High Cholesterol Treatment and Prevention in Singapore
by: Dr. Paul Chang, General Practitioner, Regis Medical
High cholesterol is a common health condition in Singapore. High cholesterol is one of the biggest causes of cardiovascular diseases, with statistics suggesting that about 1 in 3 deaths from coronary heart diseases is due to high cholesterol.
High Cholesterol in Singapore
Approximately 1 in 3 Singaporeans aged between 18 to 69 is diagnosed with high cholesterol, not accounting for those living with the condition undiagnosed. In 2020, the prevalence of high cholesterol in Singaporeans was reported to be 39.1%, with a higher prevalence in males in comparison to women.
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What is High Cholesterol?
High Cholesterol, also known as hyperlipidemia, occurs when there is high cholesterol in the blood lipids. Cholesterol refers to a waxy, fat-like substance that is present in all the cells in your body. Cholesterol is necessary for your body to produce hormones, vitamins, and substances your body needs. Cholesterol is mainly produced by your liver, with the minority of cholesterol coming from foods from animals that you consume.
While cholesterol is essential to the functioning of the human body, having cholesterol levels that are too high can result in the buildup of fatty deposits in your arteries, slowing or stopping the blood flow in your body.
Types of Cholesterol
Cholesterol is mainly classified into two types: low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
- LDL, sometimes referred to as bad cholesterol, is problematic because it can build up on your artery wall, essentially narrowing your arteries and causing possible blockages. High levels of LDL can be caused by excessive consumption of saturated fats and trans fats. Saturated fats exist in food products made from animals, such as cheese, milk and butter. Trans fats are often found in processed foods such as cookies, crackers and other baked goods.
- HDL, sometimes referred to as good cholesterol, is responsible for carrying other kinds of cholesterol (including LDL) away from the arteries and back to the liver, where it is removed from the body.
Triglycerides
Triglycerides refer to a type of fat that is created when the body receives more calories than it requires. While triglycerides are not the same as cholesterol, high levels of triglycerides can cause artery blockages similar to LDL cholesterol. Triglyceride levels that are too high can also cause a rare complication called Pancreatitis where the pancreas is inflamed, causing severe and sudden abdominal pain and vomiting.
Symptoms of High Cholesterol
High cholesterol is dangerous since it has no symptoms and only manifests as health emergencies that are the result of the formation of plaque in your arteries. These emergencies can be life-threatening, such as a heart attack or stroke.
The only way to know if you have high cholesterol is through a blood test.
Risk Factors for High Cholesterol
High cholesterol is often the result of poor lifestyle choices, an unhealthy diet, pre-existing medical conditions, or a combination of the above factors. Factors that put you at risk of developing high cholesterol include:
- Age. Your risk of developing high cholesterol increases as you age. Men aged 45 or older and women aged 55 or older have a higher risk of developing high cholesterol.
- Family History. You may have a higher risk of developing high cholesterol if one or more of your family members have had high cholesterol or early heart disease.
- Familial hypercholesterolemia. This is a genetically inherited disease that results in high LDL levels at a young age.
- Type 2 Diabetes. Type 2 diabetes increases your LDL cholesterol levels while decreasing your HDL cholesterol levels.
- Diet. Excessive consumption of trans fats, saturated fat, sugar and cholesterol (from animal products) can raise your overall cholesterol levels.
- Weight. Being obese or overweight can cause LDL cholesterol levels to increase and HDL cholesterol levels to decrease.
- Lack of physical activity or exercise. Long periods of physical inactivity and a lack of exercise can not only lead to weight gain but also cause LDL cholesterol levels to go up while decreasing HDL cholesterol levels.
- Smoking. Smoking can damage your blood vessels, causing them to become prone to collecting fatty deposits, as well as lowering HDL cholesterol levels.
- Alcohol. Alcohol consumption can lead to an increase in cholesterol levels, as well as cause fatty liver disease, which reduces your liver’s ability to remove cholesterol from the body.
Complications of High Cholesterol
If left untreated, high cholesterol can lead to the buildup of plaque in your arteries. This causes your arteries to narrow, known as atherosclerosis. This condition limits the blood flow through your arteries, raising your risk of developing blood clots that can be life-threatening. Health complications that may arise include.
- Stroke. Blood clots in the arteries can limit or even prevent blood flow to the brain, causing a stroke.
- Heart attack. Blood clots in the arteries can block off blood flow to the heart, causing a heart attack.
- Chest pain. Blockages in the blood vessels leading to your heart can result in chest pains.
- High blood pressure. The narrowing of your blood vessels will force your heart to pump harder to get blood flowing, which increases your blood pressure (Hypertension)
- Chronic kidney disease. High cholesterol levels have been linked to the development of chronic kidney diseases.
- Peripheral vascular disease. This disease is the result of the narrowing of arteries, reducing blood flow to other parts of your body causing pain and fatigue.
Diagnosing High Cholesterol
A blood test is required to diagnose high cholesterol. This is called a lipid panel or lipoprotein profile. You will be required to fast for 8 to 12 hours before the test, which is usually conducted in the morning. It tests for your:
- Overall cholesterol levels
- LDL Cholesterol levels
- HDL Cholesterol levels
- Triglycerides
High cholesterol numbers will vary depending on your age group and sex, as well as whether you have heart disease. Your doctor will explain the results of the test to you.
Should you be diagnosed with high cholesterol, you may be advised by your doctor to undergo additional tests to screen for complications of high cholesterol, or related diseases. These can include:
- Cardiovascular risk assessment. This aims to assess your risks of developing cardiovascular diseases by profiling your height, weight and body mass index (BMI), measuring your blood pressure and heart rate and conducting electrocardiogram (ECG) tests.
- Diabetes screening. High cholesterol may be caused by diabetes. If you have not been diagnosed as diabetic, you may be advised to undergo diabetes screening. This can include a fasting glucose test and/or a HbA1c blood test.
- Liver test. Your liver is responsible for removing cholesterol from your body. High cholesterol can affect the liver’s functions over time and these tests screen for liver damage. These may include an ALT or AST blood test.
Preventing High Cholesterol
High cholesterol can lead to many health complications and requires regular medication and management. It is ideal to prevent high cholesterol from developing by taking preventive measures to lower your risks of developing high cholesterol.
Your lifestyle choices and diet heavily influence your risk of developing high cholesterol, therefore making changes to your lifestyle and diet should be the simplest way of preventing high cholesterol.
Diet
Avoid foods high in saturated fats, trans fats, sodium, and sugar. These contribute to high cholesterol levels and should be limited or avoided as much as possible. Instead, replace these foods with foods low in saturated fats, trans fats, sodium, and sugar. These include:
- Lean meat
- Fat-free/Low-fat milk
- Whole grains
- Seafood
Foods rich in fibre and unsaturated fat should also be included in your diet as they can help prevent high levels of LDL cholesterol and increase HDL cholesterol levels. This includes foods such as:
- Oatmeal
- Beans
- Avocado
- Nuts
Controlling your calorie intake
Your body converts excess calories into triglycerides. By only consuming the calories you need, you can lower the amount of triglycerides in your bloodstream.
Controlling your weight
Being overweight or obese can increase your LDL cholesterol levels. By keeping your weight within a healthy range, you can lower your cholesterol levels as well as the risk of developing high cholesterol in the future. A healthy BMI range would be between 18.5 to 24.9.
Physical activity or exercise.
Regular physical activity or exercise can not only help you control your weight but also lower cholesterol and blood pressure levels. It is recommended that you get 2 hours and 30 minutes of moderate exercise a week, which averages to just 30 minutes of exercise a day. Simple exercises such as brisk walking can make all the difference in improving your health.
Quit Smoking.
Smoking can cause damage to your blood vessels, causing arteries to harden. Studies have also shown that smokers had significantly higher levels of LDL cholesterol and triglycerides compared to non-smokers.
Limit your alcohol consumption.
Excess consumption of alcohol can raise cholesterol levels and triglycerides. The recommended daily consumption of alcohol is 2 drinks for males and 1 drink for females.
Treatment for High Cholesterol
The financial aspects of treating high cholesterol in Singapore
Like any other chronic disease, high cholesterol requires regular monitoring and check-ups, as well as long-term medication. This means that the disease can become a financial burden to you over time. High cholesterol can also cause many other health complications, which can incur further financial costs. Serious health complications such as cardiovascular diseases and chronic kidney disease can require hospitalisation and surgeries, which can be very costly.
High Cholesterol Medication
High cholesterol will also require medication depending on the severity of your condition and the condition of your health, if lifestyle changes are not enough.
Statins. Statins are commonly used to treat high cholesterol. Statins work by slowing your liver’s production of cholesterol and removing cholesterol from your blood. Statins licensed in Singapore include:
- Atorvastatin
- Fluvastatin
- Pravastatin
- Rosuvastatin
- Simvastatin
Bile acid-binding drugs. Drugs such as Cholestyramine causes your liver to produce more bile that uses up the cholesterol in your body.
PCSK9 Inhibitors. PCSK9 Inhibitors such as Alirocumab and Evolocumab help your liver absorb more LDL cholesterol, lowering your cholesterol levels. However, these medications are rarely available and imported in Singapore.
Fibrates. Fibrates such as Fenofibrate and Gemfibrozil reduce the triglycerides in your bloodstream.
Do ensure that you only consume the recommended dosages prescribed by your doctor. These medications may cause side effects including:
- Mild muscle ache
- Nausea or vomiting
- Constipation or diarrhea
- Redness, swelling or itching
- Flu-like symptoms
These symptoms are usually transient and dose dependent. For patients that are taking it long term and at a low dosage, these symptoms usually do not bother the patient.
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