Lipid Disorders
Lipid disorders, also known as dyslipidaemia, occur when lipid levels in the blood are abnormal. In Singapore, the estimated prevalence of dyslipidaemia among adults is 48.1%, with about 20% unaware that they have the condition and about 40% meeting criteria for lipid-lowering therapy1. When lipid levels are imbalanced, harmful deposits called plaques can develop within the blood vessels, increasing the risk of cardiovascular disease over time.
Individuals with lipid disorders can benefit from a detailed assessment and an evidence-informed treatment plan. At LG Endocrinology, our approach focuses on identifying the metabolic and hormonal factors that contribute to abnormal lipid levels while supporting you in strengthening your cardiovascular health. If you are concerned about elevated cholesterol or triglycerides, expert guidance is available to help you better control your lipid profile.
What Are Lipids?
Lipids include cholesterol, triglycerides, and fatty acids. They support essential functions such as forming cell membranes, producing hormones, and supplying energy. Maintaining healthy lipid levels is important for long-term cardiovascular health.
What Are The Types of Lipid Disorders?
Several major forms of dyslipidaemia affect individuals of different ages and health backgrounds, such as:
Hypercholesterolaemia (High Cholesterol)
Hypercholesterolaemia refers to elevated low-density lipoprotein (LDL) cholesterol. Excess LDL can contribute to the formation of plaque within blood vessels, leading to atherosclerosis.
Hypertriglyceridaemia (High Triglycerides)
Hypertriglyceridaemia occurs when triglyceride levels are raised. High triglycerides increase cardiovascular risk and may also trigger pancreatitis.
Familial Hypercholesterolaemia (FH)
Familial hypercholesterolaemia is a genetic condition that causes very high LDL levels from birth. Genetic mutations impair the body’s ability to clear LDL, significantly increasing the risk of early cardiovascular disease.
Mixed Dyslipidaemia
Mixed dyslipidaemia involves more than one abnormal lipid value. It is commonly associated with metabolic syndrome and diabetes.
What Are The Causes of Lipid Disorders?
Lipid disorders can develop due to a combination of genetic, lifestyle and medical factors. Understanding these causes helps guide effective prevention and treatment.
Family history has a strong influence on lipid levels. For example, inherited conditions such as familial hypercholesterolaemia result in very high LDL levels from childhood because the body is unable to clear cholesterol effectively.
Diets high in saturated fats and trans fats can raise LDL cholesterol and triglycerides, especially when combined with limited physical activity, which lowers protective HDL. Excess weight, particularly around the abdomen, further promotes insulin resistance and increases the likelihood of dyslipidaemia.
Other risk factors, such as smoking, reduce good HDL and damage blood vessels. Excessive alcohol intake can also raise triglycerides and strain the liver, which disrupts normal lipid metabolism.
Conditions such as diabetes, hypothyroidism, kidney disease, and metabolic syndrome can alter lipid metabolism. These disorders disrupt hormonal balance or key metabolic pathways that regulate cholesterol and triglycerides. Proper management of these conditions often leads to improvements in lipid levels.
Certain medications can influence lipid levels. For instance, steroids, antipsychotics, diuretics, hormonal therapy, and immunosuppressants may affect metabolic processes that control lipid balance. Reviewing medication regimens is advisable if lipid levels rise unexpectedly.
What Are The Symptoms of Lipid Disorders?
Lipid disorders often develop silently and may not cause noticeable symptoms in the early stages. As the condition progresses, certain warning signs may appear, indicating the need for medical evaluation. Common symptoms include:
- Chest pain or angina
- Shortness of breath
- Palpitations (irregular heartbeat)
- Yellowish deposits under the skin, known as xanthomas, often around the eyes or on the hands and feet
How Are Lipid Disorders Diagnosed?
Diagnosing lipid disorders in Singapore involves evaluating overall health, identifying contributing factors and measuring specific lipid values to assess cardiovascular risk.
The assessment begins with a review of family history, lifestyle habits and general health status. This helps identify factors that may contribute to dyslipidaemia, such as genetics, dietary patterns or underlying medical conditions.
Abnormal LDL, HDL, or triglyceride levels can indicate an increased likelihood of cardiovascular disease. A lipid profile measures total cholesterol, LDL, HDL, and triglycerides, providing a clear overview of lipid status. The findings are compared with target ranges that are tailored to an individual’s overall cardiovascular risk.
Note:
Before the tests, fasting for 9 to 12 hours may be recommended to improve the accuracy of triglyceride and LDL results.
Further assessments, such as apolipoprotein B, lipoprotein(a), high-sensitivity C-reactive protein (hs-CRP), or coronary calcium scans, may be used to gain more detailed information if initial lipid profiles are not fully conclusive. Some individuals may also require genetic testing or evaluations for underlying health conditions. These tests are particularly useful for those with strong risk factors or suspected familial hypercholesterolaemia.
What Are The Complications of Untreated Lipid Disorders?
Untreated lipid disorders can lead to several serious health problems. Here are the key complications that may develop over time if high cholesterol or triglyceride levels are not addressed.
- Atherosclerosis: High LDL cholesterol promotes plaque formation in the arterial walls, which gradually narrows the arteries and restricts blood flow.
- Coronary artery disease: Plaque buildup in the coronary arteries reduces blood supply to the heart and increases the risk of angina or heart attacks.
- Peripheral artery disease: Plaque deposition in the arteries of the legs reduces circulation to the limbs and causes pain or slow healing.
- Stroke: Plaque formation in blood vessels supplying the brain makes blockages more likely, leading to stroke.
- Arterial stiffness: Chronic exposure to high cholesterol damages the arterial wall, causing it to stiffen. Over time, this can result in higher blood pressure.
- Hypertriglyceridaemia: Very high triglyceride levels can overwhelm the pancreas and trigger inflammation, leading to pancreatitis.
- Metabolic syndrome: Abnormal lipid levels often coexist with abdominal obesity, high glucose, and elevated blood pressure, collectively raising cardiovascular and metabolic risk.
Who Should Be Treated for Lipid Disorders?
Treatment plans are personalised. You may be advised to consider treatment if you:
- Have a history of heart attacks or strokes
- Have diabetes or chronic kidney disease
- Have persistently high cholesterol levels
- Have a family history of early heart disease
- Have a moderate to high 10-year cardiovascular risk
What Are The Treatment Options For Lipid Disorders?
Managing lipid disorders involves a combination of lifestyle changes, targeted medical therapy, and regular monitoring. Treatment is tailored to each individual’s cardiovascular risk profile, underlying health conditions, and specific lipid abnormalities. This section outlines the approaches commonly used to restore healthier lipid levels and reduce long-term cardiovascular risk.
Lifestyle modifications form the cornerstone of lipid disorder management. These changes work alongside medical therapy to improve cholesterol and triglyceride levels, reduce cardiovascular risk, and support long-term metabolic health.
- Heart-healthy diet: This includes reducing saturated fats and increasing fibre, whole grains, fruits, vegetables, and healthy fats.
- Regular aerobic activity: At least 150 minutes of weekly aerobic exercise supports cardiovascular health and helps improve lipid levels.
- Keeping a healthy weight: Maintaining a sustainable and healthy weight improves lipid balance and reduces cardiovascular risk.
- Smoking cessation: Quitting smoking improves HDL levels and supports healthier blood vessels.
- Alcohol moderation: Limiting alcohol intake helps prevent spikes in triglyceride levels.
Medications play a crucial role in managing lipid disorders, especially when lifestyle changes alone are not enough to achieve healthy cholesterol or triglyceride levels. These treatments target specific lipid abnormalities depending on the patient’s condition.
- Statins: These are the first-line treatment for lowering LDL cholesterol.
- Fibrates: These are prescribed to lower triglyceride levels.
- Ezetimibe: This medicine reduces the absorption of cholesterol in the intestine.
- PCSK9 inhibitors: These are used for severe LDL elevation or familial hypercholesterolaemia.
- Inclisiran: A newer injectable therapy that reduces LDL by lowering PCSK9 production, it is administered infrequently (every several months after initial doses). May be considered for high-risk individuals or FH after specialist assessment
- Combination therapy: This may be required when multiple lipid abnormalities are present.
The choice of pharmacological treatment should be guided by your estimated 10-year cardiovascular risk, which influences statin intensity and the type of combination treatment recommended.
Genetic counselling is an important part of managing familial hypercholesterolaemia, as it helps individuals understand inheritance patterns and the associated cardiovascular risks. Screening first-degree relatives is encouraged as well, so that early treatment can be offered where needed.
Ongoing monitoring is essential to ensure that treatment remains effective over time. Regular lipid tests are especially important during the initial stages of management to track progress and guide adjustments.
Stabilising underlying health conditions such as diabetes, hypothyroidism, or kidney disease can significantly improve lipid levels. Effective treatment of these conditions supports better metabolic control and contributes to overall cardiovascular health.
Read more about managing lipid levels from ACE Clinical Guidance.
Our Trusted Endocrinologist
Dr Linsey Gani
Consultant Endocrinologist
MBBS (Aust), B Med Sci, FRACP (Endocrine), FAMS (S’pore), MPH (Harvard), Clinical Assistant Professor (Duke-NUS Medical School)
Languages: English, Mandarin, Bahasa Indonesia
Dr Gani is a skilled endocrinologist with experience managing lipid disorders. She is a fellow of the Royal Australian College of Physicians and the Academy of Medicine, Singapore.
Why Choose Us?
At LG Endocrinology, we provide expert care for lipid disorders, including high cholesterol, familial hypercholesterolaemia, and hypertriglyceridaemia. Treatments are designed to suit your health needs and personal goals.
Our approach is based on robust clinical guidelines and research to manage lipid levels effectively. This includes lifestyle strategies, medications, and regular monitoring to reduce the risk of heart disease and other complications.
Dr Linsey Gani is an experienced endocrinologist with expertise in diagnosing and managing complex lipid disorders. She offers detailed assessments, tailored treatment plans, and ongoing follow-up to support optimal heart and metabolic health.
FAQs About Lipid Disorders
Are lipid disorders reversible?
Yes, many lipid disorders can be improved and, in some cases, reversed. However, this depends on the underlying cause. Lifestyle changes such as regular exercise and a heart-healthy diet are essential for improving lipid levels. Some individuals may also need medication, and early intervention improves long-term outcomes.
Is there a way to prevent familial hypercholesterolaemia (FH)?
No, familial hypercholesterolaemia cannot be prevented because it is inherited. However, the heart complications linked to FH can be managed and reduced. Getting an early diagnosis and treatment is essential to avoid premature and aggressive heart disease, atherosclerosis, and heart attacks.
How often should lipid levels be checked?
Adults are generally advised to have their lipid levels checked once every 3 years. Those with higher risk factors, such as a family history of heart disease or existing health conditions, may need more frequent testing to monitor and manage their lipid levels effectively.
Disclaimer
This information is provided for general education. It does not replace personalised medical advice. Please consult your doctor for guidance on the medications that may be appropriate for you.
1 Retrieved from National Library of Medicine
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Monday - Friday
08:30 - 12:30
14:00 - 17:30
09:00 - 12:00
Closed