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High Cholesterol

High cholesterol is a condition in which you have too many lipids (fats) in your blood. It's also called hyperlipidemia or hypercholesterolemia.
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Table of Contents

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.

Different type of Cholesterol

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


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’.


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’.

Signs and Symptoms

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.
Heart Attack

What are the risk factors of developing High Cholestrol 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?

Regular physical activities
aim for at least 150 minutes of brisk walk/
moderate physical workout weekly
Aim a healthy body weight
Quit Smoking
Sensible alcohol intake
(aim <14 units/ week of alcohol)
Healthy eating lifestyle
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 

Healthy Switch
• Fat chunky meat lard, Ghee
• Butter
• Coconut oil / cream
• Full cream dairy (Milk / Cheese / Yoghurt)
• Cake / Pastries / Pudding
• Biscuits / Confectionary
• Rice / Pasta / Bread / Flour / Cereals

Aim for This
• Good oily fish (Salmon, mackerel, halibut, sardines, etc)
• Seeds oils / Olive oil
• Avocado
• High fibre vegetables
• Nuts
• 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 lef 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.


What are Triglycerides?
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.
What is the statistics of residents with high cholesterol in Singapore?
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.
How can I screen my cholesterol levels? What do I expect when I see my doctor?
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.
Why does my doctor advised me to reduce my cholesterol level?

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.

When should I consider cholesterol medication for management of my high cholesterol?

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.

What are the main side effects of cholesterol medication (statin)? Is statin for lifelong to control cholesterol?

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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