When “Normal” Is Not Normal Enough
Let’s start with the facts. Most cholesterol reports in India look perfectly fine on paper — total cholesterol below 200, LDL below 130, HDL hovering near 40, triglycerides maybe a little high, but nothing alarming. So, you breathe easy. But here’s the catch: these so-called “normal” ranges were designed for Western populations — not for Indian genetics, diets, or lifestyles. That’s like using a Canadian winter jacket in a Delhi summer — it just doesn’t fit the environment. Multiple global studies (like INTERHEART, CUPS, and MASALA) have proven that Indians develop heart disease at lower cholesterol levels than Westerners. We have:- Smaller arteries,
- Higher insulin resistance,
- More “sticky” LDL particles, and
- Lower protective HDL levels.
The Curious Case of the “Perfect Report” Patient
Every cardiologist in India has at least one story like this: A 40-year-old man, non-smoker, vegetarian, not overweight, walks in complaining of mild chest discomfort. His cholesterol report from six months ago? “Completely normal.” His angiography result now? 90% blockage in a major artery. It’s not bad luck. It’s bad metrics. Because what’s considered “normal” cholesterol for the average global standard can still be deadly for the Indian heart. We’re not built the same — genetically or metabolically.Why Indian Hearts Play by Different Rules
Here’s what’s unique (and slightly unfair) about the Indian body:- We accumulate fat faster, especially around the belly. Even with a normal BMI, many Indians have high visceral fat — the dangerous, organ-hugging kind that worsens cholesterol metabolism.
- We’re genetically wired for higher triglycerides and lower HDL. A cruel combo. HDL is like your body’s cleaning crew; less of it means more sticky debris in your arteries.
- We eat too many refined carbs and sugars — not just fat. Ironically, it’s not the butter but the biscuits, breads, and mithai that push cholesterol imbalance.
- We handle stress like a national sport. Chronic stress raises cortisol, which in turn raises blood lipids — all while keeping your heart under constant tension.
- We underestimate risk because we don’t “look” sick. You can have a slim frame, run on the treadmill, even be a vegetarian — and still have dangerously sticky arteries.
What the Numbers Don’t Reveal
Here’s a truth bomb: your standard cholesterol test misses half the story. It measures quantity, not quality. Your LDL might be “fine” at 110 mg/dL — but if most of it is the small, dense type (which sticks to arteries), your risk is still sky-high. Similarly, your HDL might look decent — but if it’s not doing its job efficiently (which happens with chronic inflammation and poor sleep), it’s practically useless. That’s why advanced markers like ApoB, LDL particle size, and Lp(a) are now becoming the real game changers in preventive cardiology. Here’s what they reveal:- ApoB = Total number of atherogenic (plaque-forming) particles.
- LDL Particle Size = Whether your LDL is light and fluffy (safe) or small and sticky (dangerous).
- Lp(a) = A genetic factor that increases risk even if all your other numbers are perfect.
Deep Thinking: The Danger of Comfort
There’s something about “normal” that gives us false comfort. It’s like being told your flight is delayed by “just 10 minutes” — and somehow that stretches into three hours. We cling to the illusion that if the report looks fine, life must be fine too. But the truth is, numbers don’t heal — habits do. You can’t eat, sit, or stress your way into bad health and expect a lab report to keep you safe. Real health isn’t a line on paper. It’s a pattern of living — how you eat, move, sleep, think, and recover. And until we understand that, we’ll keep mistaking “normal” for “okay.”So, What Should Indians Do Differently?
Simple. Stop celebrating normal reports — start demanding smarter ones. Here’s what a Heartiest-approved lipid test should ideally include:- ApoB – shows total risk particles.
- LDL particle size – tells whether your LDL is “sticky.”
- Lp(a) – genetic cholesterol marker; one-time test for life.
- Triglyceride-to-HDL ratio – key insulin resistance predictor (should be under 2).
- hs-CRP – inflammation marker that predicts arterial damage.
- “Are these numbers right for my ethnicity?”
- “Is my LDL the dangerous type?”
- “What’s my inflammation level?”
