When you hear the word “cholesterol”, you may immediately think of clogged arteries, heart attacks and foods you have been told to avoid. But cholesterol itself is not the enemy. The problem arises when the balance of cholesterol carried in your blood becomes unhealthy, when levels of low-density lipoprotein (LDL) cholesterol become too high.
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, balanced lipid profile.
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 or brain becomes restricted or blocked, this can result in heart attack or stroke. This usually does not happen overnight, and develops progressively over time, which is one reason managing risk earlier can matter for long-term health. Moreover, the longer the cholesterol deposits remain in the body as plaque, the more they harden, 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. 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. 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, 39.1% among adults aged 18–69 in 2021–2022 have this condition.
Genetics, diet, physical activity, diabetes, smoking, age and other medical factors can all influence cholesterol levels and high LDL, 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.
- Eat more fibre-rich foods. Foods such as vegetables and fruits can form part of a heart-healthy diet.
- Stay physically active. Regular activity supports weight management and cardiovascular health.
- Avoid Cigarette smoke. This damages blood vessels, even second-hand smoke!
- Work towards a healthy weight where appropriate. For overweight or obese individuals, weight management can help with risk management.
And importantly, know your up-to-date cholesterol levels.
When Should You Check Your Cholesterol?
High cholesterol can be silent. In Singapore, population-level screening 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. 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 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.
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. Treatment 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.
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 is not 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.
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 regular screening and taking medication when clinically required can all form part of protecting your cardiovascular health.
This National Cholesterol Education Month, don't fear cholesterol. Understand it.
References
- Centers for Disease Control and Prevention. Cholesterol myths and facts [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2024 [cited 2026 Sep 18]. Available from: CDC — Cholesterol Myths and Facts
- Centers for Disease Control and Prevention. Testing for cholesterol [Internet]. Atlanta (GA): Centers for Disease Control and Prevention [cited 2026 Sep 18]. Available from: CDC — Testing for Cholesterol
- Centers for Disease Control and Prevention. Risk factors for high cholesterol [Internet]. Atlanta (GA): Centers for Disease Control and Prevention [cited 2026 Sep 18]. Available from: CDC — Risk Factors for High Cholesterol
- HealthHub. Hyperlipidemia [Internet]. Singapore: Ministry of Health Singapore [cited 2026 Sep 18]. Available from: HealthHub — Hyperlipidemia
- HealthHub. Eat less [Internet]. Singapore: Health Promotion Board [cited 2026 Sep 18]. Available from: HealthHub — Nutrition Hub: Eat Less
- HealthHub. Weight management [Internet]. Singapore: Ministry of Health Singapore [cited 2026 Sep 18]. Available from: HealthHub — Weight Management
- HealthHub. Evidence-based recommendations on health screening tests [Internet]. Singapore: Ministry of Health Singapore [cited 2026 Sep 18]. Available from: HealthHub — Health Screening Recommendations
- MedlinePlus. Fibrates [Internet]. Bethesda (MD): National Library of Medicine [cited 2026 Sep 18]. Available from: MedlinePlus — Fibrates
