Mr Fashola was 48, had no chest pain, and thought he was in reasonable health. His mandatory health check found an LDL cholesterol of 5.1 mmol/L — nearly double the safe level — combined with a family history, smoking, and elevated blood pressure. His 10-year cardiovascular risk score was 28%. A statin was started the same day.
Banker, Ikeja. Presented for a mandatory annual health check. No cardiovascular symptoms. Smoker (10 cigarettes/day). Family history: father died of heart attack at 54. BMI 27. Blood pressure 138/88 mmHg. Total cholesterol: 7.4 mmol/L. LDL: 5.1 mmol/L. HDL: 0.9 mmol/L. Triglycerides: 3.2 mmol/L.
Lipid Profile (Cholesterol)Mr Fashola came to the health check because it was mandatory — not because he was worried. He had never had chest pain. He played tennis every other Sunday. He felt well. His father had died of a heart attack at 54, but his father had been "a different generation" — different diet, different stress.
The lipid profile came back the following morning. The doctor reviewed the results alongside his blood pressure (138/88 — mildly elevated), his smoking history (10 cigarettes daily for 22 years), his father's death at 54 from MI, and his BMI. A 10-year cardiovascular risk calculation (QRISK3) placed his 10-year risk of a heart attack or stroke at 28%.
"That means without intervention," the doctor said, "there is approximately a 28% chance of a cardiac event in the next 10 years. With treatment — statin, blood pressure control, smoking cessation — that risk can be reduced by 30–50%. We are having this conversation now because you have no symptoms yet. That is exactly the right time."
A lipid profile measures the cholesterol and fat fractions in blood. These are direct risk factors for cardiovascular disease — atherosclerosis, heart attack, and stroke. The profile identifies risk silently, years before a cardiac event.
The sum of all cholesterol types. Normal: < 5.0 mmol/L. Mr Fashola's: 7.4 mmol/L — significantly elevated.
Low-density lipoprotein — deposits cholesterol in arterial walls, causing atherosclerosis. Target < 2.6 mmol/L (or < 1.8 with high risk). Mr Fashola's: 5.1.
High-density lipoprotein — removes cholesterol from arterial walls. Higher is protective. Target > 1.0 mmol/L. Mr Fashola's: 0.9 — below target.
Blood fats — elevated with alcohol, refined sugar, or metabolic syndrome. Target < 1.7 mmol/L. Mr Fashola's: 3.2 — significantly elevated.
Calculated from age, sex, BP, cholesterol, smoking, and diabetes status. Mr Fashola's: 28% — high risk (interventions strongly indicated).
LDL cholesterol deposits in arterial walls silently over years — narrowing the coronary arteries that supply the heart. The first symptom is often a heart attack. Mr Fashola had an LDL of 5.1 mmol/L — the kind of level that, in a 48-year-old man with his risk factors, would plausibly produce a cardiac event within 5–10 years without treatment.
His father's heart attack at 54 was both a family tragedy and a genetic signal: familial hypercholesterolaemia and cardiovascular risk are strongly heritable. Mr Fashola had 6 years before his father's age at death. The lipid profile gave him those 6 years — and more — as time to act.
A high-intensity cholesterol-lowering medication was started for his risk category. A blood pressure medication was also started (target < 130/80). Smoking cessation counselling; nicotine replacement therapy offered.
Repeat lipid profile at 3 months on treatment: LDL 2.8 mmol/L (reduced by 45% from baseline), total cholesterol 4.6 mmol/L. Target: LDL < 1.8 mmol/L given high-risk status — atorvastatin dose increased to 80 mg.
At 6 months: LDL 2.1 mmol/L (approaching target). Blood pressure 124/78 mmHg (on target). Smoking: reduced to 2/day — cessation target within 1 month.
LDL 5.1, total cholesterol 7.4, triglycerides 3.2, HDL 0.9. 10-year CVD risk 28%. Statin + antihypertensive started.
A cholesterol-lowering medication (dose increased at 3 months); a blood pressure medication; smoking cessation support; dietary modification (reduce saturated fat); repeat lipid profile at 3 months.
3-month LDL: 2.8 mmol/L. 6-month LDL: 2.1 mmol/L. BP 124/78. Smoking: stopped at 7 months. 10-year CVD risk recalculated at 12 months: 14%.
LDL halved within 3 months. Blood pressure controlled. Smoking stopped at 7 months. 10-year CVD risk reduced from 28% to 14% at 12-month review. Mr Fashola's father's story is not his destiny.
High cholesterol causes no symptoms. The first symptom is often a heart attack. A fasting lipid profile at 40 — earlier with a family history — is the test that gives the warning before the event. Mr Fashola's father had no warning. He did.
A statin taken daily reduces LDL by 40–50% and cardiovascular event risk by 30%. Combined with blood pressure control and smoking cessation, the risk reduction is substantial. The intervention works — but only if the test is done first.
High cholesterol feels like nothing — until it causes a heart attack. An affordable blood test and a daily tablet could be the difference between following your father's path and outliving him.
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