Heart-healthy Malaysian meal with grilled mackerel and lime, brown rice, fresh ulam greens, oats with banana and mixed nuts

Kolesterol Tinggi: Normal Levels, Signs & How to Lower It

Kolesterol tinggi (high cholesterol) means you have too much of a fatty substance called cholesterol in your blood, which can block blood vessels and raise your risk of heart attack and stroke. It is very common: Malaysia's 2023 National Health and Morbidity Survey found that about 1 in 3 adults (33.3%) had high cholesterol. It usually causes no symptoms, so the only way to know is a blood test. As a guide for healthy adults, total cholesterol should be below 5 mmol/L, but your personal target depends on your overall heart risk. Eating less saturated fat, eating more fibre such as oats, exercising regularly, stopping smoking and limiting alcohol all help, and some people also need medicine such as statins. This guide explains how to read your results, the causes, how to lower cholesterol, and what to know about medicines.

What is kolesterol tinggi?

Cholesterol is a fatty substance your body needs to make hormones and vitamin D. Problems start when there is too much of it in your blood. According to the NHS, too much cholesterol can block your blood vessels and make you more likely to have heart problems or a stroke.

There are different types of cholesterol in a blood test:

  • LDL cholesterol ("bad" cholesterol, kolesterol jahat): the main type that builds up in artery walls. It is the main target of treatment.
  • HDL cholesterol ("good" cholesterol): higher levels may make you less likely to have heart problems or a stroke.
  • Non-HDL cholesterol: total cholesterol minus HDL, which includes LDL and other harmful types.
  • Total cholesterol: the overall amount.

High cholesterol is very common in Malaysia. In the 2023 National Health and Morbidity Survey, 33.3% of adults, almost 7.5 million people, had high cholesterol, and many younger adults with it did not know.

Are there signs of high cholesterol?

Usually not. The NHS says high cholesterol does not usually cause symptoms, and you can only find out if you have it from a blood test. Searches for "tanda kolesterol tinggi" or "simptom kolesterol tinggi" often list tiredness, headaches or neck pain, but these are not reliable signs; people can feel completely well while their cholesterol is high.

Some people ask about "biji kolesterol", yellowish lumps or patches on the eyelids or skin. These can have several causes; if you notice them, ask a doctor to check your cholesterol rather than guessing.

Because there are usually no warning signs, regular checks matter, especially if you are over 40, have diabetes, high blood pressure, are overweight, smoke, or have a family history of heart disease or high cholesterol.

Bacaan kolesterol normal: what your results mean

The NHS gives this guide for healthy adults:

Result Healthy level
Total cholesterol Below 5 mmol/L
HDL (good cholesterol) Above 1.0 mmol/L for men, above 1.2 mmol/L for women
Non-HDL (bad cholesterol) Below 4 mmol/L

Your LDL target depends on your risk. In Malaysia, doctors set LDL targets according to your overall cardiovascular risk, which they estimate from factors such as age, sex, blood pressure, smoking, diabetes and cholesterol levels. Under the 2017 Malaysian Clinical Practice Guidelines on dyslipidaemia, as summarised by Malaysian specialists in 2023:

Cardiovascular risk LDL cholesterol target
Low or moderate Below 3.0 mmol/L
High 2.6 mmol/L or below, or a reduction of more than 50%
Very high (for example, after a heart attack or stroke) Below 1.8 mmol/L, or a reduction of more than 50%

Newer guidance recommends even lower LDL targets for people at high or very high risk, so ask your doctor what your own target is. Do not compare your result only with the "normal" range printed on a lab report.

What causes high cholesterol?

According to the NHS, high cholesterol (punca kolesterol tinggi) can be caused by:

  • eating fatty food, especially food high in saturated fat;
  • not exercising enough;
  • being overweight;
  • smoking;
  • drinking alcohol.

You are also more likely to have high cholesterol if you are over 50, a man, have been through the menopause, are of South Asian origin, or it runs in your family. An inherited form, familial hypercholesterolaemia, causes very high cholesterol from a young age, so tell your doctor if relatives had heart problems early.

How to lower your cholesterol

Lifestyle changes are the foundation for everyone (cara turunkan kolesterol). The NHS recommends:

1. Eat less saturated fat. Cut down on fatty meat, sausages, butter, lard and ghee, cream and cheese, cakes and biscuits, and food containing coconut oil or palm oil. In Malaysian meals, that often means fewer deep-fried dishes, less santan-rich curries and gulai, and less ghee-heavy food.

2. Eat more of these:

  • oily fish, such as mackerel (ikan kembung) and salmon;
  • unsaturated oils, such as olive oil and rapeseed (canola) oil;
  • brown rice, wholegrain bread and wholewheat pasta;
  • nuts and seeds;
  • fruit and vegetables.

3. Add oats. Oats contain beta-glucan, a soluble fibre. A meta-analysis of 58 trials found that about 3.5 g of oat beta-glucan a day lowered LDL cholesterol by about 0.19 mmol/L. That is a modest effect, but it adds up with other changes.

4. Exercise more. Aim for at least 150 minutes of moderate activity, such as brisk walking, swimming or cycling, or 75 minutes of vigorous activity a week. Our guide to exercise for weight loss has ideas to get started.

5. Stop smoking, which raises cholesterol and the risk of heart attack, stroke and cancer.

6. Cut down on alcohol. The NHS advises not regularly drinking more than 14 units a week.

7. Manage your weight. Being overweight makes high cholesterol more likely. Our Malaysian food calories guide and healthy meal planning guide can help you plan meals.

Be wary of "petua turunkan kolesterol dengan cepat" or supplements that promise fast results. Lifestyle changes take weeks to months to show in a blood test, and they work best when kept up long term.

Ubat kolesterol: statins and other medicines

You might need medicine if your cholesterol has not gone down after changing your diet and lifestyle, or if you are at high risk of a heart attack or stroke. According to the NHS:

  • Statins are the most common medicine. They reduce the amount of cholesterol your body makes and are usually taken once a day, long term.
  • Other medicines, such as ezetimibe tablets or injections, may be used if statins do not work well enough or you cannot take them.
  • Statins should not be taken during pregnancy or when trying to get pregnant, or by women of childbearing age who are not using contraception.

What about side effects (kesan sampingan ubat kolesterol)? Muscle pain is the most feared side effect, but it is much less common than many people think. A 2022 analysis of individual data from 19 double-blind trials (nearly 124,000 people) comparing statins with placebo found that statins caused only a small excess of mostly mild muscle pain, mainly in the first year, and that more than 90% of muscle symptoms reported by people taking statins were not actually caused by the statin. If you have side effects, talk to your doctor before stopping; there are usually other options.

High cholesterol in women

Women are more likely to have high cholesterol after the menopause, which the NHS lists as a risk factor. A healthy HDL level is also higher for women (above 1.2 mmol/L). Some conditions that affect women, such as polycystic ovary syndrome, are linked to a higher risk of unhealthy cholesterol levels; see our guide to PCOS symptoms. Have your cholesterol checked as part of regular health screening, especially from midlife.

Frequently asked questions (FAQ)

What is a normal cholesterol reading (bacaan kolesterol normal)?

As a guide for healthy adults, the NHS lists total cholesterol below 5 mmol/L, HDL (good) cholesterol above 1.0 mmol/L for men or 1.2 mmol/L for women, and non-HDL cholesterol below 4 mmol/L. Your personal LDL target depends on your heart risk; Malaysia's 2017 dyslipidaemia guideline set LDL below 3.0 mmol/L for low and moderate risk, and lower targets for people at high risk.

What are the signs of high cholesterol (tanda kolesterol tinggi)?

High cholesterol does not usually cause symptoms. The only way to know is a blood test. That is why many people do not know they have it: in Malaysia's 2023 national health survey, about one in three adults had high cholesterol.

What causes high cholesterol (punca kolesterol tinggi)?

High cholesterol is more likely if you eat a lot of fatty food, do not exercise enough, are overweight, smoke or drink alcohol. It is also more likely if you are over 50, a man, have been through the menopause, are of South Asian origin, or have a family history of high cholesterol.

How can I lower my cholesterol quickly (cara turunkan kolesterol)?

Eat less saturated fat (such as fatty meat, butter, ghee, coconut oil and palm oil), eat more wholegrains, oily fish, nuts, fruit and vegetables, exercise at least 150 minutes a week, stop smoking and cut down on alcohol. Oats can help: about 3.5 g of oat beta-glucan a day lowered LDL cholesterol in a meta-analysis. Some people also need medicine.

Do statins (ubat kolesterol) cause muscle pain?

Sometimes, but much less often than people think. A large analysis of over 150,000 people in double-blind trials found statins caused a small excess of mostly mild muscle pain, and more than 90% of muscle symptoms reported by people taking statins were not caused by the statin. Talk to your doctor before stopping.

Is high cholesterol common in women?

Yes. The NHS lists having been through the menopause as a risk factor for high cholesterol. Women should have their cholesterol checked as part of regular health screening, especially from midlife.

How often should I check my cholesterol?

Ask your doctor, because it depends on your age and risk. Many adults have it checked during routine health screening at a klinik kesihatan or private clinic, and more often if they have diabetes, high blood pressure, a family history of high cholesterol or heart disease, or are on treatment.

Disclaimer

This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor or pharmacist. Health supplements are not intended to diagnose, treat, cure or prevent any disease.

References

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