What’s cholesterol?

Cholesterol is a type of fat produced by our body, mainly the liver. Most of the cholesterol that circulated in our blood is obtained through our daily diet.

Cholesterol can be divided into “good” cholesterol, so-called high-density lipoprotein (HDL), and “bad” cholesterol, so-called low-density lipoprotein (LDL). Good cholesterol, HDL is important to our body. It is used in the production of vitamins, hormones, and repairing of cell structures. However, a high level of bad cholesterol, LDL can be detrimental to our health.

According to Malaysia National Health and Morbidity Survey (NHMS) 2019, 4 out of 10 people in Malaysia (8 million adults) have raised in total cholesterol level. Unfortunately, 25% of them were unaware of it. Besides. females have a higher total cholesterol level compared to males.

cholesterol 2
Sources: Malaysia National Health and Morbidity Survey (NHMS) 2019

How do I know I have high cholesterol?

The manifestation of high cholesterol range from no symptom to coronary heart disease or stroke. One can be asymptomatic and diagnosed with high cholesterol through a regular health check-up.

In another way, one can have symptoms or complications related to high cholesterol such as skin manifestations, heart attack, stroke, or peripheral vascular disease.

Besides, one should aware of high cholesterol when they are under high-risk groups such as high blood pressure, diabetes mellitus, overweight, smoking, and a family history of high cholesterol.

The definitive way to diagnose one person to have high cholesterol is through a blood test, which called a lipid profile. High total cholesterol can be diagnosed when the total cholesterol is more than 5.2mmol/L

Why high cholesterol bad for our body?

Cholesterol started to become detrimental when there is too much bad cholesterol (LDL) in our body. This bad cholesterol will start to accumulate in the vessel wall. Accumulation of cholesterol starts to form plaque which then narrows the blood vessel (Picture 1).

Long-term accumulation of plaque reduces the blood supply to our vital organs such as the heart, brain, and lower limb. One will start to experience chest pain, one-sided body weakness, loss of vision, or calf pain.

cholesterol blood vessel 1
Pic 1: Accumulation of cholesterol (formation of plaque) which narrows the blood vessel.

How can we prevent or lower the level of cholesterol through our daily habits?

According to American Heart Association, there are 4 main key lifestyle changes that can reduce the level of cholesterol

First, eat a healthy diet. As part of the cholesterol is comes from what you eat. In another world, reduce your fat intake especially trans fat and saturated fat. Examples of foods that high in trans fat and saturated fat are red meat, organ meat, processed food, fried food, and full-fat dairy products. It should be replaced by fruits and vegetables, poultry, fish, and food high in fiber.

Second, Get moving and start the exercise. Studies have shown that exercise able to reduce bad cholesterol (LDL) and increase good cholesterol (HDL). It’s recommended to have at least 150minutes/ week of low to moderate intensity or aerobic exercises such as brisk walking, exercise, cycling, and swimming.

Third, reduce your weight. Being overweight or obese tends to increase your bad cholesterol, LDL and reduce your good cholesterol, HDL. Hence, maintain a BMI of less than 23kg/m2 and reduce at least 5-10% of your body weight able to reduce the cholesterol level

Fourth, stop smoking and avoid passive smoking. smoking has shown to increase the risk of getting a heart attack, stroke, and peripheral vascular disease if the person is having high cholesterol.

What can we eat in high cholesterol??

Daily food nutrition also plays an important role in lowering our blood cholesterol.

Whole Grains. Researches have shown that whole grains should be emphasized in our diet to reduce the level of cholesterol. Examples of whole grains foods are brown rice, barley, oats, wheat and etc. Studies also recommend people reduce the intake of refined carbohydrates foods such as white rice.

Vegetable protein. Studies have recommended that around 15-20% of total calorie intake should be emphasized on vegetable proteins. Examples of vegetable proteins are tofu, tempeh, seeds, walnuts and etc.

Dietary Fiber. It is recommended to take at least 20-30g of fiber-rich foods per day especially the soluble fiber sources. Examples of fiber-rich foods are fruits, vegetables, whole grains, high-fiber cereals, oatmeal, legume, and beans.

Plant Sterols and Stanols. Plant sterols can help to reduce the absorption of cholesterol in our gut. Examples of plant sterols and stanols are wheat bran, wheat germ, fortified milk, peanuts, almonds, and vegetable oil.

Omega-3 fatty acid. Omega-3 fatty acids are recommended to people with high or very high cardiovascular risk such as diabetes, hypertension, chronic kidney disease, and smoking. It has shown to reduce the cardiovascular risk in these groups of people.

Cholesterol Drug. The last sort of choice to reduce the cholesterol is through medication if all of the above therapeutic lifestyle measures have failed. Cholesterol drug has been proven to be effective in controlling cholesterol. Always seek advice from your healthcare provider, as they will provide a good treatment plan that is suitable for you.

Lastly, always remind yourself about 3C in cholesterol which are Check, Change, Control. By taking good control of your cholesterol, will increases your overall well-being.


Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., … & Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology73(24), e285-e350.

Ministry of Health Malaysia (2017). Clinical Practice Guidelines on Management of Dyslipidemia 2017 (5th ed.).

Ministry of Health Malaysia (2020). National Health and Morbidity Survey 2019: Non-communicable diseases, healthcare demand, and health literacy. Retrived from http://iptk.moh.gov.my/images/technical_report/2020/4_Infographic_Booklet_NHMS_2019_-_English.pdf

Walker, B. R., & Colledge, N. R. (2013). Davidson’s principles and practice of medicine e-book (22nd ed.). Elsevier Health Sciences.

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