High Cholesterol or Hyperlipidaemia

High cholesterol, especially a raised Low Density Lipid (LDL) is closely associated with the development of atherosclerosis which is the usual culprit of heart attack and stroke. 

It is therefore surprising that the treatment of high cholesterol remains one of the most debated topics in a cardiology outpatient clinic. 

The medical profession is unified in recommending lipid lowering therapy in patients with proven heart disease or those with high risk of developing it (eg. with diabetic patients). However, there are also plenty of confusing messages coming out from the media that painted a very mixed picture in the use of cholesterol lowering drugs.

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)