Hard-to-Control Cholesterol Treatment in Singapore
- Dr Chan Po Fun
- Oct 18, 2025
- 4 min read
Writer: Dr Chan Po Fun, Consultant Cardiologist
Why Your Cholesterol Stays High, Even After Doing Everything Right
Doctor, I’ve cut down on fried food, I walk every day. Why is my cholesterol still high?
You’ve cut down on fried food, you walk regularly, and you’ve been taking your medication faithfully. Yet your cholesterol still refuses to drop.
If this sounds familiar, you’re not alone.
Hard-to-control cholesterol (also called difficult-to-treat or resistant cholesterol) is far more common than people think, especially in Singapore, where genetics, hormones, and stress play a big part.
What Is Hard-to-Control Cholesterol?
Hard-to-control cholesterol means your LDL (“bad”) cholesterol stays high even after you’ve made lifestyle changes and taken standard medication.
In many cases, this happens because of:
Familial Hyperlipidaemia (FH): inherited high cholesterol present from birth — like a “family recipe” passed down unintentionally. Affects 1 in 250 people.
Hormonal or metabolic changes: menopause, thyroid imbalance, or insulin resistance can slow cholesterol clearance.
Medication tolerance: some people cannot process statins well — just like how some react strongly to coffee or painkillers.
Lifestyle triggers: late meals, poor sleep, or ongoing stress can keep cholesterol high despite good habits.
Some patients are also unable to tolerate statins, the most common cholesterol-lowering drugs, due to side effects like muscle pain, fatigue, or brain fog. This makes long-term control challenging.
If your cholesterol seems “immune” to effort, it’s not your fault. Your body’s wiring may just need a different approach.
When Statin Side Effects Get in the Way
Some patients describe statins as “a love-hate relationship.”
They know it helps their heart, but the muscle aches or fatigue make it hard to stay consistent.
Common symptoms include:
Muscle pain or cramps (especially in the thighs or arms)
Fatigue or poor-quality sleep
Brain fog or memory lapses
Imagine trying to go for a jog in heavy shoes. You can do it, but it feels harder every step. That’s how statin intolerance feels for some people -- tiring, frustrating, and discouraging.
But we have alternatives:
Switching to hydrophilic statins (gentler on muscles)
Adding Co-enzyme Q10 for muscle support
Using low-dose combinations to minimise side effects
Transitioning to injection-based therapies like PCSK9 inhibitors (Evolocumab, Alirocumab) and Inclisiran (Leqvio®), which skip the liver entirely
The goal isn’t just lower cholesterol levels. It’s helping you stay healthy enough to live your life fully.
When Tablets Aren’t Enough — New Cholesterol Treatments
If tablets haven’t done the job, new therapies can offer a breakthrough.
Think of them as “precision tools”. Rather than hammering away at the same nail, they target the exact pathway that keeps LDL-C high.
Treatment | How It Works | Frequency | Typical LDL-C Reduction |
PCSK9 inhibitors (Evolocumab, Alirocumab) | “Antibody bodyguards” that block cholesterol buildup | Every 2–4 weeks | 50–60 % |
Inclisiran (Leqvio®) | Silences the gene that tells your liver to make LDL cholesterol | Twice a year | 45–55 % |
Ezetimibe / Bempedoic Acid | Non-statin tablets that lower LDL in a different way | Daily | 20–30 % |
These are especially useful for:
Familial hyperlipidaemia (genetic cholesterol)
Statin-intolerant patients
Those whose LDL-C goals aren’t met despite best efforts
When to See a Specialist
Book a review if:
Cholesterol remains high (> 3.0 mmol/L) despite medication and effort
You have a family history of early heart disease
You’ve stopped medication due to side effects
You have diabetes, thyroid, or kidney issues but cholesterol stays high
Early assessment is like checking your car engine before a long drive. It prevents trouble before it happens.
Lifestyle Still Matters.
Lifestyle is the foundation to keep your treatment growing strong. Even when genetics play a role, healthy habits amplify the benefit of medication.
Eat smart: think less fried, more fibre.
Move often: aim for 150 minutes of activity weekly — like a brisk 30-minute walk five days a week.
Manage stress: constant stress releases cortisol, which raises cholesterol.
Sleep well: lack of rest upsets your metabolism the same way a tired phone battery drains faster.
Small steps, done consistently, lead to long-term heart protection.
Common Questions from My Patients
Q: Why does my cholesterol stay high even with medicine?
A: Some people have inherited genes or hormonal patterns that make cholesterol resistant to treatment. Adjusting therapy often solves this.
Q: What if I can’t take statins?
A: There are newer, well-tolerated options, like PCSK9 inhibitors or Inclisiran, that work differently and don’t cause muscle aches.
Q: Can I fix high cholesterol through diet modifications alone?
A: Diet is essential, but for genetic or resistant cholesterol, medication is usually needed to reach safe levels.
Q: How do I know if I have familial hyperlipidaemia?
A: If your cholesterol has always been high or a family member had early heart disease, a lipid profile or genetic test can confirm it.
You Don’t Have to Struggle Alone
If you’ve done everything right and your cholesterol still refuses to budge, it’s time to look deeper.
Dr Chan Po Fun, a cardiologist in Singapore, focuses on helping patients with difficult-to-control cholesterol, familial hyperlipidaemia, and statin intolerance achieve safe, comfortable, and sustainable results.
Clinics:
Mount Alvernia Hospital
# 05-51 Medical Centre D, 820 Thomson Road, Singapore 574623
Gleneagles Hospital
Annexe Block # 03-37C, 6A Napier Road, Singapore 258500
About Dr Chan Po Fun
Dr Chan Po Fun is a consultant cardiologist in Singapore with special expertise in lipid disorders, women’s heart health, and cardio-oncology. She helps patients with hard-to-control cholesterol and statin intolerance achieve safe, sustainable heart protection through personalised, empathetic care.
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