“I didn’t know I had high cholesterol”

High cholesterol and other lipid issues often go unnoticed, which is why regular cholesterol checks are so important. 

Screening helps catch problems early before symptoms appear – and gives you a better chance of protecting your heart in the long run.

When Michael* went to his company’s wellness day, he didn’t expect a simple finger-prick test to show that his cholesterol levels were abnormal. That small test result led to several lifestyle changes aimed at protecting his long-term health.

Dr Martin de Villiers, a specialist physician at Mediclinic Cape Town, says cases like Michael’s are very common. “Often, people with lipid abnormalities don’t experience any symptoms until they experience an event like a heart attack,” he says.

Lipid abnormalities simply mean that the levels of fats in your blood, such as cholesterol and triglycerides, are too high or out of balance. This raises your risk of developing heart disease.

That’s why regular screening for cholesterol is critical, Dr De Villiers insists. “It’s the only way we can find out if there are abnormalities, and what action is required.”

Why cholesterol screening is important

Dr De Villiers explains that screening for lipid abnormalities is quick and easy and can be done by a nurse or pharmacist. A small drop of blood is taken and tested using a handheld device, which shows your total cholesterol levels. “These tests are increasingly sophisticated, so that even a basic screen can measure specific cholesterol molecules,” he says.

This matters because it helps your doctor understand exactly what kinds of cholesterol are in the high range in your blood. For example, a high level of low-density lipoprotein (LDL) – the “bad” cholesterol – can be a warning sign, as it can form plaque in your arteries and increase your risk of heart disease and stroke.

Your specialist will need this information to determine the most appropriate treatment.

Guarding against high cholesterol

Dr De Villiers says treatment focuses on managing lipid levels to prevent atherosclerosis, a condition where fatty plaques build up in the arteries. As these plaques grow, they narrow the arteries and slow blood flow. If a plaque ruptures, it can trigger a heart attack or stroke.

In many cases, simple lifestyle changes are enough to bring lipid levels under control. This is often true, Dr De Villiers explains, because lifestyle factors play a major role in high cholesterol, especially in people with obesity or metabolic syndrome. If this applies to you, your doctor may recommend adjusting your diet by cutting down on animal fats – a major contributor to abnormal lipid levels, particularly when combined with a diet high in processed foods and refined carbohydrates – and avoiding alcohol.

Regular exercise can also support weight management, which may improve your lipid levels.

However, you may also be prescribed medication, especially if you have high cholesterol at a young age or if there are other risk factors present, such as a family history, or diabetes. “Your doctor will base their decision on your individual risk profile,” Dr De Villiers explains.

Monitoring lipid abnormalities

If there is a severe family history of lipid abnormality within your family – if a parent or grandparent died of a heart attack or stroke while in their forties, for example – it may be necessary to have a cholesterol screening from age 16.

However, if there’s no family history and no other risk factors present, such as obesity or diabetes, you only need to start screening after age 30 – and so long as your test results are normal, an annual screening is sufficient.