Young, slim… and hiding high cholesterol?

Even if you're of normal weight, you may not be as healthy as you think.

Many young adults who are apparently healthy and don't have a weight problem may have a build-up of fat and cholesterol in the walls of their arteries — a condition called atherosclerosis — which puts them at a higher risk of developing heart disease and/or a stroke later in life.

Once thought to only afflict older people, this hidden thickening of arteries is now being observed in younger and otherwise healthy adults.

Dr Tan Hong Chang, Associate Consultant at the LIFE Centre of Singapore General Hospital, explains: "Atherosclerosis occurs when cholesterol, fat and other substances build up in the arteries over the years and form hard structures known as plaque."

When this happens, blood flow to vital organs could be restricted. These plaques can also burst, causing a blood clot," Dr Tan adds.

Atherosclerosis develops gradually and there may not be any symptoms until an artery is so narrowed that it cannot supply adequate blood supply to your organs and tissues. Symptoms of moderate-to-severe atherosclerosis depend on which arteries are affected. Atherosclerosis could affect arteries of the heart, brain or in the arms or legs.

"When a blood clot completely blocks the artery or even breaks apart, it can cause a heart attack or stroke which can be debilitating or even fatal," warns Dr Tan.

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Are you at risk?

High cholesterol is one of the major risk factors for atherosclerosis. While it is strongly recommended that clinicians routinely screen men and women age 40 years and older for lipid disorders, younger adults (age 18 and older) should also be screened in the presence of any of the following:

• Diabetes mellitus

• A family history of cardiovascular disease before age 50 years in male relatives or age 60 years in female relatives

• A family history suggestive of familial hyperlipidaemia

• Multiple coronary artery disease risk factors (eg. tobacco usage, hypertension, obesity)

Recent studies have found that Asian population including Singaporeans, have a higher proportion of body fat (including visceral fat) compared with Caucasian population of the same age, gender, and body mass index (BMI). This would be one of the explanations for the greater risk for cardiovascular and diabetes mellitus in Asians at relatively low BMI levels.

Related article: Why do we gain weight as we age?

Get screened early

Body mass index is the recommended index to define overweight and obesity. This simple measurement --weight in kilograms divided by the square of height in meter--, is useful for screening excess weight and is highly correlated with body fat percentage and risk for cardiovascular diseases.

It is important to note that the cut-off points for health concerns in Asians are lower at 23 kg/m² than the international and WHO cut-off of 25 kg/m². Similarly, the waist circumference cut-off for Asians is lower at 90 cm for men and 80 cm for women.

A wide range of investigations is available to identify atherosclerosis but further screening would depend on the presence of symptoms and the global assessment of risk factors.

7 tips for a healthy lifestyle

1. Stick to a healthy diet: This means eating a well-balanced meal with daily servings of fruits and vegetables as well as portions of fish. Avoid unhealthy food choices such as fast food as this is high in fat and cholesterol. Sweetened drinks like colas are also unhealthy because of their high sugar content.

2. Exercise: Work out for 20-30 minutes a day. If you're short of time, try to incorporate physical activity into your daily routine, such as climbing the stairs instead of taking the lift. Try our 10-minute perfect morning workout.

3. Keep your blood pressure low: Periodic measurement for high blood pressure for all adults age 18 years or older is recommended. It should be repeated every two years or more frequently depending on initial blood pressure or presence of other risk factors. A normal blood pressure is < 130/80 mmHg.

4. Monitor your cholesterol levels: Get screened regularly and keep the level within normal range with heart-friendly food and exercise.

5. Maintain a healthy weight: If you are overweight or obese, visceral fat may be present in and around your body tissues. So keep to an optimum weight and BMI.

6. Don't smoke: Keep yourself tobacco-free and you will drastically reduce your risk of heart disease and stroke.

7. Limit alcohol consumption: Don't drink more than one to two glasses a day.

For young adults, it's important to understand that youth does not equate to good health. Dr Tan advises: "If you lead an unhealthy lifestyle, it will eventually catch up with your health. So watch out and consult a doctor to help you stick to your lifestyle goals."

This article was written by Jaclyn Lim for Health Xchange, with expert input from the LIFE Centre, Singapore General Hospital.

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