Even with a disciplined exercise routine and a balanced diet, some individuals may still struggle with high cholesterol, raising questions about when lifestyle changes are sufficient and when medication becomes necessary. Dr. Sudhir Kumar, a senior neurologist trained at CMC Vellore and working with Apollo Hospitals, highlighted this issue through a recent patient case that has caught his attention.
A Patient Who Follows All the Right Steps
Dr. Kumar shared the case of a 74-year-old Indian man who, despite adhering to a healthy lifestyle, presents with consistently high cholesterol levels. According to the doctor, the patient exercises regularly, following WHO guidelines, maintains a healthy weight and body mass index, has a normal waist circumference, and abstains from smoking and alcohol. He also has no history of diabetes, hypertension, cardiovascular events, or family history of heart disease.
Despite these healthy habits, the patient’s lipid profile has remained abnormal for the past decade. His total cholesterol stands at 219 mg/dL, LDL cholesterol at 159 mg/dL, triglycerides at 319 mg/dL, and HDL cholesterol at 32 mg/dL.
Lifestyle vs. Medication: A Clinical Dilemma
Dr. Kumar explained that such cases create a management dilemma. On one hand, continuing with lifestyle measures has clear benefits, particularly for overall cardiovascular health. On the other, persistent lipid abnormalities may require pharmacological intervention to reduce long-term risks, especially in elderly patients.
“The challenge lies in determining whether lifestyle measures alone are sufficient or if introducing medications like statins or fenofibrate is the safer option,” Dr. Kumar noted.
While lifestyle modifications remain foundational for cardiovascular prevention, they may need to be complemented with medication when cholesterol levels remain high over an extended period.
High cholesterol is not always a sign of poor lifestyle choices in patients. For some individuals, even with strict adherence to exercise and diet, it may not be enough to bring them back to normal levels naturally.
A Patient Who Follows All the Right Steps
Dr. Kumar shared the case of a 74-year-old Indian man who, despite adhering to a healthy lifestyle, presents with consistently high cholesterol levels. According to the doctor, the patient exercises regularly, following WHO guidelines, maintains a healthy weight and body mass index, has a normal waist circumference, and abstains from smoking and alcohol. He also has no history of diabetes, hypertension, cardiovascular events, or family history of heart disease.
Despite these healthy habits, the patient’s lipid profile has remained abnormal for the past decade. His total cholesterol stands at 219 mg/dL, LDL cholesterol at 159 mg/dL, triglycerides at 319 mg/dL, and HDL cholesterol at 32 mg/dL.
Lifestyle vs. Medication: A Clinical Dilemma
Dr. Kumar explained that such cases create a management dilemma. On one hand, continuing with lifestyle measures has clear benefits, particularly for overall cardiovascular health. On the other, persistent lipid abnormalities may require pharmacological intervention to reduce long-term risks, especially in elderly patients.
“The challenge lies in determining whether lifestyle measures alone are sufficient or if introducing medications like statins or fenofibrate is the safer option,” Dr. Kumar noted.
Clinical management dilemma
— Dr Sudhir Kumar MD DM (@hyderabaddoctor) September 8, 2025
▶️74 year old, otherwise healthy, Indian man, not on any medications
▶️He has no past history of Transient ischemic attack (TIA), stroke, or heart attack.
▶️He has no past history of diabetes or hypertension.
▶️He regularly exercises as per WHO… pic.twitter.com/W856Yq5xuz
While lifestyle modifications remain foundational for cardiovascular prevention, they may need to be complemented with medication when cholesterol levels remain high over an extended period.
High cholesterol is not always a sign of poor lifestyle choices in patients. For some individuals, even with strict adherence to exercise and diet, it may not be enough to bring them back to normal levels naturally.
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