Cholesterol Isn’t Only an Old-People Problem: When Should You Check Yours?

Cholesterol Isn’t Only an Old-People Problem: When Should You Check Yours?

Cholesterol is often called a “silent killer” because it can quietly build up in your arteries for years, increasing your risk of heart attack and stroke—without any obvious symptoms. Many Singaporeans assume cholesterol checks are only necessary after 40, but new expert advice and local health trends suggest we should be starting much earlier. Here’s what you need to know, with a focus on Singapore’s unique context.

Why Early Cholesterol Checks Matter in Singapore

Leading cardiologists recommend that adults have their cholesterol checked for the first time at age 20, especially if there is a family history of heart disease. The recommended test is a fasting lipid profile, which measures total cholesterol, LDL (“bad” cholesterol), HDL (“good” cholesterol), and triglycerides. If your results are normal, you can wait four to six years before your next test. However, if you have risk factors—such as a family history of heart disease, diabetes, high blood pressure, or obesity—you should be screened earlier and more frequently.

Singapore’s fast-paced, urban lifestyle means many of us are at risk of developing high cholesterol earlier than we might expect. Sedentary desk jobs, high-stress environments, and easy access to rich, processed foods all contribute to rising cholesterol levels among young adults. Local statistics highlight the urgency: Cardiovascular disease (CVD) is the leading cause of death in Singapore, accounting for nearly 1 in 3 deaths in 2022, according to the Singapore Heart Foundation. The 2019 National Population Health Survey found that 33.6% of Singapore residents aged 18 to 74 had high blood cholesterol (defined as total cholesterol ≥ 5.2 mmol/L). Alarmingly, the prevalence of high cholesterol among those aged 30 to 39 was already 26.2%, showing that this is not just an issue for older adults. Early cholesterol screening is especially important for Singaporeans of South Asian and Malay descent, as studies show these groups are genetically predisposed to higher cholesterol and heart disease risk, even at a young age.

Who Is More at Risk—and What Can You Do?

While high cholesterol can affect anyone, certain groups in Singapore are at greater risk due to a combination of genetic, lifestyle, and health factors. If you have a family history of high cholesterol or early heart disease, you are more likely to develop high cholesterol yourself, sometimes due to inherited conditions like familial hypercholesterolaemia. Ethnicity also plays a role, with South Asians and Malays in Singapore facing a higher risk of metabolic conditions, including high cholesterol, often linked to both genetic factors and dietary patterns. Chinese individuals, while generally at a lower genetic risk, are still susceptible, especially with unhealthy lifestyle choices.

Lifestyle factors are significant contributors. An unhealthy diet, characterised by frequent consumption of processed foods, deep-fried hawker fare, and rich, creamy dishes, can raise cholesterol levels. A lack of physical activity, common with desk jobs, reduces HDL (“good”) cholesterol and increases LDL (“bad”) cholesterol. Obesity is another major factor; excess body fat, particularly around the abdomen, can alter how your body processes fats and sugars, leading to higher LDL and lower HDL levels. The 2019 National Population Health Survey indicated that 10.5% of Singapore residents aged 18-74 were obese. Smoking damages blood vessel walls and lowers HDL cholesterol, while excessive alcohol consumption can raise triglyceride levels.

Several existing health conditions also increase susceptibility. Individuals with diabetes often have higher triglyceride levels and lower HDL cholesterol, a combination that significantly increases heart disease risk. The prevalence of diabetes in Singapore was 11.3% among residents aged 18-74 in 2019. High blood pressure often co-exists with high cholesterol, dramatically increasing the risk of heart disease and stroke. Women with Polycystic Ovary Syndrome (PCOS) are at higher risk of developing high cholesterol, insulin resistance, and obesity. Kidney disease and hypothyroidism can also affect lipid metabolism, leading to elevated cholesterol and triglyceride levels. Furthermore, cholesterol levels naturally rise with age, though younger adults are increasingly affected. Before menopause, women tend to have lower LDL cholesterol than men, but levels often rise after menopause. Chronic stress and poor sleep can also disrupt metabolic processes and contribute to higher cholesterol and other cardiovascular risk factors.

One of the most dangerous aspects of high cholesterol is that it rarely causes symptoms until significant damage has occurred. Some late-stage signs—such as chest pain, fatty deposits around the eyes, or numbness in the limbs—only appear after years of silent buildup. This is why proactive testing is the only reliable way to monitor your cholesterol and prevent irreversible heart damage.

To maintain healthy cholesterol levels and reduce your risk of heart disease, consider these evidence-based lifestyle changes: Eat a balanced diet rich in fibre, whole grains, fruits, and vegetables, limiting trans fats, processed foods, and excessive red meat. Exercise regularly, aiming for at least 150 minutes of moderate activity per week, whether it’s brisk walking around your HDB estate or cycling at East Coast Park. Manage stress through mindfulness or a walk in Singapore’s green spaces. Avoid smoking and limit alcohol consumption, and prioritise 7–9 hours of sleep nightly. Lastly, schedule annual health check-ups, even if you feel healthy.

Singapore’s multicultural diet is both a blessing and a challenge. While there are plenty of healthy options, many local dishes like char kway teow, laksa, and fried chicken rice are high in saturated fats and cholesterol. Opt for healthier alternatives when possible, and be mindful of portion sizes. Additionally, Singapore’s Health Promotion Board (HPB) offers subsidised health screenings under the Screen for Life programme, making it easier and more affordable for residents to monitor their cholesterol and other key health indicators.

Cholesterol checks are not just for older adults. Starting at age 20, especially if you are in a high-risk group, can make a significant difference in your long-term heart health. Regular screenings, combined with healthy lifestyle habits, can protect you from serious complications down the line. Taking action in your 20s or 30s may reduce your chances of needing medication or facing cardiovascular procedures later in life. Your heart health is in your hands. Do not wait until it is too late—take the first step towards a healthier future today.