Hyderabad: India’s most recognised cities, such as Mumbai or Delhi, usually dominate most health conversations. However, when Apollo Hospitals screened millions of people across its network in 2025, the highest cholesterol burden surfaced in smaller cities such as Trichy, Nellore, Warangal and Bilaspur.
These cities rarely feature in national health policy discussions. Combined, they hold populations well under 10 lakh each. Yet their dyslipidemia rates—the measure of abnormal fat levels in blood, or in common language, high levels of cholesterol—outran every major metro in the Health of the Nation 2026 report.
Here’s a breakdown of the data:
- Trichy recorded 76.6%
- Nellore reached 73.8%
- Warangal and Bilaspur came in at 70.6% and 73%, respectively.
Here’s how the more well-known cities fared: Mumbai recorded 66.8%, Bengaluru 46.2% and Chennai 63.2%.
A regional pattern across States, not isolated data points
The numbers do not read as outliers once the state-level picture comes into view.
Tamil Nadu, as a state, recorded 63.2 per cent dyslipidemia. Telangana stood at 70.6 per cent. Karnataka at 52.4 per cent and Andhra Pradesh at 56.7 per cent. Every southern state in the Apollo data crossed the 50 per cent mark, with Telangana leading the region.
How did Hyderabad fare?
Hyderabad, one of South India’s largest and most economically consequential cities, recorded 70.6 per cent, matching Warangal exactly. The city of over a crore people and the city of under 10 lakh produced identical lipid abnormality rates.
That convergence points toward something structural.
What the spending data reveals
As per the Household Consumption Expenditure Survey 2023-24, Tamil Nadu spends the highest nationally on processed food.
Urban households in the state allot 34.3 per cent of their entire food budget toward beverages, refreshments and processed food. Rural Tamil Nadu spent close to 30 per cent, also the highest in India.
Telangana’s urban residents follow at 33.6 per cent; Karnataka urban households spend 33.2 per cent; Andhra Pradesh urban households spend 25.7 per cent.
The four Southern States that lead processed food spending nationally also carry four of the highest dyslipidemia rates in the Apollo data. Even if the overlap does not establish causation, it establishes a pattern that runs consistently across state lines.
Dr Prabhakar Sastry, an Internal Medicine Consultant in Hyderabad, who tracks metabolic trends across South Indian populations, draws the clinical connection directly.
“In clinical practice, we are seeing a clear pattern where diets rich in trans fats, refined carbohydrates, and processed foods are elevating LDL cholesterol and triglycerides, while physical inactivity is simultaneously reducing protective HDL levels,” he said. “This imbalance is further compounded by a high burden of Type 2 diabetes and insulin resistance, both of which accelerate lipid abnormalities.”
A metabolic shift across the region
Dr Sastry situates the dyslipidemia data within a broader physiological story.
“Across South India, the rising prevalence of dyslipidemia reflects a deeper metabolic shift rather than an isolated biochemical abnormality,” he said. “The convergence of high-calorie diets, sedentary lifestyles and increasing obesity is driving a sustained elevation in atherogenic lipids.”
The obesity numbers from HoN 2026 run alongside the cholesterol figures in the same cities: Trichy recorded 84.1 per cent of screened individuals as overweight or obese, Nellore stood at 85.3 per cent, Madurai at 83.5 per cent, Hyderabad at 81.3 per cent, and Tamil Nadu as a state recorded 79.4 per cent.
Diabetes compounds the picture further.
Madurai recorded 36.4 per cent diabetes among those screened; Trichy came in at 34.1 per cent; Mysore at 32%; and Karaikudi at 34.2%. These rates cluster in the same geographies that carry the highest lipid abnormality burden.
The genetic factor
Beyond what people eat and how much they move, Dr Sastry points to a vulnerability that operates at the population level.
“South Asian populations also carry a unique genetic susceptibility, characterised by a tendency for central adiposity and dyslipidemia even at lower body mass indices,” he said. “This makes early screening critical, as a significant proportion of patients remain asymptomatic until advanced disease manifests.”
Apollo’s data confirmed the asymptomatic gap.
Among individuals who underwent coronary calcium scoring, 45 per cent showed early atherosclerosis despite no symptoms. Among those with fatty liver confirmed through ultrasound, 74 per cent carried normal liver enzyme levels. Routine blood tests, the most common form of health check in smaller cities, would have returned nothing unusual.
Where it goes if it stays untreated
The clinical endpoint of persistent dyslipidemia follows a documented course. Dr Sastry describes it without ambiguity.
“Persistent dyslipidemia leads to endothelial dysfunction and progressive atherosclerosis, culminating in conditions such as Coronary Artery Disease and stroke,” he said. “What is particularly concerning is the shift towards younger age groups, with cardiovascular events increasingly reported in individuals in their third and fourth decades.”
HoN 2026 recorded that more than half of the under-30s screened were obese and more than half showed abnormal cholesterol. Dr Sangita Reddy, Joint Managing Director of Apollo Hospitals, framed the stakes in the report: “The right health check, at the right time, can detect heart disease and cancers at Stage 1 when they are most treatable and least life-disrupting.”
The report also recorded what follow-up produces.
Among those who returned for structured care, 56 per cent improved their hypertension and 34 per cent improved their blood sugar control.
Dr Prathap C Reddy, Founder Chairman of Apollo Hospitals, described the direction the data demands: “Genuine health is personal, proactive and highly precise. Since no two lives are the same, our approach to prevention must be as individual as the people we serve.”
The question Gujarat raises
One data point resists the pattern.
Gujarat recorded 18.6 per cent dyslipidemia, the lowest figure in the entire Apollo dataset, despite urban households spending Rs 980 a month on processed food, which represents 31.5 per cent of their food budget. That is comparable to southern states in absolute spending terms.
The available data does not explain the divergence. It may involve dietary composition, cooking methods, or genetic variation within the broader South Asian category. It merits its own examination.
The intervention question
What the data from the Apollo survey establishes clearly is that South India’s cholesterol burden concentrates in cities and towns that receive the least policy attention—the Trichys, the Nellores, the Warangals and the Bilaspurs that sit below the threshold where national health infrastructure focuses.
Dr Sastry outlined the response that is required: “Population-level interventions targeting diet, physical activity and obesity must be prioritised, alongside routine lipid screening and early pharmacological management where indicated,” he said. “Without timely intervention, dyslipidemia will continue to fuel a growing cardiovascular disease burden in the region.”
The screening exists. The data exists. The clinical pathway from detection to improvement exists and produces results when followed.
What the small cities of South India have not yet received is the policy weight that matches the numbers they are generating.
