Medicine
Hyperlipidemia
High levels of fat particles (lipids) in the blood, such as cholesterol and triglycerides, which increase the risk of heart disease.
Hyperlipidaemia is elevated blood cholesterol or triglycerides — a silent but major risk factor for heart attack, stroke, and peripheral artery disease. LDL cholesterol drives atherosclerotic plaque formation within arterial walls.
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Hyperlipidemia often has no visible symptoms but silently contributes to the buildup of plaque in arteries, increasing cardiovascular risk.
High Cholesterol: A Silent Driver of Heart Disease
Your body needs cholesterol to build cells and hormones. The problem is one specific carrier — the LDL particle — which, when there is too much of it in the blood, slips into the artery wall and is trapped there. The immune system reacts, and over years a plaque builds up.
Hyperlipidaemia produces no symptoms at all until that plaque causes an event: a heart attack, a stroke, or leg artery disease. It is the single most modifiable cause of these, and lowering LDL cholesterol reliably reduces the risk — which is why we look for it actively rather than wait.
Hyperlipidaemia produces no symptoms at all until that plaque causes an event: a heart attack, a stroke, or leg artery disease. It is the single most modifiable cause of these, and lowering LDL cholesterol reliably reduces the risk — which is why we look for it actively rather than wait.
The Number That Matters: LDL, Not Total
A lipid panel reports several figures, but they are not equal. LDL cholesterol (and its close relatives, non-HDL cholesterol and ApoB) is the causal particle and the treatment target. HDL is a risk marker, not something to treat. Triglycerides matter mainly when they are very high.
- The reference range printed beside your LDL result is a population average, not your goal — your target is set by your overall cardiovascular risk
- Broadly: LDL below 2.6 mmol/L at borderline or intermediate risk, below 1.8 at high risk, below 1.4 if you have established cardiovascular disease
- ApoB is worth measuring when triglycerides are raised, and lipoprotein(a) once in your life to pick up an inherited risk that a standard panel misses
Why It Runs High
Most raised cholesterol is a mix of lifestyle and genetics.
- A diet high in saturated and trans fat; refined carbohydrate and alcohol push triglycerides up
- Inactivity, excess weight and smoking
- Type 2 diabetes, an underactive thyroid and kidney disease, and some medications
- Familial hypercholesterolaemia — an inherited condition affecting roughly 1 in 250 people that causes very high LDL from birth and early heart disease, and which means first-degree relatives should be tested
Lowering It: Diet First, Then the Right Medicine
Diet and lifestyle are the foundation for everyone, and for some people they are enough.
- A Mediterranean-style pattern, 5 to 10 g of soluble fibre a day, replacing saturated fat with olive or canola oil, regular exercise, weight loss and stopping smoking together lower LDL by around 10 to 15%
- A statin, dosed to reach your target, lowers LDL by 30 to 55%
- Ezetimibe adds a further 15 to 25%; a PCSK9 inhibitor or twice-yearly inclisiran adds 50 to 60% for very-high-risk patients still above target
- Icosapent ethyl or a fibrate is used when triglycerides are the main problem
Statins: What They Do, and the Myths
Statins have more safety data behind them than almost any drug class: across trials of over 170,000 people, every 1 mmol/L fall in LDL cuts major cardiovascular events by about 22%.
Muscle aches are common in life and usually turn out not to be caused by the statin — in blinded trials, people report the same aches on placebo. Real side effects exist: a small increase in the risk of developing diabetes, and rare liver enzyme rises, both outweighed by the benefit in anyone at meaningful cardiovascular risk. You generally stay on treatment long term, because stopping lets LDL, and the risk, climb straight back.
Muscle aches are common in life and usually turn out not to be caused by the statin — in blinded trials, people report the same aches on placebo. Real side effects exist: a small increase in the risk of developing diabetes, and rare liver enzyme rises, both outweighed by the benefit in anyone at meaningful cardiovascular risk. You generally stay on treatment long term, because stopping lets LDL, and the risk, climb straight back.
Screening and Monitoring in Singapore
Have a lipid panel from around age 40, or earlier if you smoke, have diabetes, high blood pressure or a family history of early heart disease — and in your late teens or twenties if familial hypercholesterolaemia runs in the family.
After starting or changing treatment we recheck the lipids at 8 to 12 weeks, then yearly once stable. Where the decision to start a statin is genuinely borderline, a coronary artery calcium score often settles it. We set a personalised LDL target and build the plan around it from Paragon Medical Centre on Orchard Road.
After starting or changing treatment we recheck the lipids at 8 to 12 weeks, then yearly once stable. Where the decision to start a statin is genuinely borderline, a coronary artery calcium score often settles it. We set a personalised LDL target and build the plan around it from Paragon Medical Centre on Orchard Road.
Hyperlipidemia: Common Questions
Concerned About Hyperlipidemia?
Dr. Peter Chang offers specialist assessment and personalised management at Paragon Medical Centre, Singapore.