In Singapore, from the age of 18 to 69, about 8.3% of the population in that category have high cholesterol. Cholesterol is a substance inside your body, circulating inside the blood vessels; the body requires it to build cells and make vitamins and hormones. However, too much cholesterol will lead to burdens and problems in the body.

Singapore’s 2021 Guidelines

Risk LevelNormalBorderlineHigh
Total Cholesterol< 5.25.2 – 6.1≥ 6.2
HDL Cholesterol1.0 – 1.5​≥ 1.6
LDL Cholesterol​< 3.43.4 – 4.0​≥ 4.1
Triglycerides< 2.3≥ 2.3

There are two types of cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.

The LDL cholesterol is the type that is often called bad cholesterol as it is more likely to cause health problems. A high amount of extra LDL causes plaque build-up in the blood vessels.

HDL cholesterol is known as good cholesterol, which protects the body as it can help prevent cholesterol build-up in the blood vessels. As it has a higher density, it will mean that the lipoprotein has a higher amount of protein to transport the lipids through the blood to the liver, which helps prevent plaque build-up.

High cholesterol is determined using the lipid panel, which measures the total amount of cholesterol, HDL cholesterol and LDL cholesterol in the unit of milligrams of cholesterol per deciliter of blood (mg/dL). Desirable cholesterol levels are:

  • LDL cholesterol: Less than 100 mg/dL
  • HDL cholesterol: Higher or equal to 60 mg/dL

Signs & Symptoms

​Initial Stage Symptoms
Nausea Extreme fatigue Shortness of breath Numbness / Coldness in the extremities (As the plaque in the blood vessels builds up slowly, patients might not be able to feel any difference or discomfort over time.)
​Severe Stage Symptoms Angina / Chest PainHeart AttackStroke

Causes of High Cholesterol

A high-fat diet is a risk factor and the cause of high amounts of extra LDL cholesterol, mainly if the food consumed contains too much saturated fat or trans fat. These types of fat could trigger the upsurge production of the very-low-density lipoprotein (VLDL) cholesterol in the liver, which is the precursor of LDL. Then it is sent to the bloodstream, sticking to the wall of the blood vessels for the cells and tissues to absorb the triglycerides the VLDL carries, resulting in intermediate-density lipoprotein (IDL). Then the IDLs undergo further absorption from the different cells, forming the LDL cholesterol, making it a cause and risk factor of high cholesterol.

Risk Factors


As we age, body functions decline. The role of the liver and small intestine, where HDL is mainly secreted, declines, too, causing HDL levels to be lower. As a result, this reduces the rate of clearing cholesterol particles in the blood, causing the number of cholesterol particles in the blood when tested to be higher.

Family history of high cholesterol

Family hypercholesterolemia is a condition that is an inherited defect in how the body processes cholesterol, causing the individual to have a very high level of cholesterol. Through the decades of family members having high cholesterol, the LDL-receptor gene mutates, which changes how the body processes cholesterol preventing the body from removing LDL cholesterol from the blood.


Smoking refers to the lighting and burning of cigarettes, which produces chemical compounds such as acrolein. Acrolein is easily created by burning things such as trees, tobacco, plants, gasoline, and oil. Most importantly, it is toxic to the human body. Inhaling acrolein can hinder the ability and functions of HDL cholesterol to retrieve LDL cholesterol from the blood back to the liver for processing.


High cholesterol can develop into cardiovascular diseases like carotid artery disease, coronary heart disease, heart attack, peripheral artery disease, stroke and sudden cardiac arrest. All of these diseases are related to the circulatory system. The circulatory system circulates blood and lymph through the body, consisting of the heart, blood vessels, lymphatic vessels and glands.

When LDL cholesterol levels are too high, plaque builds up in the blood vessels preventing the blood from circulating to the heart. This causes conditions such as heart attack, carotid artery disease, coronary heart disease, peripheral artery disease, and stroke (ischemia – loss of blood supply).

When insufficient blood travels to the brain, the brain sends signals for the heart to pump faster for more blood to travel through the blood vessels, causing the clotted blood vessels to burst and cause a stroke (hemorrhage – bleeding in the brain).

Recommended Treatments

Making changes to one’s lifestyle could help in regulating and improve cholesterol levels, making the body healthier.

  1. Exercising Regularly At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity per week. This helps in the raising of HDL cholesterol which could help in the regulation and clearing of LDL cholesterol in the blood, having a positive effect on cholesterol levels.
  2. Healthy Diet Consume food products that are rich in plant sterols and stanols that block the absorption of cholesterol. Consume food that contains polyunsaturated fat which lowers LDL cholesterol levels. Avoid food with saturated and trans-fat (e.g Meat-based products, Dairy products, and Vegetable oils such as palm oil, coconut oil, and cocoa butter).
  3. Quit Smoking By quitting smoking, one can increase the function of HDL cholesterol, and improve overall health. Research has shown that within three months of quitting, blood circulation and lung function begin to improve. Within a year of quitting, the risk of getting heart disease is half that of a smoker.

Manage High Cholesterol with Hallmark Physiotherapy

At Hallmark Physiotherapy, it is our commitment to helping our clients learn how to effectively manage conditions such as high cholesterol. Like all our programs, they are carefully developed, using years of research and experimentation as the backbone of our methods.

The two main strategies that we adopt in our program are diet management and regular exercise. Our methods are non-invasive, and results can be seen within a few numbers of sessions. We aim to equip our clients with the necessary knowledge to manage and solve high cholesterol for life. For a free consultation, make a booking here!

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