LDL cholesterol is what most doctors focus on.
But that is like treating someone for acne while he's bleeding to death from a gunshot wound.
Ok, maybe I'm being melodramatic here, but I need to get my point across.
LDL is carried in the bloodstream by apolipoproteins. ApoB100, mainly.
Indians tend to react very poorly to a high carbohydrate diet. That is why we have such a huge population of diabetics here. Its probably one of the few areas where we beat China to the top.
When we indians eat too much carbohydrates, (All of us do, trust me) the body struggles to deal with the rush of sugar into the bloodstream. It pushes as much as it can into the muscles. Then into the liver and the rest into fat cells.
Muscles will not take up much sugar because we dont do any intense exercise anymore. Hell! We dont even walk to the neighbouring shops these days. Its always "live to drive!"
The liver will not take up any sugar, because its stores are full too. It takes around 12-16hours without food to empty your liver glycogen stores significantly. How many of us go without food for 12hrs continuosly?
The fat cells come to your rescue!
They soak up all the excess sugar and save you temporarily, but in the process make you fat.
At some point, even the fat cells cant take anymore sugar, the sugar is then converted to triglycerides and floats around in VLDL, LDL and displaces cholesterol from the lipoprotein vehicle that is carrying it.
The body senses that there are not enough lipoprotein carriers to ferry around the LDL and grossly excessive triglycerides. The liver responds by making more ApoB100 among other things.
The increased apob100 exposure, combined with the inflamatory state of too much sugar and body fat, then triggers atherosclerosis.
Indians cant push enough sugar into their fat cells like the europeans can. Even if they do, they push it into visceral fat(the fat around the organs) That fat is dangerous, it pumps out inflamatory chemicals at an alarming rate. That inflammation further feeds into the atherosclerosis.
This is why you'll see relatively thin indians dying of heart attacks at 30.
It doesnt mean we need drugs. It means we need to fix our lifestyle.
Our grandparents had heart attacks at 70 or 80. Our parents at 50-60, us at 30-40. Our children are next. The availability of medicines has increased from the time of our grandparents, but the incidence of heart disease has increased. Our genetics have not changed in 3 generations.This is not a deficiency of medicines. This is a deficiency in our lifestyle.