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High Cholesterol (Hyperlipidaemia)

High cholesterol (hyperlipidaemia) refers to elevated levels of lipids (fats) in the blood, particularly cholesterol and triglycerides. Over time, excess lipids contribute to fatty deposits in blood vessels, leading to narrowing (atherosclerosis) and increasing the risk of cardiovascular events such as heart disease and stroke. While high cholesterol itself does not cause immediate symptoms, it has long-term effects on overall metabolic and vascular health. Management typically involves lifestyle modifications, and in some cases, medication.

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Dr Adrian Mondry
Physician (FRG) | MD (HHU Düsseldorf) | MRCP (London) | IM Specialist (ÄKNo) | Hypertensiologist (DHL)
Symptoms Causes Diagnosis Treatment Prevention FAQ
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Symptoms
Causes
Diagnosis
Treatment
Prevention
FAQ

Symptoms of High Cholesterol

High cholesterol does not usually cause noticeable symptoms until complications develop. However, certain physical signs may indicate persistently high lipid levels.

  • Xanthomas

    Yellowish, fatty deposits that develop under the skin, often on the tendons of the hands, elbows, knees, and feet. These occur when excess cholesterol accumulates in tissue.

  • Corneal Arcus

    A greyish-white ring forming around the cornea of the eye. While commonly seen in older adults, its presence in younger individuals may suggest abnormal lipid metabolism.

  • Xanthelasmas

    Soft, yellow cholesterol deposits around the eyelids, which may indicate underlying lipid disorders.

Causes and Risk Factors

Several factors contribute to high cholesterol, ranging from genetic predisposition to lifestyle choices and underlying health conditions.

  • Genetic Factors

    Inherited mutations affecting lipid metabolism can lead to high cholesterol. A family history of elevated cholesterol or early heart disease increases the risk. Genetics are the dominant factor contributing to individual cholesterol profile.

  • Dietary Habits

    Diets high in saturated fats, trans fats, and cholesterol, such as those rich in processed foods, red meat, and full-fat dairy, can raise blood lipid levels.

  • Physical Inactivity

    A sedentary lifestyle impairs the body’s ability to process and eliminate excess lipids, contributing to weight gain and metabolic disturbances.

  • Age and Metabolic Changes

    Lipid profiles tend to worsen with age, particularly in individuals with metabolic syndrome, obesity, or hormonal fluctuations.

  • Underlying Medical Conditions

    Diabetes and insulin resistance disrupt cholesterol and triglyceride levels. Hypothyroidism slows lipid metabolism, raising cholesterol. Liver disease, including NAFLD, is linked to high cholesterol and triglycerides. Chronic kidney disease alters lipid metabolism, increasing cardiovascular risk.

  • Smoking and Alcohol Consumption

    Smoking lowers HDL (good) cholesterol while raising LDL (bad) cholesterol, contributing to arterial damage. Excessive alcohol intake can raise triglycerides significantly.

Diagnostic Methods

  • Lipid Profile Test: This blood test measures total cholesterol, LDL, HDL, and triglycerides. Fasting for 9–12 hours before testing ensures accurate results.
  • Physical Examination: The doctor checks for signs such as xanthomas and corneal arcus while also assessing body weight, waist circumference, and blood pressure to evaluate metabolic health.
  • Medical History Assessment: A review of lifestyle habits, diet, family history, and pre-existing medical conditions helps identify potential causes of high cholesterol.
  • Additional Blood Tests: Liver function tests help identify liver-related causes of high cholesterol, while thyroid function tests determine if hypothyroidism is a contributing factor. Fasting blood glucose and HbA1c are used to assess diabetes and insulin resistance, both of which can affect lipid metabolism.

Treatment Options

Managing high cholesterol requires an individualised approach, combining lifestyle modifications with medication when necessary.

Lifestyle Changes for Cholesterol Management

  • Dietary Adjustments: Reducing saturated fats, trans fats, and processed carbohydrates helps lower cholesterol. Increasing fibre-rich foods like oats, legumes, and vegetables limits cholesterol absorption, while heart-healthy fats from fish, nuts, and seeds support cardiovascular health.
  • Regular Exercise: Engaging in at least 150 minutes of moderate-intensity exercise per week, including aerobic activities and strength training, helps regulate cholesterol levels, improve circulation, and support weight management.
  • Weight Management: Maintaining a healthy weight lowers LDL cholesterol and triglycerides while improving insulin sensitivity. Balanced nutrition and regular exercise reduce the risk of metabolic disorders linked to high cholesterol.
  • Avoiding Tobacco and Excess Alcohol: Quitting smoking improves lipid profiles and reduces cardiovascular risks. Limiting alcohol intake prevents excessive triglyceride levels and metabolic imbalances.

Medications for High Cholesterol

When lifestyle changes are not enough to control cholesterol levels, medication may be prescribed based on individual risk and lipid profile.

  • Statins: The first-line treatment that lowers LDL cholesterol by reducing its production in the liver.
  • Fibrates: Primarily used to lower high triglycerides but can also help reduce LDL cholesterol.
  • Bile Acid Sequestrants: Bind to bile acids in the intestines, reducing cholesterol absorption and complementing statin therapy.
  • PCSK9 Inhibitors: Injectable medications used for familial hypercholesterolaemia or individuals with very high LDL cholesterol who do not respond to statins.

Treatment selection depends on cholesterol levels, overall cardiovascular risk, and individual tolerance to medications.

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Prevention and Long-Term Management

Routine cholesterol monitoring helps track lipid levels over time. Adults with no known risk factors can have their cholesterol checked every 4–6 years, while those with cardiovascular disease, diabetes, or a family history of high cholesterol may need annual testing. Maintaining a heart-healthy diet, regular exercise, and weight control supports cholesterol management. Sleep quality and stress management also contribute to overall metabolic health.

Frequently Asked Questions (FAQ)

How long does it take to lower cholesterol levels?

The time needed to lower cholesterol depends on the approach taken. Lifestyle changes, such as diet and exercise, typically show results within 3–6 months. Medication, when prescribed, can lower cholesterol more quickly, often within weeks. Regular monitoring helps track progress and adjust treatment if needed.

Can stress affect cholesterol levels?

Chronic stress may raise cholesterol levels by altering hormone levels and promoting unhealthy habits like poor diet and inactivity. Managing stress through lifestyle changes can help support overall cholesterol control.

Can cholesterol levels fluctuate?

Yes, cholesterol levels can vary due to factors such as diet, hydration, illness, stress, and medication use. While temporary fluctuations are normal, long-term trends provide a clearer indication of cholesterol health.

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Dr Adrian Mondry

Physician (FRG)|MD (HHU Düsseldorf)|Specialist for Internal Medicine (ÄKNo)|Hypertensiologist (DHL)|MRCP (London)

Dr. Mondry has over 30 years of experience as an internal medicine & hypertension specialist.

  • Previously a Senior Consultant in the Department of Medicine at the National University Hospital and Ng Teng Fong General Hospital, where he is currently a visiting consultant.

  • Hypertension Specialist accredited by the German Hypertension League (DHL)

  • Contributed to the latest Singapore ACE Clinical Guidance on “Hypertension – Tailoring the Management Plan to Optimise Blood Pressure Control” as a committee member.

Read Full Bio

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