prevention is exactly what you described. Someone who's had heart failure, heart attack, has had some cardiovascular disease, and we're looking to reduce that second event. And the reason that's so important, once you've had the first event, you're very high risk for another event. So we'd even want to double down even further and try to control your cholesterol in that situation.
SPEAKER_01Okay. So we you see patients at all, you know, stages. You see them from prevention to transplant. And, you know, we've talked about cholesterol, and I and I think what I've heard from you is really checking it is number one, and really checking it even at the young age of 20 or 30 years old. But what would you tell people, you know, from our conversation today, what's the take-home message? What would you want people to be aware about with regard to the cholesterol, heart attacks, and of course, heart failure?
SPEAKER_02Yeah. So, first, like you said, I want to I want to really uh repeat that. Check your cholesterol, get it checked, talk to your physician, figure out lifestyle changes, plus maybe pharmacologic therapies. Think about this as a combination of therapies. And the second thing is look at any other modifiable disease. When you talk about heart attacks and heart failure, cholesterol, high blood pressure, being overweight, being inactive are all risk factors. And the reason I'm bringing them all up here is the takeaway from this is a lot of these things are modifiable. If we modify that, we can significantly reduce your chance of a heart attack or heart failure or even dying from cardiovascular disease.
SPEAKER_01And and I've heard also it's never too late. Even if you've had the problem, it's even more important to double down and even be stricter with your lifestyle changes and with medication.
SPEAKER_02100%. At Baptist Health, we actually have a complete program for cardiometabolic and lipid management that anybody can come to, and we can do it virtually so you don't even have to come to the office, make it even as even easier for you for the long run.
SPEAKER_01And it's not just the cholesterol, it's much more than that. There's a lot of other, what I guess what you guys describe as particles within the cholesterol, right?
SPEAKER_02That is exactly right. And we have more sophisticated testing that we can do so we can go beyond that lipid panel and we can test other aspects that can tell us even what your risk is even further, so we can actually tell your therapies even more.
SPEAKER_01Wow. Great discussion. So it's been great to hear from you and listen to you and understand that the you know cholesterol is so important. And what we want to do is prevent patients from ending up in your office uh with heart failure and heart transplants. That's exactly right. All right. Well, Dr. Gulati, thank you. Thank you for the great conversation, and thank you for sharing your insight. Remember, viewers, be sure to hit that subscribe button on our channel right here to keep up with the latest health and wellness information and tips from our experts like Dr. Gulati. So you can also find Baptist Health Talk on Apple Podcasts, Spotify, or wherever you listen to podcasts, so you can tune in anytime, anywhere.net slash news.
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