Understanding high cholesterol, and how to bring it down

High cholesterol is one of the most common results flagged at a health screening in Singapore. It rarely causes symptoms, so many people only find out from a blood test. Left untreated, it slowly builds up in the arteries and raises the risk of heart attack and stroke. The good news is that it is easy to check and can be managed.

What is cholesterol?

Cholesterol is a fatty substance your body needs to build cells and make hormones. Your liver makes most of it, and the rest comes from food. It travels in the blood in particles called lipoproteins, and the type matters:

• LDL cholesterol, often called "bad" cholesterol, can build up in the walls of your arteries
• HDL cholesterol, often called "good" cholesterol, helps carry cholesterol away from the arteries
• Triglycerides are another type of blood fat, which rise with excess calories, sugar and alcohol

Why it matters

Over the years, excess LDL cholesterol forms fatty deposits, called plaque, inside the arteries. This narrows them and can lead to a heart attack or stroke if a plaque breaks open and a clot forms. High cholesterol has no warning signs, which is why regular checks matter.

Understanding your results

A lipid panel is a simple blood test. These are the general guides used in Singapore for adults, in mmol/L:

• Total cholesterol: below 5.2 is desirable; 6.2 or above is high
• LDL cholesterol: below 2.6 is optimal; 4.1 or above is high
• HDL cholesterol: below 1.0 is low; higher is better
• Triglycerides: below 1.7 is optimal; 2.3 or above is high

Your own target depends on your overall risk. If you have diabetes, heart disease, kidney disease or have had a stroke, your doctor will usually aim for a lower LDL level than these general guides.

Who is at higher risk

• people with a family history of high cholesterol or early heart disease
• people with diabetes, high blood pressure or kidney disease
• people who smoke, are overweight or are not physically active
• men over 45 and women after menopause

When to get checked

Singapore's national screening guidance recommends a cholesterol check every three years from age 40, or earlier if you have risk factors. Your doctor may suggest checking more often if your results are borderline or you are on treatment.

How high cholesterol is managed

For many people, lifestyle changes are the first step:

• eat less saturated fat, found in fatty meat, coconut milk, butter and fried food
• choose wholegrains, vegetables, fruit, beans and fish more often
• be active for at least 150 minutes a week
• stop smoking, and keep alcohol within recommended limits
• reach and keep a healthy weight

If your cholesterol stays high, or your overall risk of heart disease is high, your doctor may recommend cholesterol-lowering medicine. The most commonly used are a group of medicines called statins. Whether you need medicine, and which one, depends on your results and your health, so it is a decision to make with your doctor.

If you are prescribed medicine

• take it as advised, usually long term, even when you feel well
• keep up healthy eating and exercise, which still make a difference
• go for follow-up blood tests so your doctor can check how well it is working
• tell your doctor about any new muscle aches or other side effects, rather than stopping on your own

This article is general health information and does not replace advice from your doctor.