How to Manage Cholesterol - Doctor Q&A

High cholesterol, the silent killer.

Many people with high cholesterol may feel perfectly well with no symptoms; hence they may be unaware that their cholesterol levels are above the recommended range.

Raising awareness about early detection, lifestyle habits and appropriate treatment is key to preventing long‑term complications.

There are different types of cholesterol in the body, and health concerns arise when certain types become excessively elevated, particularly low-density lipoprotein (LDL) cholesterol, commonly referred to as “bad cholesterol.”

Why is cholesterol harmful?

When LDL cholesterol levels are excessively high, cholesterol can accumulate along the walls of arteries and blood vessels, forming fatty deposits known as plaque.

Over time, this process narrows and hardens the arteries, a condition known as atherosclerosis. This significantly increases the risk of cardiovascular diseases such as heart attack (myocardial infarction), stroke and peripheral arterial disease (PAD) which causes poor blood circulation to the legs.

Our body also contains high-density lipoprotein (HDL) cholesterol, often referred to as “good cholesterol.” HDL helps to remove excess cholesterol from the bloodstream and transports it back to the liver for disposal.

In simple terms, LDL deposits cholesterol in the arteries, whereas HDL helps to clear cholesterol away from them.

Common risk factors of high cholesterol

Common risk factors for elevated LDL cholesterol include:

• Diets high in saturated fats and trans fats,
• Excessive intake of processed or deep-fried foods, and a
• Sedentary lifestyle with insufficient physical activity or exercise.

Other contributing factors include being overweight or obese, smoking, excessive alcohol consumption and genetic conditions such as familial hypercholesterolemia.

Practical tips for managing cholesterol

Adopting a healthier lifestyle is essential for cholesterol management. This includes:

• Consuming a balanced diet rich in vegetables, whole grains and oats, while
• Reducing the intake of foods high in saturated and trans fats such as processed meats, cheese, cream and deep-fried foods.
• Regular physical activity or exercise is also important. Activities such as brisk walking, light jogging, or cycling for at least 30 minutes, five times per week can help to improve cholesterol levels and overall cardiovascular health.
• Maintaining a healthy body weight, 
• Avoiding smoking and limiting alcohol intake
• Regular health screenings and follow-up consultations with primary care physicians through Healthier SG enrollment are recommended to monitor cholesterol levels and overall cardiovascular risk.

How to live well with high cholesterol

In addition to maintaining a healthy lifestyle through proper diet and regular exercise, individuals who are prescribed cholesterol-lowering medications such as statins should be compliant and take them consistently and attend regular follow-up appointments with their primary care doctors.

As elevated LDL cholesterol increases the risk of cardiovascular diseases such as heart attack and stroke, it is also important to undergo screening for related conditions including diabetes mellitus and hypertension (high blood pressure).

Living well with high cholesterol is largely about developing sustainable long-term habits rather than seeking rapid solutions. With consistent management of overall cardiovascular risk factors, many individuals with high cholesterol are able to lead long, healthy and active lives.

This Q&A is your chance to get doctor's advice on cholesterol management. Submit your questions now! 

Dr Foo Jong Yi is a Consultant from the Department of Post-Acute & Continuing Care (PACC) at Sengkang Community Hospital (SKCH).

He graduated from the National University of Malaysia in 2014 and obtained his Master of Medicine (Family Medicine) from the National University of Singapore in 2020. He subsequently completed his fellowship training in Family Medicine and was conferred the Fellowship of the College of Family Physicians Singapore, FCFP(S) in 2024.

In his current role at Sengkang Community Hospital (SKCH), Jong Yi works with a multi-disciplinary team to provide holistic care to inpatients to optimise their recovery before their transition back to the community.

He also serves as Head of Infection Prevention and Control at SingHealth Community Hospitals, where he collaborates with his team to implement infection prevention and control initiatives, establish standards for disinfection and environmental hygiene, oversee infection surveillance, and develop appropriate infection control strategies to enhance the quality of care.

His clinical interest is in Family Medicine, with a strong emphasis on delivering holistic, person-centred care to patients in the community hospital setting, while supporting the continuity of care as they transition back to their homes and the wider community.

1. Question by Venetia

Hi Dr. Foo,

Would like your professional advice on how to manage LDL for people who are on Oratane (isotretinoin).

My son who has severe acne issue is on Oratane and I understand this medication actually alleviate the LDL even if he maintain a healthy lifestyle in terms of diet and exercise. Thank you.

Answer by Dr Foo Jong Yi

Hi Venetia,

You are correct that Oratane (isotretinoin) can affect lipid levels. In some individuals, it may increase LDL cholesterol and triglycerides during treatment. Fortunately, this effect is usually reversible after the medication is stopped.

For patients on isotretinoin, I would recommend:

• Continue a healthy diet and regular exercise.
• Avoid excessive intake of food containing saturated fats and trans fats.
• Monitor fasting lipid levels periodically, especially if isotretinoin treatment is prolonged.
• Discuss with the dermatologist if there is a significant rise in LDL cholesterol or triglycerides after isotretinoin treatment and any other alternative treatment.

In a young person without other cardiovascular risk factors, a temporary rise in LDL during isotretinoin treatment is generally less concerning than in some high risk patients with diabetes, hypertension, hyperlipidaemia or established cardiovascular disease.

Therefore, treatment decisions should be individualised to overall cardiovascular risk rather than just LDL level alone.

2. Question by Rose

Hi Doc,

If I have borderline cholesterol level and don’t wish to start taking statin… is it safe for me to consume Red Yeast Supplement (e.g. Hypercol) from shelves or liver tablet (e.g. from South Korea) to bring down cholesterol level? Thank you.

Answer by Dr Foo Jong Yi

Hi Rose,

I have to read on these supplements.

Red yeast rice supplements may lower LDL cholesterol because they contain monacolin K, a naturally occurring compound that is chemically similar to lovastatin.

However, there are several concerns I can think of:

• The amount of active ingredient varies significantly between products.
• Quality control is often inconsistent.
• Side effects can be similar to statins, including liver injury and muscle-related adverse effects.
• Some products may contain contaminants.

As for liver supplements, there is currently insufficient scientific evidence that they effectively lower LDL cholesterol, from what I know.

Before considering any supplement, I would recommend assessing your overall cardiovascular risk first, Eg 10-year cardiovascular risk using Singapore-modified Framingham Risk Score.

Many individuals with borderline cholesterol may not require medication and can focus on healthy lifestyle measures such as diet and exercise. If medication is eventually needed, prescribed statins remain the most extensively studied and evidence-based medication for reducing LDL and hence, cardiovascular risk, heart attacks and strokes.

3. Question by Yap

Hi Dr Foo,

I am aware about high cholesterol, but also know that cholesterol is critical for our bodily functions.

What is the impact of too low a cholesterol level or what is considered too low a cholesterol level?

Thank you for your advice.

Answer by Dr Foo Jong Yi

Hi Yap,

You are right. Cholesterol is indeed essential. It is required for hormone production, vitamin D synthesis and to build cells and create bile acid that digests fat.

Interestingly, current evidence suggests that achieving very low LDL cholesterol levels through lipid-lowering therapy like statin is generally safe in high-risk cardiovascular patients.

One of the clinical studies (IMPORVE-IT trial) have shown that LDL level below 1.0 mmol/L was not associated with increased risks of muscle problems, liver problems, cognitive impairment or haemorrhagic stroke in patients receiving intensive lipid-lowering therapy.

Therefore, for most people, we are more concerned about LDL being too high rather than too low.

If a person has unexpectedly low cholesterol without treatment, doctors may investigate for other causes such as malnutrition, hyperthyroidism or liver disease.

4. Question by Riddhi

Dear Dr,

If cholesterol is under control, within prescribed limit, what is your advice on eating egg yolks? Thank you.

Answer by Dr Foo Jong Yi

Hi Riddhi,

Yes. For most people with well-controlled cholesterol, moderate consumption of egg yolks is acceptable as part of a balanced diet.

Current evidence suggests that dietary cholesterol from eggs has a smaller impact on blood cholesterol than saturated fats and trans fats. Therefore, I generally advise patients to focus more on:

• Reducing processed foods
• Limiting food with saturated fats and trans fats
• Increasing fruits, vegetables and whole grains
• Maintaining a healthy weight/BMI

5. Question by Elaine

Dear Dr,

I have high TG (super high range) since my 30s and have started fenofibrate for years.

I am now on double dosage and added statin but the reading could not be brought down to normal range. I walk regularly and climb stairs whenever I can. Adjusted my diet to reduce sugar and fried items but the number just could not come down.

My BMI is 18.5 and has always been on the underweight category. Female and my HDL has been less than 20 as well. Appreciate your advice.

Answer by Dr Foo Jong Yi

Hi Elaine,

Your situation suggests that further evaluation is warranted.

You have persistently very high triglycerides despite on both fenofibrate and statin therapy. You also have a markedly low HDL cholesterol level (<20 mg/dL), a BMI of 18.5 and are already following a healthy lifestyle with appropriate dietary measures and regular physical activity.

Given these factors, your persistently abnormal lipid profile is less likely to be due to lifestyle alone and further evaluation for secondary or inherited causes would be appropriate.

In such cases, we should consider secondary and genetic causes including familial hypertriglyceridemia, hypothyroidism, diabetes mellitus or any liver or kidney disease.

I would recommend consultation with an endocrinologist if this has not already been done.

6. Question by Arthur

Hi Dr,

I read many reports claiming cholesterol has "nothing to do" with heart attacks. If so, what harm does high cholesterol do that we have to worry about? Thank you.

Answer by Dr Foo Jong Yi

Hi Arthur,

This is a common question that many ask.

While cholesterol is not the only cause of heart attacks, LDL cholesterol plays a central role in the development of atherosclerosis.

Excess LDL cholesterol enters artery walls and contributes to plaque formation. Over time, plaques may rupture and trigger clot formation, leading to heart attacks or strokes.

Importantly, every 1 mmol/L reduction in LDL cholesterol achieved with statin therapy reduces major cardiovascular events by approximately 20–25%.

Therefore, while factors such as smoking, diabetes mellitus, hypertension and obesity also contribute, LDL cholesterol remains one of the most important modifiable cardiovascular risk factors.

7. Question by Glen

Hi Dr, will taking two eggs a day can increase LDL?

Answer by Dr Foo Jong Yi

Hi Glen,

For most healthy individuals, eating two eggs a day is unlikely to cause a clinically significant increase in LDL cholesterol.

The overall dietary pattern is more important than any single food item.

8. Question by Alfred

Dear Dr Foo

My blood test results:

Total Cholesterol 6.5

HDL 1.6 LDL 4.4

Triglycerides 1.2

Chol:HDL Ratio 4.1

One doctor said my cholesterol high, another doctor said I am ok because Chol:HDL ratio ok. Who is correct? Do I need to take cholesterol medicine? Thank you for your advice.

Answer by Dr Foo Jong Yi

Hi Alfred,

Your results are:

• Total cholesterol: 6.5 mmol/L
• HDL: 1.6 mmol/L
• LDL: 4.4 mmol/L
• Triglycerides: 1.2 mmol/L
• TC:HDL ratio: 4.1

I would look at your LDL cholesterol which was elevated at 4.4mmol/L.

Current lipid management guidelines place greater emphasis on overall cardiovascular risk rather than relying solely on cholesterol ratios.

Decisions regarding statin therapy should consider your age, blood pressure, smoking status, history of diabetes mellitus, chronic kidney disease, family history of cardiovascular diseases and etc.

If you are otherwise healthy with low cardiovascular risk, lifestyle measures (diet modification, regular exercise) may be appropriate initially with repeat lipid panel 3-6 months later.

However, if you have additional risk factors, statin therapy may be beneficial.

I would recommend a formal cardiovascular risk assessment with your doctor, can measure 10-year cardiovascular risk using Singapore-modified Framingham Risk Score.

9. Question by Guo

Hi Dr Foo, I would like to ask:

a) Does taking red yeast capsules help with controlling or reducing bad cholesterol?

b) Does statin have blood thinning effect?

c) What are the side effects of taking statin for cholesterol control?

Thank you!

Answer by Dr Foo Jong Yi

Hi Guo,

a) I have to read on red yeast rice. Yes, short answer is it may lower LDL cholesterol because it contains compounds similar to statins. However, potency and quality may vary considerably between products.

b) No, statins are not blood-thinning medications. Blood thinners include medications such as aspirin, clopidogrel and others. Statins work by lowering LDL cholesterol and stabilising arterial plaques.

c) Most people tolerate statins well but possible side effects include muscle aches or weakness, fatigue, headache, nausea, constipation and etc.

10. Question by Ashri

Hi Dr Foo,

I’m 37 years old guy, slightly overweight, with slightly high LDL.

a) I would like to know the most impactful, scientifically proven method to reduce LDL levels. Not just suggested recommendations.

b) My worry with exercise is if just 30 minutes, might be too little. If I exercise too hard, will I get a stroke?

c) How do we check for heart or artery blockage levels? What scans do we have to go for?

d) How do we monitor LDL levels from home? Is there a home scanner like glucose reader?

Thank you.

Answer by Dr Foo Jong Yi

Hi Ashri,

a) The interventions with the strongest evidence are dietary modification, regular exercise, weight reduction (if overweight) and medication like statins.Among medications, statins remain the most effective first-line therapy and reduce major cardiovascular events by approximately 20–25% for every 1 mmol/L LDL reduction.

b) For most healthy individuals, exercise reduces stroke risk. The ACE clinical guideline recommends aiming for 150–300 minutes of moderate-intensity physical activity per week. Exercise can be increased gradually, if you have symptoms such as chest pain, breathlessness, dizziness or significant cardiovascular risk factors, discuss with your doctor before embarking on vigorous exercise. 

c) Depending on the situation, investigations may include CT coronary angiography, stress test, Myocardial Perfusion Imaging and others. The choice depends on the age, symptoms and overall cardiovascular risk and is best advised by the cardiologist. 

d) Generally, we never do LDL cholesterol monitoring at home setting. For most people, periodic blood testing through a clinic remains the preferred and most reliable method of monitoring LDL cholesterol.

Ref: F26