Lipid Disorders
Cholesterol or Lipid Disorders in Singapore
Cholesterol and lipid disorders, also known as dyslipidaemia, occur when the levels of fats, or lipids, in the blood are abnormal. These may include high LDL cholesterol, high triglycerides, or low HDL cholesterol. Cholesterol and triglycerides are carried through the bloodstream by particles called lipoproteins. Over time, abnormal lipid levels can contribute to plaque buildup in the arteries and increase the risk of cardiovascular disease, including heart attack and stroke. Very high triglyceride levels may also increase the risk of pancreatitis.
Causes of Lipid Disorders
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Genetic Factors: Some people inherit conditions that affect how the body processes cholesterol and other blood fats. In Asian populations, familial hypercholesterolaemia is commonly linked to variants in the LDL receptor gene (LDLR). Elevated lipoprotein(a), or Lp(a), can also be inherited and may increase cardiovascular risk.
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Lifestyle Factors: Diet and lifestyle can also affect lipid levels. Common contributing factors include a diet high in saturated fat and trans fat, physical inactivity, smoking, excess calorie intake, and excessive alcohol consumption.
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Medical Conditions: These include diabetes, hypothyroidism, chronic kidney disease, nephrotic syndrome, bile duct disorders, and obesity-related metabolic syndrome. Diabetes is especially important because it is often associated with high triglycerides, low HDL cholesterol and smaller, denser LDL particles.
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Medications: Some medications may affect cholesterol or triglyceride levels. These include corticosteroids, some diuretics such as thiazides, certain beta-blockers, retinoids, antiretroviral medications, immunosuppressants such as cyclosporine or tacrolimus, oral birth control pills.
Visible Signs of Lipid Disorders
Xanthomas
Xanthomas are yellowish fatty deposits that can appear under the skin or around tendons. When they occur around the eyelids, they are known as xanthelasma. They may also appear over pressure areas such as the elbows, knees, heels, or around tendons. These signs can be associated with lipid disorders, including inherited conditions such as familial hypercholesterolaemia.
Corneal Arcus
Corneal arcus appears as a grey, white, or pale ring around the outer edge of the cornea. It is more common with ageing, but when seen in younger adults, it may suggest an underlying lipid disorder and should prompt a cholesterol and cardiovascular risk assessment.
Arterial Changes
Over time, cholesterol and other fatty substances can build up as plaque inside the arteries. This process, known as atherosclerosis, can narrow the arteries and reduce blood flow. Depending on which arteries are affected, symptoms may include chest pain or discomfort, leg pain during walking, or stroke-like symptoms such as sudden weakness, numbness, or difficulty speaking.
Diagnosis
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Treatment Approaches
Cholesterol and lipid management focuses on identifying underlying metabolic factors, improving lipid levels, reducing cardiovascular risk, and preventing long-term complications such as heart disease and stroke.
Lifestyle Modifications
Lifestyle changes play an important role in managing cholesterol and lipid disorders. This may include reducing saturated and trans fats, increasing fibre intake, maintaining a healthy weight, staying physically active, avoiding smoking and limiting alcohol intake. A structured care plan may also include medical nutrition therapy and regular metabolic monitoring to track lipid levels and overall cardiovascular risk.
Medications
Medications may be recommended when lifestyle changes alone are not enough or when cardiovascular risk is high. Statins are commonly used to lower LDL cholesterol, while other options may include ezetimibe, bile acid sequestrants, fibrates and injectable therapies. For suitable patients, 2-weekly or monthly PCSK9 inhibitor injections, or 6-monthly PCSK9 inhibitor injections, may be considered. Treatment is personalised based on lipid levels, cardiovascular risk, family history and response to therapy.
Management of Underlying Conditions
Managing cholesterol and lipid disorders also involves identifying and treating underlying conditions that may affect lipid levels. These may include insulin resistance, diabetes, hypothyroidism, metabolic syndrome, kidney disease or liver-related conditions. Hormonal and metabolic assessments can help uncover contributing factors and guide a more personalised treatment plan.
Prevention & Long-Term Management
Long-term cholesterol and lipid management involves regular monitoring, sustainable lifestyle changes and adherence to prescribed treatment. Routine check-ups help track lipid levels, review cardiovascular risk and adjust treatment when needed. A heart-healthy diet, regular physical activity, healthy weight management, smoking cessation and limiting alcohol intake all support better long-term lipid control and cardiovascular health.
Frequently Asked Questions
