Dr Hilda Ganesen

Female Family Physician

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Dyslipidaemia or hyperlipidaemia is a medical term used to describe a high total cholesterol (TC), high low density lipoprotein(LDL) or high Triglyceride ( TGA) levels.

A practical approach to high cholesterol test results

  1.  Have you random finger prick cholesterol is done (done at most wellness days or pharmacies)? Were you told it was raised? If the reading was greater than 5mmol/l you should go see your doctor (preferably fasted to do blood tests) to discuss the results.


  2. Your doctor will do a full medical examination, a lipogram and a risk assessment called the Framingham risk assessment. 
    • A lipogramis a fasting blood test that is sent to a lab that consists of:
      •  Low density lipoprotein (LDL)  : Target LDL is less than 2mmol/l.  Most of the cholesterol in the blood is carried by LDL. This is known as the bad cholesterol because it combines with other substances to clog the arteries. A diet high in saturated fats and trans fats tends to raise the level of LDL cholesterol. Your level of LDL cholesterol should be under 2 mmol/L.
      • High density lipoprotein(HDL): Target HDL is greater than 2mmol/l. Up to a third of blood cholesterol is carried by HDL. This is called good cholesterol because it helps remove bad cholesterol, preventing it from building up inside the arteries. The higher the level of HDL cholesterol, the better. People with too little are more likely to develop heart disease. Eating healthy fats, such as olive oil, may help boost HDL cholesterol.
      • Triglycerides(TGA): Target is less than 1.7mmol/l. The body converts excess calories, sugar and alcohol into triglycerides, a type of fat that is carried in the blood and stored in fat cells throughout the body. People who are overweight, inactive, smokers or heavy drinkers tend to have high triglycerides, as do those who eat a very high-carb diet. Levels exceeding 2 mmol/L may be associated with increased risk of heart disease.


  1. Your doctor will decide if the high cholesterol readings are secondary to another medical condition and may request a few additional tests.
    • Secondary causes of dyslipidaemia:
      1. Diabetes Mellitus
      2. Hypothyroidism
      3. Liver disease
      4. Kidney disease
      5. Excessive alcohol consumption
      6. Medications:
        • Progestins: found in contraceptives
        • Steroids: such as prednisone
        • Antiretroviral treatment: used to treat HIV
        • Retinoids : used to treat acne eg: Roccutane, Oratane

  1. Your doctor will set out treatment goals ie:  target Total cholesterol and LDL needed for you.  Your Framingham risk assessment will be done.  The risk assessment will determine your treatment goals. You may also be referred to a dietitian for a more detailed analysis of your current diet and changes required. 

  1. Treatment is prescribed

  1. Follow up in 8 weeks to monitor the cholesterol levels.


Management of high cholesterol

There are 5 major interventions to consider:

  1. Dietary intervention
  • It is advised that you see a dietitian for a comprehensive assessment and management.
  • Understand your fats and fibres.

Fats are nutrients in the diet that give you energy.  Fats have 9 calories in each gram.   Trans Fats: Artificial Trans fats are formed when oils are hydrogenated which makes the oil more solid.  It is also referred to as hydrogenated fat. Found in biscuits and cakes to prolong the shelf life. It is also used to fry food. Fats can be saturated or unsaturated.



  • Soluble fibre: Found in legume, fruit, vegetables, whole grains and oats.  It can help reduce cholesterol. The major soluble fibres are B glucan ( found in oats, barley and yeast),psyllium ( found in husks of blonde psyllium seeds), pectin ( found in fruit) and gums.
  • Insoluble fibre: Found in wholegrain products, nuts and skins and pips of vegetables and fruit.
  • Balance your total caloric intake with physical activity
  • Consume a diet rich in fruit and vegetables
  • Choose whole grain high fibre foods
  • Consume fish especially oily fish at least twice a week: Found in Salmon, mackerel pilchards and sardines.
  • Limit the intake of saturated fat to 7% of the total energy, trans fats to 1% of energy and cholesterol to 300mg/day
  • Minimise intake of trans fats in the diet.
  • Minimise your intake of beverages and foods with added sugars:  Added sugar maybe labelled as sucrose, corn syrup and high fructose.
  • Choose and prepare foods with little or no salt.
    • Choose low sodium or no salt added versions of foods
    • Choose fresh or frozen vegetables.
    • Use poultry , fish, lean meat instead of canned ,processed or cured foods
    • Limit cured foods ( bacon/ham), food packed in brine ( pickles, sauerkraut) and condiments ( sauces, soy sauce, teriyaki sauce)
    • Cook rice and pasta without salt.  Avoid instant flavoured rice and pastas
    • Avoid take away foods
    • When using canned foods, rinse the contents to decrease the salt content.
    • Use spices instead of salt to flavour food.
  • Ideally it is advised not to consume alcohol. When consuming alcohol have a meal with it.
    • Men: Limit to no more than two drinks per day
    • Women : Limit to one drink per day.

2.  Physical activity

  • Before starting an exercise programme make sure you have a physical exam done by a doctor.
  • Exercise occur at least 5 days of the week.
  • Exercise must consist of  endurance type training ( running, swimming, cycling) and resistance training.
  • The duration of each exercise session should be about 45 minutes.


3.  Stress Management

  • Stress is known to increase cortisol levels in the body which interferes with lipid metabolism.


4.  Stop smoking

  • Consider behavioural therapy and/or medication to assist with smoking cessation.  Smoking is a modifiable risk factor. Smoking cessation that can help decrease the risk of heart disease.


5.  Medication

  • The commonly used medications are the statins used to lower LDL. However, there are side effects experienced with this class of drugs.Your doctor will advise you accordingly.