When we talk about heart attacks and strokes, we often visualise dramatic scenes: a sudden sharp chest pain or a collapsed individual. It is estimated that roughly four Indians suffer a heart attack every minute, which equals more than 5,700 heart attacks every single day. Cardiovascular diseases claim about 2.8 million lives in India each year, which are responsible for 27% deaths of our country. But long before a heart attack strikes, a quiet, invisible process has usually been unfolding inside the body for years, if not decades.At the centre of this hidden process is a condition known as dyslipidaemia – a term doctors use to describe abnormal levels of lipids (fats) in the blood. Understanding the causes of this condition and how modern medicine can treat it can literally save millions of lives. Cholesterol and triglycerides are fatty substances that your body actually needs to build cells and produce vital hormones. However, problems arise when these fats circulate in the bloodstream in unbalanced amounts and that is what constitutes dyslipidaemia. It involves raised levels of LDL (Low-Density Lipoprotein) cholesterol, often called “bad” cholesterol. There is a type of cholesterol called HDL (High-Density Lipoprotein) cholesterol, often called “good” cholesterol, which helps clear excess fats and High Triglycerides. Its high levels are good for heart health. Yet another type of fat in the blood linked to diet and metabolic health is triglycerides. It is often co-existent with low HDL cholesterol, making a person prone to fat deposition in arteries. When “bad” LDL cholesterol levels remain elevated, excess cholesterol particles begin to penetrate the delicate inner lining of your arteries. Over time, these particles oxidise and trigger an inflammatory reaction, turning into a sticky substance called plaque. This buildup is known as atherosclerosis, or hardening of the arteries.It is essential to follow the lipid screening programme as recommended by the American College of Cardiology, American Heart Association and Multi-Society Dyslipidaemia Guidelines in March 2026. These are as follows.Children: Universal screening is recommended between ages 9 and 11, with earlier cascade screening around age 2 if there is a family history of familial hypercholesterolemia (FH) or premature heart disease. Young Adults: Baseline lipid panel is recommended starting at age 19. Adults (General): Re-screening is advised at least every 5 years, or more frequently if cardiovascular risk factors are present. Lipoprotein(a) [Lp(a)]: Recommended measurement at least once in all adults to identify hidden genetic risk. A normal lipoprotein(a) or Lp(a) level is less than 30 mg/dL (or less than 75 nmol/L), which indicates a low risk for heart disease. Levels from 30 to 50 mg/dL (75 to 125 nmol/L) are borderline or intermediate risk, while levels above 50 mg/dL (125 nmol/L) are considered high riskApolipoprotein B (ApoB): Reasonable to measure for patients on lipid-lowering therapy with diabetes, high triglycerides, or established heart disease to guide treatment intensification. Normal levels being less than 100 mgs. Lower it is the better is the prognosis.LDL c Goals: The currently recommended Goals for Primary prevention target <100 mg/dL High risk <70 mg/dL; Very high risk/Secondary prevention <55 mg/dL). Effects of Dyslipidaemias Your blood vessels are like smooth plumbing pipes. Plaque buildup acts like sludge lining the pipe walls, making them narrower, stiff, and rough. If a piece of this plaque cracks or ruptures, the body attempts to heal it by forming a blood clot. If that clot blocks a vessel supplying the heart, it causes a heart attack. If it blocks blood flow to the brain, it triggers a stroke.The management of this issue for almost everyone, managing cholesterol starts with lifestyle habits. What you eat, how much you move, and how you care for your body play a very important role in maintaining healthy lipid levels. Heart-healthy nutrition is the key. Focus on diets rich in soluble fibre (oats, beans, lentils), healthy unsaturated fats (olive oil and nuts,) and lean proteins. Limit saturated fats found in fatty meats and full-fat dairy, and avoid trans fats (vanaspati ghee, margarine, etc.) entirely. Engaging in 150 minutes of moderate aerobic exercise per week (like brisk walking, cycling, or swimming) helps boost “good” HDL cholesterol while keeping weight in check. Shedding excess abdominal fat significantly improves how your body processes fats and sugars.There are several instances where the above narrated measures are not sufficient. A common misconception is that high cholesterol is simply the result of a poor diet or a lack of exercise. In reality, your liver produces most of the cholesterol in your body, heavily influenced by genetics. For many individuals – especially those with a history of heart disease, severe hypercholesterolemia, or diabetes – lifestyle changes alone will not bring LDL cholesterol down to safe target levels. For high-risk individuals, medication is not a failure of willpower; it is a vital medical necessity. Although a number of agents are available these days. Statin group of drugs (Atorvastatin and Rosuvastatin) are the foundation therapies for cholesterol lowering. These work by blocking a key enzyme in the liver responsible for producing cholesterol. Not only do statins dramatically lower LDL levels, but they also help stabilise existing arterial plaque, making it much less likely to rupture and cause a heart attack.When statins alone aren’t enough, or if a patient cannot tolerate high doses, doctors often add Ezetimibe. This daily pill works differently: instead of stopping cholesterol production in the liver, it blocks the absorption of cholesterol from the food you eat in your digestive tract. A newer oral option, Bempedoic Acid, blocks cholesterol production in the liver just like statins, but earlier in the chemical pathway. Because it remains inactive in skeletal muscle, it is a valuable option for patients who experience muscle aching on statins. Modern injectable therapiesFor extremely high-risk patients who still cannot reach their target cholesterol levels despite taking oral medications, medical science has developed advanced injectable treatments. PCSK9 inhibitors (e.g., Evolocumab) which is given as a self-administered injection once every two weeks (or monthly in a higher dose), these targeted therapies block a specific protein in the liver. This allows the liver to clear vast amounts of bad cholesterol from the bloodstream, often lowering LDL by 50–60%. During the last few years, we have another breakthrough molecule belonging to the group of small Interfering RNA (Inclisiran). It uses advanced RNA technology to stop the liver from producing the PCSK9 protein in the first place. After an initial dose and a follow-up at 3 months, it only requires one injection every 6 months. This twice-a-year schedule makes staying on track effortless for patients. While high cholesterol is the most important reversible risk factor it does not act in isolation. It works synergistically with other health factors to damage your arteries. To truly prevent heart attacks, high-risk individuals must manage the complete picture by acting on other risk factors too.Tobacco smoke damages blood vessel walls, making it much easier for LDL cholesterol to cling to arterial walls and form plaque. High pressure constantly strains and tears the delicate inner lining of arteries, creating sites where cholesterol easily collects. Elevated blood sugar changes the structure of LDL particles, making them smaller, denser, and more prone to causing arterial damage. Finally, stress hormones drive up blood pressure and inflammation, aggravating cardiovascular risk over time.Dyslipidaemia is a silent condition. You won’t feel high cholesterol until it causes a crisis. The good news is that with routine blood tests, personalised lifestyle changes, and modern medications, cardiovascular disease is largely preventable. Talk to your physician about checking your lipid panel – taking action today is the best gift you can give to your heart and enjoy a happy life for a much longer duration. Upendra Kaul is chairman of the Batra Heart Centre, and Dean Academics and Research, Batra Hospital and Medical Research Centre.