High Cholesterol

What is cholesterol?

Cholesterols are fat particles. They are important in generating cell membrane, vitamin D, hormones in our body and plays a role in production of bile salt. Cholesterol can either be made from our liver, or we can acquire cholesterol from our diet.

What are the different types of cholesterols?

Cholesterols are transported in our bloodstream through proteins known as lipoproteins. There are 2 main lipoproteins in our body:

Low density lipoprotein (LDL)

While LDL transports cholesterols to cells in different part of our body, when there is excessive amount of LDL, it can build up in the walls of our blood vessels. These fat deposits, also known as plaques, overtime can narrow the blood vessel diameter, restrict blood flow to vital organs of our body such as the heart, brain, muscles, limbs. LDL is termed as the ‘bad cholesterol’.

High density lipoprotein (HDL)

HDL carries cholesterol from the cells back to the liver to be later removed from our body system. HDL is also known as the ‘good cholesterol’.

What are the signs and symptoms of high cholesterol?

As the cholesterol plaques takes months to years to build up and narrow our blood vessels, most patients with high cholesterol has no symptoms, until more serious conditions such as angina, heart attack or stroke sets in.

In view of the serious possible long term implication, and the subtlety of the symptoms, you are encouraged to discuss with doctor to consider regular health checkup/health screening to screen for high cholesterol.

High cholesterol

What are the risk factors of developing high cholesterol level?

Cholesterol levels can be affected by your lifestyle, age, family history, underlying medical conditions, or medication that you are taking.

Risk factors for high cholesterol include

  • Diet rich with saturated fat
  • Physically inactive
  • Smoking
  • Excessive alcohol drinking
  • Obesity
  • Family history of elevated cholesterol
  • Concurrent chronic conditions such as diabetes, high blood pressure

Underlying medication conditions such as familial hypercholesterolemia, or thyroid disease may increase risk of developing high cholesterol.

You are advised to consider screening your cholesterol level, and discuss with doctor on both lifestyle and medication (if necessary) management for controlling the cholesterol level.

How can I lower my cholesterol in Singapore?

  • Regular physical activities- aim for at least 150 minutes of brisk walk/moderate physical workout weekly
  • Aim a healthy body weight
  • Quite smoking
  • Sensible alcohol intake (aim <14 units/ week of alcohol)
  • Healthy eating lifestyle with high fiber diet, low saturated fat and low carbohydrate diet
  • Control any concurrent blood pressure or diabetes medical condition
  • Compliant with the medications that are prescribed by your doctor, don’t stop on your own!
  • Keep stress at bay

Dietary Switching for better cholesterol

Healthy SwitchAim for This
Fat Chunky meat

Lard, Ghee


Coconut oil/cream

Full cream diary (milk/cheese/yoghurt)

Cake/pastries/ Pudding



Good oily fish (salmon, mackerel, halibut, sardines etc)

Seeds oils/Oilive oil


High fiber vegetable


Full grains/ wholemeal/Oats/beans/peas

What will happen if I don’t control my high cholesterol levels?

If your cholesterol levels are persistently high, you are at risk of developing:

  1. Atherosclerosis — As the arteries or blood vessels are build up with excessive cholesterol plaques, the arteries will narrow.
  2. Angina — If the narrowing of arteries occurs in the heart, one may experience a heavy, dull, chest tightness over the center of the chest, spreading to the left side of the arm, neck, jaw or even the back. This is known as angina. The symptoms of angina are due to reduced blood flow to the heart muscle especially when you are under physical exertion.
  3. Heart attack/ Myocardial infarction — When the blood supply to the heart is completely cut off/ blocked by cholesterol plaques or even a blood clot, a person can develop a heart attack. This is a medical emergency and you can succumb to the condition if no immediate medical attention is given.
  4. Coronary heart disease — Patients can be asymptomatic even with evidence of blockages of the main arteries of the heart. Without appropriate health intervention, these patients are at higher risk to develop angina or heart attack.
  5. Stroke—If the blood supply to the brain is completely blocked by the cholesterol plaques, a stroke can occur. This is a serious medical emergency. The outcome of a stroke event ranges from full recovery, mild disability, bedridden, inability to talk/  move or even death.
  6. Transient ischemic attack (TIA) or mini stroke — This is due to temporary interruption or blockage of blood flow to the brain due to cholesterol plaques.
  7. Peripheral vascular disease — If the blood vessels flow is reduced or blocked by cholesterol plaques, a personal can develop peripheral vascular disease. Symptoms of peripheral vascular disease include changes of skin colors, weak pulses on the limbs, hair loss, or even gangrene.

In view of the possible complications, primary prevention with good control of cholesterol is imperative. Speak to your doctor to discuss further on cholesterols.


Triglycerides are fats acquired from food. They enter the blood stream, and are subsequently metabolized as energy fuels. However, when there are excessive amount of triglycerides from diet, the body will not able to metabolise and remove them from your blood stream.

Patients with very low HDL has a tendency to have elevated triglyceride reading. When the triglyceride levels are too high, with a low HDL, one has increased risk of developing fatty liver, pancreatitis, coronary heart disease or even type 2 diabetes.

Based on Singapore’s Disease Burden Statistics, 33.6% of adults between age 18 to 69 has high cholesterol. High cholesterol is a common chronic condition in the community and if the medical condition is not address, it can lead to serious morbidities and mortalities later on in life. Do discuss with your doctor on both screening and management of cholesterol levels.

Your doctor will obtain a blood sample from your arm to send it to the laboratory to measure the cholesterol levels in your body. Usual cholesterol tests involve a screen for total cholesterol, HDL, LDL, total cholesterol/HDL ratio and triglyceride levels. You can speak to your doctor if you are keen for cholesterol blood tests.

Your doctor may advise you on lowering your cholesterol level to reduce the risks of cardiovascular conditions.

Indications to lower your cholesterol levels include:

  • If your cholesterol levels are higher in comparison to a person at your age and sex,
  • If your risk for heart attack, stroke, vascular (circulatory) disease are high
  • If you have very high level of LDL and low level of HDL

Do discuss with your doctor on ways to manage the cholesterol levels, if required, your doctor may discuss on medication options to lower the cholesterol levels.

If you have increased risk of heart disease, diabetic, family history of high cholesterol or other cardiovascular conditions, your doctor may advise you to consider a medication called statin to lower the cholesterol level on top of lifestyle measures of exercise and healthy eating.

Your doctor will discuss with you on the target levels of your cholesterol depending on the cause of your high cholesterol levels, your age, and other risk factors that you may have.

Contrary to concerns of negative side effect of statin, most patients who are on statin tolerated well and uneventfully. Common side effects include, muscle aches and possible abnormal liver blood tests.

However, it is worth noting that your doctor will start and titrate your cholesterol for the lowest possible effective dose to control your cholesterol. You will be monitored with follow up blood tests after starting consuming statin. If there are abnormal results to suggest side effect from statin, your doctor may advise you to lower or stop the dose.

Side effects usually resolve with withdrawal of medication. The decision of starting statin involves a weigh-up of both risks of pill burden and long term benefits of cardiovascular disease prevention. You can discuss with your doctor during your consultation on cholesterol levels.

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