Obesity & Metabolic Health
Lipid Disorders & Familial Hypercholesterolaemia
High cholesterol causes no symptoms and does its damage over decades. Familial hypercholesterolaemia in particular is common, dangerous, and repeatedly missed until a heart attack in the forties.
Symptoms that bring people in
- No symptoms in most people — found on a blood test
- Yellowish deposits on the eyelids
- A pale ring at the edge of the cornea in a young person
- Thickened tendons at the ankle or knuckles
- Chest pain or breathlessness on exertion
- A family history of heart attack or sudden death before 55 in men, 65 in women
Having one of these does not mean you have this condition — several overlap with far more common problems. It means the question is worth asking properly.
Cholesterol matters because of arteries, not because of a number. The purpose of treating it is to prevent heart attacks and strokes, and the intensity of treatment should follow overall cardiovascular risk rather than the lipid panel read in isolation. South Asians develop coronary disease earlier and at lower lipid levels than European populations, which argues for acting sooner rather than later.
Assessment
A full lipid profile including LDL, HDL, triglycerides and non-HDL cholesterol, with lipoprotein(a) measured once in people with a strong family history. Secondary causes are excluded before labelling a lipid disorder primary — hypothyroidism, nephrotic syndrome, cholestatic liver disease, poorly controlled diabetes, alcohol and certain drugs all disturb lipids, and correcting them may be all that is required. Risk is then assessed alongside blood pressure, smoking, diabetes, family history and, where useful, a coronary calcium score or carotid imaging.
Familial hypercholesterolaemia
An inherited condition affecting roughly one in two to three hundred people, causing very high LDL cholesterol from birth and, untreated, coronary disease in early middle age. It is grossly under-diagnosed. The clues are a markedly raised LDL, tendon xanthomas or corneal arcus in a young person, and premature heart disease in the family. Diagnosis has consequences beyond the patient: first-degree relatives should all be screened, since each has a one-in-two chance of carrying it, and children can be identified and protected early. Dr Ghosh has published on familial hypercholesterolaemia.
Treatment
Diet and exercise for everyone; statins as the mainstay, with ezetimibe, bempedoic acid or the injectable PCSK9 inhibitors added where LDL targets are not met or statins cannot be tolerated. Genuine statin intolerance is far less common than reported, and is worth investigating properly rather than accepting, because the alternative is leaving high-risk arteries untreated. Very high triglycerides carry a separate risk of pancreatitis and are managed on their own terms.
This page is general information. Doses and treatment choices in endocrinology are individual, and are decided at a consultation with your reports in front of us. Please do not start, stop or change a medicine based on this page.
Common questions
Before your first visit
How do I book an appointment?
Use the appointment form on this website and the clinic will telephone you to confirm a time, usually within one working day. For a same-day or urgent request, please ring the number in the page header instead — a phone call is always faster than a form.
Hospital OPDs at CMRI and Narayana Memorial are booked through the hospital's own reception. For district chambers, it is worth calling the chamber number listed on its page before travelling.
Which chamber should I choose?
Whichever is easiest for you to reach and return to. Endocrine conditions need review over months and years rather than a single visit, so the chamber you can get to comfortably every few months is nearly always the better choice than the one that seems most impressive.
That said: if your problem needs same-day tests, an ultrasound, or admission, a hospital OPD is the better setting. The Chambers page lists every location with its days and timings, and the weekly timetable shows them all side by side.
Do chamber timings ever change?
Yes — and this is worth taking seriously if you are travelling any distance. Several district visits run on a monthly rotation, such as the 1st and 3rd Saturday, and a hospital OPD can be rescheduled at short notice. Timings shown on this website are kept up to date and any known cancellation appears on the chamber's page, but please telephone ahead before a long journey.
What should I bring to the first consultation?
Bring everything you have, even if it seems old or irrelevant:
- all previous prescriptions, including from other doctors
- every blood report and scan you hold, in date order if possible
- the actual strips or boxes of the medicines you take, or a written list with doses
- your home blood sugar or blood pressure diary, if you keep one
- for a child, the growth chart and immunisation record
Old reports are genuinely useful. A five-year-old thyroid result or an earlier scan often changes the plan, because what matters in endocrinology is frequently the trend rather than today's number.
Consultation
Request an appointment
Tell us which chamber suits you and when. We will confirm your slot by phone.