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National Cholesterol Education Month: Cholesterol Isn’t All Bad. Here’s What You Should Know

What Is Cholesterol?

Cholesterol is a waxy, fat-like substance found in your body. Because it cannot travel freely through blood, it is transported in particles called lipoproteins.

Two you will commonly hear about are:

LDL cholesterol, often called “bad” cholesterol. When LDL levels are too high, cholesterol can accumulate in artery walls and contribute to the formation of plaque.

HDL cholesterol, often called “good” cholesterol. HDL helps transport cholesterol from the bloodstream back to the liver, where it can be removed from the body.

So the goal is not to eliminate cholesterol. It is to maintain a healthy lipid profile and, importantly, keep LDL cholesterol appropriately controlled for your individual cardiovascular risk.

Why Does High LDL Cholesterol Matter?

When LDL cholesterol remains elevated, cholesterol can accumulate within the walls of your arteries. Over time, this contributes to atherosclerosis, the process in which plaque develops and arteries become narrowed.

If blood flow to the heart becomes restricted or blocked, this can result in angina or a heart attack. Disease affecting blood vessels supplying the brain can contribute to stroke.

The important thing to remember is that this usually does not happen overnight.

Atherosclerosis develops progressively over time, which is one reason managing cardiovascular risk factors earlier in life can matter for long-term health. Moreover, the longer the cholesterol deposits remain in the body as plaque, the more they harden due to circulating substances such as calcium ions in the blood, and the more difficult it becomes to reverse or remedy.

Moreover, unlike many other conditions, high cholesterol usually does not cause obvious symptoms. You can feel perfectly healthy while having unhealthy cholesterol levels, all the way until the day it causes a serious complication such as a heart attack or “Acute Myocardial Infarction (AMI)”. Regular screening blood tests are therefore the only way to find out.

What Does Obesity Have to Do With Cholesterol?

Weight and cholesterol are closely connected, although body weight is only one part of a person's overall cardiovascular risk.

Obesity is associated with higher triglycerides, higher LDL cholesterol and lower HDL cholesterol. Abdominal or visceral fat is particularly important because it is metabolically active and is associated with changes including higher LDL cholesterol, blood glucose and blood pressure. However, having high cholesterol does not necessarily mean that someone has obesity.

Also, just because someone does not have obesity does not necessarily mean that they do not have high cholesterol, or “Hyperlipidemia”. In Singapore, hyperlipidaemia is common: HealthHub reports a prevalence of 39.1% among adults aged 18–69 in 2021–2022, using LDL cholesterol ≥4.1 mmol/L for that statistic.

Genetics, diet, physical activity, diabetes, smoking, age and other medical factors can all influence cholesterol levels. Some inherited conditions, such as familial hypercholesterolaemia, can cause very high LDL cholesterol even in otherwise fit and healthy individuals.

What Can You Do to Improve Your Cholesterol?

For many people, cardiovascular prevention starts with everyday habits.

Choose healthier fats. Saturated and trans fats can adversely affect cholesterol levels. Where possible, replace them with unsaturated fats from foods such as nuts, seeds and healthier oils. Singapore's Health Promotion Board also recommends checking food labels and choosing products lower in saturated fat.

Eat more fibre-rich foods. Foods such as vegetables, fruits, beans, oats and whole grains can form part of a heart-healthy diet. Soluble fibre in particular can help lower cholesterol.

Stay physically active. Regular activity supports weight management and cardiovascular health. The CDC recommends adults aim for at least 150 minutes of moderate-intensity physical activity each week.

Avoid smoking. Smoking damages blood vessels and increases cardiovascular risk.

Work towards a healthy weight where appropriate. For people living with overweight or obesity, sustainable weight management can improve several cardiovascular risk factors.

And importantly, know your cholesterol levels.

When Should You Check Your Cholesterol?

High cholesterol can be silent, so screening matters.

In Singapore, population-level screening for high blood cholesterol is recommended from age 40, generally once every three years as part of cardiovascular risk screening. Younger adults may need earlier or more frequent assessment depending on factors such as family history and individual cardiovascular risk.

A cholesterol blood test, often called a lipid profile, commonly measures:

LDL cholesterol (LDL-C)

HDL cholesterol (HDL-C)

Triglycerides (TG)

Total cholesterol (TC)

Rather than interpreting one number in isolation, discuss the results with your doctor. The cholesterol level that is appropriate for you depends partly on your overall cardiovascular risk.

What If Lifestyle Changes Aren't Enough?

Healthy habits remain important, but some people require medication in addition to lifestyle changes to control their cholesterol levels and reduce their long-term risks of heart attacks or stroke. Here are some options your doctor may discuss with you:

1. Statins

Statins are among the main medicines used to lower LDL cholesterol. They reduce cholesterol production in the liver and increase the liver's ability to remove LDL cholesterol from the bloodstream.

Whether you need a statin depends on more than a single cholesterol reading. Your doctor will consider your overall cardiovascular risk, medical history and other risk factors before recommending treatment.

2. Non-statin medicines

Other cholesterol-lowering medicines are available when clinically appropriate.

For example, fibrates primarily help lower high triglyceride levels and may also increase HDL cholesterol. Other drug classes can be considered depending on the type of lipid abnormality, treatment goals and whether someone can tolerate statins.

Treatment therefore needs to be individualised rather than choosing a medicine based solely on whether your cholesterol is labelled “high”.

3. Glucagon-Like-Peptides (GLPs) such as Ozempic, Wegovy and Mounjaro

You may also have heard about medicines targeting pathways such as GLP-1, including semaglutide or Ozempic, and newer combination medicines such as tirzepatide. These medicines should not be thought of simply as “cholesterol lowering drugs”.

They are used for specific approved indications such as diabetes and/or combination treatment of obesity and obesity-associated cardiovascular risk factors such as Hyperlipidemia, depending on the individual patient’s condition and risk. For example, Singapore's HSA has approved tirzepatide (Mounjaro) for type 2 diabetes and for weight management in eligible adults, while semaglutide 2.4 mg (Wegovy) has indications that include weight management and cardiovascular-risk reduction in certain adults with established cardiovascular disease and overweight or obesity.

Because obesity, diabetes and abnormal cholesterol often occur together, treating these interconnected risk factors can improve a person's broader cardiometabolic health.

However, these medications are not substitutes for established cholesterol-lowering treatment when LDL reduction itself is the main treatment goal. The right medication depends on the individual’s risk and requires discussion with your doctor.

4. Emerging and experimental approaches, such as medications targeting PCSK9

Newer injectable therapies are emerging that may promise to expand the options available for people who require substantial additional LDL lowering in future.

One experimental example is inclisiran (Leqvio). It uses small-interfering RNA technology to reduce production of PCSK9 in the liver, ultimately helping the liver remove more LDL cholesterol from the circulation. After the initial dose and another dose three months later, inclisiran is given once every six months as maintenance treatment. It will not be a replacement for healthy habits and will not be for everyone; its suitability depends on an individual's risk, existing diagnoses, LDL goals and response to other therapies.

Final Thoughts

Cholesterol is not inherently bad. In fact, your body needs it.

The issue is balance.

Persistently elevated LDL cholesterol can contribute to plaque formation in the arteries, while factors including obesity, diabetes, high blood pressure, smoking and family history can further influence individuals’ cardiovascular risk.

The good news is that cholesterol is something we can measure, monitor and manage.

Healthy eating, regular physical activity, avoiding smoking, maintaining a healthy weight where appropriate, going for recommended screening and taking medication when medically indicated can all form part of protecting your cardiovascular health.

This National Cholesterol Education Month, don't fear cholesterol. Understand it.

Frequently Asked Questions (FAQs)

Is all cholesterol bad?

No. Cholesterol performs essential functions in the body, including helping to build cells and produce hormones. LDL and HDL are lipoproteins that transport cholesterol differently; excessive LDL is associated with plaque formation, while HDL helps carry cholesterol back to the liver.

Can I have high cholesterol even if I am young or slim?

Yes. Weight is only one risk factor. Physical activity, diet, family history, genetics, co-morbidities such as diabetes, and other factors can influence cholesterol levels. High cholesterol also usually has no symptoms.

Does obesity cause high cholesterol?

Obesity is associated with an increased likelihood of higher LDL and triglycerides and lower HDL, but it is not necessarily the cause of unhealthy cholesterol levels.

Can diet and exercise replace cholesterol medication?

Not necessarily. Lifestyle changes are important for everyone, but some people still require medication to achieve appropriate LDL levels or reduce cardiovascular risk. Do not stop prescribed cholesterol medication without discussing it with your doctor.

Are statins the only treatment available?

No. Statins are a major cholesterol-lowering treatment, but other options include medicines targeting different lipid abnormalities and newer injectable therapies. The appropriate choice depends on the individual.

When should I see a doctor?

Consider discussing cholesterol screening or cardiovascular risk with your doctor if you are due for routine screening, have previously had abnormal cholesterol results, or have risk factors such as obesity, diabetes, high blood pressure, smoking or a strong family history of premature cardiovascular disease. In Singapore, routine population-level hyperlipidaemia screening is recommended from age 40, while earlier assessment may be appropriate for some people based on individual risk.

This article is for general health education and does not replace personalised medical advice. Speak with your healthcare professional about screening and treatment appropriate for you.