"Doctor, How’s My Cholesterol?"
By Dr. Sandy
A typical day in my clinic goes something like this: Mrs. Lim, a cheerful retiree with a soft spot for nasi lemak and kuih lapis, strolls in for her routine check-up. After a quick chat about her grandkids, she asks, "Doctor, how’s my cholesterol this time?"
Ah, cholesterol—everyone’s favorite health buzzword. But the real question isn’t just about the numbers; it’s about how those numbers affect your heart health. That’s where ASCVD (Atherosclerotic Cardiovascular Disease) risk analysis comes in—a tool that predicts your chances of heart attacks or strokes. Think of it as a science-backed crystal ball for your heart.
When I look at Mrs. Lim’s results, I don’t just focus on her LDL (low-density lipoprotein, or "bad" cholesterol). I also consider her age, blood pressure, blood sugar, and lifestyle. All of these go into the ASCVD risk calculator to give us a clearer picture of her cardiovascular health.
Why Risk Analysis Matters
Research shows lowering LDL cholesterol is key to reducing heart disease risk. Statins often take center stage for high-risk individuals, but they’re not magic pills. Medications work best when paired with lifestyle and dietary changes.
Mrs. Lim’s ASCVD risk score came back moderately high, meaning we needed a two-pronged approach: a healthy diet and, if necessary, medication.
“But Doctor, I Avoid Fried Food!”
Here’s the part where patients look confused when I suggest dietary changes. Many think skipping fried chicken solves the problem. While that’s a great start, it’s not the whole picture.
Take Mrs. Lim’s breakfast: white bread with kaya and a sweet teh tarik. Delicious, yes, but it spikes blood sugar and worsens inflammation—both of which are bad for cholesterol.
I suggested a few easy swaps:
- Bread: Replace white bread with multigrain or whole grain.
- Spread: Swap kaya for avocado or peanut butter (unsweetened).
- Drink: Cut down sugar in teh tarik or switch to black coffee.
Fiber and Healthy Fats: Your Heart’s Best Friends
One of the easiest ways to lower cholesterol is eating more fiber. Foods like oats, barley, fruits, and vegetables help reduce LDL by binding to it in the gut and flushing it out.
Healthy fats are another win. Many panic at the word “fat,” but not all fats are the enemy. Omega-3 fatty acids in fish, nuts, and seeds are heart-friendly. Even a simple Malaysian favorite, ulam (raw herbs and vegetables), paired with sambal made from olive oil, can do wonders.
For Mrs. Lim, I recommended adding chia seeds to her yogurt and replacing regular cooking oil with olive or canola oil.
Personalized Care with ASCVD Risk Analysis
The beauty of ASCVD risk analysis is its personalized approach. For Mrs. Lim, her moderately high risk meant we combined diet changes with a low-dose statin. But if she were frail or had other health issues, we might reconsider medication.
For younger patients or those with family histories of high cholesterol, lifestyle interventions take center stage. Studies show that consistent exercise, calorie moderation, and dietary adjustments are powerful tools—even for children with genetic predispositions.
Small Changes, Big Results
At her follow-up, Mrs. Lim came in beaming. She’d swapped white rice for brown, started evening walks, and cut down her teh tarik habit to once a week. Her LDL dropped, and her ASCVD risk score improved.
It’s stories like hers that remind me why I love my job. As a doctor, my role isn’t to scold—it’s to guide. Life is meant to be enjoyed, but small, mindful choices make a big difference.
So, next time you’re at your favorite hawker stall, think about what you can tweak. Maybe swap that sugary drink for water or add some veggies to your plate. Your heart will thank you. And when you visit your doctor, don’t just ask about cholesterol. Ask, “How’s my heart?”
Takeaways:
- Diet Matters: Fiber and healthy fats can help reduce cholesterol.
- ASCVD Risk Analysis: This personalized tool looks beyond cholesterol numbers.
- Small Steps Count: Sustainable changes lead to lasting health benefits.
Your health isn’t about perfection—it’s about progress. Small wins add up, one bite at a time.
Dr. Lee Pei San ( Dr. Sandy Lee)
M.D. (USM)
MMED candidate in sexual and reproductive health (SYD, AUS)
Singapore