High Cholesterol or Hyperlipidaemia

Hyperlipidemia, or high cholesterol, is a condition wherein there is an excess amount of lipids or fats in the bloodstream. Cholesterol is a naturally occurring substance in our body, as well as something we get from the foods we eat. However, there are different types of cholesterols, out of which some are essential and some are harmful.
High-density lipoprotein, also known as good cholesterol, as it goes to the liver where it gets disintegrated. Low-density lipoprotein, on the other hand, is known as bad cholesterol, as it doesn’t reach the liver and instead clogs your arteries.
Hyperlipidemia is a very commonly occurring condition in many, and if not detected and tackled early on, can lead to serious medical complications in the future. High cholesterol can often lead to problems such as:
  • Heart attacks
  • Strokes
  • Coronary artery disease
  • Cardiac arrest
  • Microvascular disease
Hyperlipidemia is often caused by several reasons, including:
  • Smoking and/or drinking
  • Eating foods high in saturated/trans fats
  • Inactive lifestyle
  • Stress and/or anxiety
  • Genetics and heredity
  • Obesity
  • Other underlying conditions (liver diseases, diabetes, PCOS, hypothyroidism, lupus, etc.)
It is imperative to consult the doctor about your condition, as a proper diagnosis can determine the type and intensity of the treatment required for your case. Treatment is often differentiated based on the presence of an underlying medical condition, and is known as primary (for those without any conditions) or secondary (for those with underlying heart conditions) prevention.

Primary Prevention

This refers to healthy subject with no heart disease. Their cholesterol level may be moderately elevated as is commonly seen in an affluent society. The initial treatment of choice should be lifestyle modification. This involves having a healthy diet and taking up regular exercise.  Cholesterol lowering drugs should only be considered when lifestyle modification has failed. 

An exception to this is in people with familiar hyperlipidaemia. This is a relatively rare condition but this inherited form of cholesterol disease is associated with very high LDL and can cause major cardiovascular problem very early on in life. Patients with inherited type of lipid disease will need to start drug therapy immediately upon diagnosis.

Secondary Prevention

As mentioned earlier, this refers to patients who has confirmed heart disease or stroke. They typically have undergone angioplasty or had heart attack in the past.  The evidence here is very clear cut. The cholesterol especially LDL has to be kept as low as possible.  A group of drugs called statin is frequently prescribed to achieve such target.

Is cholesterol drug safe to take long term?

Cholesterol lowering drugs like the modern statins are extremely effective in lowering LDL cholesterol and have very good safety profile.  Such drugs are used long term.

What are the side effects of statin and are there any alternatives?

Some patients may complain of big muscle group aches especially when taken in higher dosages. In rare occasion it can result in abnormal liver blood tests. Your doctor should be monitoring these findings during your follow up visit.

In the rare occasion where one cannot tolerate the use of statin, there are newer and even more powerful drugs called PCSK9 to lower the LDL. You may want to discuss this with your doctor.



Heart Diseases

Our Cardiologist

Dr. Paul Ong

Senior Consultant Cardiologist

BA (Cambridge)
MB BChir (Cambridge)
MA (Cambridge)
CCST Cardiology (UK)
FRCP (London)
FESC (Europe)

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