High cholesterol has no noticeable symptoms, making it a silent threat that often manifests only during emergencies like heart attacks or strokes. Risk factors include:

1. Age: Risk increases for men over 45 and women over 55.
2. Family History: A genetic predisposition, such as familial hypercholesterolemia, elevates risk.
3. Lifestyle Factors: Poor diet, obesity, smoking, excessive alcohol consumption, and lack of exercise contribute significantly.
4. Medical Conditions: Type 2 diabetes and other conditions can disrupt cholesterol balance.

Untreated high cholesterol can lead to atherosclerosis (narrowed arteries), increasing the likelihood of strokes, heart attacks, chest pain, high blood pressure, chronic kidney disease, and peripheral vascular disease.

A lipid panel blood test, requiring 8hrs of fasting, measures overall cholesterol, LDL, HDL, and triglyceride levels. Results vary by age, sex, and existing heart conditions. Additional tests, such as cardiovascular risk assessments, diabetes screenings, or liver function tests, may be recommended to evaluate related complications.

Managing high cholesterol involves a combination of medication, lifestyle changes, and regular monitoring. In Singapore, medications are prescription-only and available through hospitals, clinics, or online consultations with transparent pricing.

Treatment Options in Singapore

1. Statins: The most commonly prescribed cholesterol-lowering drugs, statins (e.g., atorvastatin, rosuvastatin, simvastatin) reduce liver cholesterol production. They are recommended for:
   • Pre-existing atherosclerotic cardiovascular disease.
   • Diabetes (especially long-term cases).
   • High LDL levels (>190 mg/dL or 4.9 mmol/L).
   • Multiple cardiovascular risk factors. Statins can cause side effects like muscle aches, nausea, or digestive issues, but these are typically mild and dose-dependent.
2. Ezetimibe: This drug reduces cholesterol absorption in the intestines and can be used alone or with statins.
3. PCSK9 Inhibitors: Injectable options like alirocumab and evolocumab are reserved for patients intolerant to statins, enhancing liver LDL absorption.
4. Other Medications: Bile acid-binding drugs (e.g., cholestyramine) and fibrates (e.g., fenofibrate) target cholesterol and triglyceride levels, respectively.

A local study found medication adherence to be highly effective, controlling cholesterol in up to 85% of cases compared to 10–20% for lifestyle changes alone. Despite this, myths about statins persist, deterring some patients.

Debunking Statin Myths

1. Myth: Statins are a catch-all solution.
   Reality: Statins are prescribed selectively for high-risk patients to prevent or manage cardiovascular disease, not as a universal fix.
2. Myth: Statins cause diabetes.
   Reality: Statins may slightly elevate blood sugar in pre-diabetic individuals, but their cardiovascular benefits outweigh this risk.
3. Myth: Statins don’t prevent blood vessel disease.
   Reality: Studies show statins reduce heart attacks, strokes, and deaths by 20–40% in high-risk groups over two to five years.

Lifestyle Modifications

While medications are critical, lifestyle changes enhance cholesterol management:

1. Diet: Limit saturated fats, trans fats, sodium, and sugar. Opt for lean meats, low-fat dairy, whole grains, seafood, and fiber-rich foods like oatmeal, beans, avocados, and nuts.
2. Weight Control: Maintain a healthy BMI (18.5–24.9) to lower LDL and raise HDL.
3. Exercise: Engage in 2.5 hours of moderate weekly exercise (e.g., brisk walking) to reduce cholesterol and blood pressure.
4. Quit Smoking: Smoking damages blood vessels and lowers HDL.
5. Limit Alcohol: Keep consumption to one drink daily for women and two for men to avoid raising cholesterol and triglycerides.

Financial Considerations

High cholesterol is a chronic condition requiring ongoing medication, monitoring, and check-ups, which can become costly. Complications like cardiovascular or kidney disease may necessitate expensive treatments or hospitalizations. Consulting a doctor ensures cost-effective, tailored treatment plans.