Consistency matters, a doctor’s perspective: Rethinking cholesterol management beyond lifestyle changes

Cardiovascular diseases (CVDs) remain the leading cause of death globally, accounting for an estimated 17.9 million deaths each year, according to the World Health Organization (WHO)1. In India, the burden is rising rapidly, with high LDL cholesterol (LDL-C) identified as a major modifiable risk factor. Often called the ‘silent killer,’ elevated LDL-C levels typically show no symptoms- yet significantly increase the risk of heart attacks and strokes.

For many patients, the hardest part isn't starting treatment, it's staying on it. Daily medication routines can feel overwhelming, especially when there are no visible symptoms to remind you why the pill matters. Life gets in the way: a busy morning, a missed dose, a feeling that things are 'under control', and before long, consistency becomes the exception rather than the rule.

A large meta-analysis published in the European Heart Journal (2019) found that nearly 50% of patients discontinue statin therapy within the first year of treatment2.

Why does adherence drop?

• Pill burden and forgetfulness: Particularly in patients with multiple chronic conditions
• Lack of symptoms: Asymptomatic conditions like high LDL-C reduce perceived urgency
• Misconceptions about recovery: Patients often stop medication once they feel ‘better’.

“You have to maintain your target LDL-C level for life. It’s not a one or two day programme.”, Dr. B. Dinesha, Director, Sri Jayadeva Institute of Cardiovascular Sciences and Research shares. Non-adherence to lipid-lowering therapy is strongly associated with adverse cardiovascular outcomes. According to the American Heart Association (AHA)3, poor adherence to statins can lead to:

• A 25–30% increased risk of cardiovascular events
• Higher rates of hospitalisation
• Increased mortality risk

Similarly, the European Society of Cardiology (ESC) Guidelines (2021) emphasise that achieving and maintaining LDL-C targets is critical for both primary and secondary prevention of CVD. Dr. B. Dinesha notes, “Failure to achieve LDL targets significantly increases the risk of future cardiac events- even among patients who may otherwise feel healthy.”

While lifestyle changes are necessary, they are not always sufficient, experts explain. Diet, exercise, and weight management are foundational to heart health. However, clinical evidence suggests that lifestyle modifications alone may not be adequate for many patients, particularly those at moderate to high cardiovascular risk4. High-risk patients often require pharmacological therapy alongside lifestyle interventions LDL-C reduction targets are unlikely to be achieved through lifestyle changes alone in many cases. “Many patients believe they can manage cholesterol through lifestyle changes alone. But in most high-risk cases, that is not sufficient. Lifestyle changes are important, but they are often not enough, especially when genetic and metabolic factors are involved,” Dr. B. Dinesha notes.

According to a review in The Lancet (2020)5:

• Long-acting therapies can improve adherence and persistence
• Reduced dosing frequency may help address behavioral barriers associated with daily medication

The role of awareness and early action
Despite increasing awareness, screening and early intervention remain inconsistent. The Indian Council of Medical Research (ICMR)6 has highlighted that a significant proportion of Indians with dyslipidaemia remain undiagnosed or undertreated.

Experts stress the importance of proactive education at all levels of care. “Awareness should start at the GP level and then at the hospital level. All doctors should educate their patients about LDL-C and the risks it poses,” Dr. B. Dinesha shares.

Managing cholesterol is not a short-term intervention; it is a lifelong commitment. Global guidelines consistently reinforce three pillars of effective management- Lifestyle modification, timely initiation of appropriate therapy and sustained adherence to treatment.

As cardiovascular disease continues to affect younger populations in India, the focus must shift from short-term fixes to long-term risk management. Because when it comes to heart health, what you don’t feel can still cause harm.

About the Initiative

Novartis presents “Beat Bad Cholesterol” in association with The Times of India - an initiative to raise awareness about LDL-C and cardiovascular risk.

Reference/s:

1. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
2. https://www.sciencedirect.com/science/article/pii/S0939475324002059
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC9748759/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC10460604/
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC7442675/
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC4016101/

Disclaimer: The views and opinions expressed in the story are independent professional judgments of the doctors/experts, and TIL does not take any responsibility for the accuracy of their views. This should not be considered a substitute for medical advice. Please consult your treating physician for more details. This article has been produced on behalf of Novartis by Times Internet’s Spotlight team.