High bad cholesterol: The silent threat, how to fight it
(Part 3 of 3)
First part: Deadly grip of cardiovascular diseases on Filipino families
Second part: Breaking hearts and the bank: The cost of heart attack, stroke in PH
MANILA, Philippines—You’ve likely heard the phrase, “An ounce of prevention is worth a pound of cure.” When it comes to atherosclerotic cardiovascular disease (ASCVD), prevention is not just a mantra — it’s a lifeline.
Hypercholesterolemia, commonly referred to as high cholesterol, is a lipid disorder characterized by elevated levels of low-density lipoprotein (LDL), often called “bad cholesterol.”
This condition is one of the most insidious contributors to atherosclerotic cardiovascular disease (ASCVD). Because it typically presents no symptoms, it has earned the ominous label of a “silent killer.”
By the time symptoms such as chest pain or shortness of breath emerge, significant cardiovascular damage may have already occurred, increasing the risk of heart attacks or strokes.
Graphics by: Ed Lustan /
For many Filipinos, the first indication of high cholesterol often comes only after a life-altering medical event, highlighting the importance of early detection and managing cholesterol levels.
“Kung mataas na ang cholesterol mo pero di pa barado yung ugat, pwedeng wala kang nararamdaman. So how will you know? The only way to know is to check your blood,” said Dr. Marc Del Rosario, head of the Cardiac Catheterization Laboratory at the Asian Hospital and Medical Center.
(If your cholesterol is high but your blood vessels are not yet clogged, you might not feel anything. So how will you know? The only way to know is to check your blood.)
Cholesterol often gets a bad reputation due to its association with heart disease. However, as noted by Harvard Health Publishing, it is a naturally occurring fatty substance in the body that plays an essential role in supporting vital functions necessary for overall health and well-being.
When a person undergoes a lipid panel — a common blood test used to evaluate the risk of cardiovascular disease (CVD) — the results typically highlight two main types of cholesterol: low-density lipoprotein (LDL), also known as the “bad” cholesterol, and high-density lipoprotein (HDL), referred to as the “good” cholesterol.
The test also measures triglycerides, a type of fat in the blood that stores unused calories and provides energy for the body.
Graphics by: Ed Lustan /
Most people, however, focus only on their total cholesterol levels when reviewing their blood test results. But, according to Dr. Ella Santos, head of preventive cardiology at Cardinal Santos Medical Center, understanding total cholesterol alone is not enough to assess one’s risk for CVD.
“Kapag kumuha kayo ng total cholesterol sa blood test, hindi po sapat ‘yun. Kailangan malaman niyo ano bang component yung nagpapataas ng total cholesterol,” Santos explained.
(When you get a total cholesterol test, that alone is not enough. You need to know which component is causing the total cholesterol to increase.)
“Kapag mataas ang triglycerides, pwedeng tumaas ang total cholesterol. Kapag mataas ang HDL, pwedeng tumaas ang total cholesterol. Kung ang LDL mataas, total cholesterol pwede tumaas. So di enough na alam niyo na mataas, kailangan malaman niyo alin doon yung mataas,” she added.
(If triglycerides are high, total cholesterol can also increase. If HDL is high, total cholesterol can go up. If LDL is high, total cholesterol may rise. So, knowing that it’s high isn’t enough— you need to determine which component is elevated.)
The real danger lies in having too much bad cholesterol in the bloodstream. This can lead to the buildup of artery-clogging plaque, known as atherosclerosis, which, if left unchecked, increases the risk of heart attacks or strokes over time.
Seeing high LDL numbers in your test results — ranging from 130 mg/dL to 190 mg/dL or higher, depending on your CVD risk — should already be a cause for concern. To drive the point home, Santos offered a vivid description of what excessive bad cholesterol in the body might look like.
Graphics by: Ed Lustan /
“Sa New York dati nagtatanggal kami ng LDL sa katawan […] it’s a process called lipid apheresis. [A]lam ninyo po [‘yung] bulalo na kapag nilagay niyo sa ref tapos sa susunod na araw kinuha niyo yung sebo sa [ibabaw] — ‘yun ang itsura ng LDL,” she said.
(Back in New York, we used to remove LDL from the body through a process called lipid apheresis. You know how bulalo [bone marrow soup] looks when you refrigerate it, and the next day, a layer of hardened fat forms on top? That’s what LDL looks like.)
“Imagine niyo andoon ‘yun, umiikot na sa dugo niyo. Imagine kung gaano katindi ‘yung bara niyan sa ugat niyo kung ‘yan ang umiikot sa dugo,” she added.
(Now imagine that circulating in your blood. Think about how severe the blockages in your arteries could be if that’s what’s flowing through your bloodstream.)
For Melody Felarca-Valenzuela, a high-powered corporate career meant long hours and relentless deadlines.
“A typical day for me starts at 7 a.m., followed by work — from Monday to Friday,” she said. While she prioritizes exercise whenever possible and maintains a routine that includes morning stretches, her demanding job makes it challenging to stay active.
In their household, meals are typically home-cooked on weekends, but weekdays mostly rely on delivery. At 47, a routine checkup revealed elevated cholesterol levels, specifically LDL-C.
Despite being aware of her family’s history of high cholesterol and staying vigilant about her health, the results still came as a surprise — there were no warning signs of high bad cholesterol.
Graphics by: Ed Lustan /
“I found out during a routine check-up. I was not experiencing any symptoms, so it was quite a surprise,” she said, adding that she “was feeling fine and had no idea there were any issues.”
“I had some understanding [about high bad cholesterol and ASCVD] but didn’t think it would affect me personally,” she stressed.
The same thing happened to a friend of hers, who also discovered his high bad cholesterol levels during a routine checkup.
Unlike Valenzuela, however, Norman Paul Famisan — whose typical workday, managing his business, starts as early as 3 a.m. and ends by 3 p.m. — was not as surprised by his diagnosis.
“I wasn’t really surprised since it runs in the family,” he said, noting that the test was done during the pandemic, so at first, he thought his elevated cholesterol might be stress-related.
Although he was aware of his family history of high bad cholesterol and ASCVD risk factors, he had never been diagnosed with it and hadn’t given it much thought.
“It didn’t really bother me. I just didn’t think about it,” Famisan said.
I now have high LDL cholesterol levels, what now? Am I at risk for a heart attack or stroke?
According to the Cleveland Clinic, high cholesterol levels can still be managed to prevent heart disease and reduce the risk of an ASCVD event. The first line of defense against high LDL-C is lifestyle changes, which can be achieved in several ways, such as:
“You’ll need to manage your high LDL for the rest of your life. However, once you make healthy habits part of your routine, you won’t need to give them much thought,” said Cleveland Clinic.
“You can start small, like having one meatless dinner a week or taking a daily walk after dinner. You can buy foods that are low in saturated or trans fats so you always have healthy food on hand. Also, you can add variety to your plant-based diet by trying vegetables you’ve never eaten before,” it added.
Valenzuela admitted that her high LDL-C diagnosis was initially overwhelming. However, with medical advice, she gradually learned to manage her condition by making lifestyle changes and incorporating medication into her routine.
“I’ve made substantial changes to my diet and activity level, focusing on healthier options and regular exercise to lower my LDL,” she said, adding that she started taking Rosuvastatin — a medication used alongside a proper diet to lower bad cholesterol and triglycerides in the blood.
“It has been both challenging and rewarding, but I see the value in making those changes,” she said.
She also highlighted the strong support from her family, noting that they, too, have made an effort to manage their cholesterol levels and reduce their risk of ASCVD.
Graphics by: Ed Lustan /
Harvard Health Publishing emphasized that the need for medication to lower cholesterol depends on an individual’s response to dietary changes and their overall risk of heart attack and stroke.
“Doctors primarily prescribe medications to lower LDL cholesterol, and most often, a statin drug is the first choice,” it explained.
In some cases, medication may also be prescribed to help regulate blood sugar, control blood pressure or manage other conditions that increase the risk of cardiovascular disease (CVD).
“Once you’ve taken medicine for 8 to 12 weeks, your provider will do another lipid panel test to see if your results improve. If your numbers don’t improve, they may increase your dose, switch you to a different cholesterol-lowering medicine, or prescribe a second medicine for you,” said Cleveland Clinic.
Del Rosario meanwhile stressed that medication for hypercholesterolemia must be sustained.
“Another Filipino misconception: you take medicine, and you’re cured. ‘If I take medicine for my cholesterol and my cholesterol levels normalize, then I’ve been treated and I’m no longer sick’,” he said.
“High cholesterol, just like high blood pressure, doesn’t go away. So usually, if you’ve noticed that your cholesterol is high, you’ve tried dieting, you’ve tried various things, but it still doesn’t go down, the only treatment is to keep your LDL low and maintain it low forever,” he explained.
“Because the moment it rises again, your risk goes up as well. If you manage to lower it for a while and then it rises again, you’ve only delayed the progression, the event, but you’ll still end up there,” he continued.
Similar to the medical advice given to patients with high LDL cholesterol, those who have not yet developed hypercholesterolemia are strongly encouraged to adopt the same heart-healthy lifestyle changes.
These habits not only help lower cholesterol but can also prevent high cholesterol from developing in the first place.
Famisan, whose diet primarily consists of Filipino — specifically Ilocano — cuisine, along with Western and Asian influences, admitted that he wished he had better access to healthier food options.
As someone who isn’t picky about food, he advised others to practice moderation and prioritize regular exercise to help prevent high LDL cholesterol.
“If you can handle the [prescribed diet], then go for it. Otherwise, eat what you want, but make sure you get plenty of exercise,” he said, admitting that he regrets being stubborn about his health and lifestyle.
“I just wish I wasn’t like this, especially when it comes to my health. I’m not really proud of myself for being this way.”
Graphics by: Ed Lustan /
Valenzuela also reflected on how she could have prevented hypercholesterolemia if she had been more proactive about her health.
“Stay informed, listen to your body, and maintain regular check-ups. Health should be a priority, and we need to take it seriously,” she advised when asked what lessons she could share to help others manage their cholesterol levels.
“The moment I decided to prioritize my health was a turning point in my journey,” she added.
Both also urged the government to revise current healthcare policies to better support individuals diagnosed with hypercholesterolemia — such as making medications more affordable, increasing access to healthier food, and improving awareness and support for heart health management.
To better understand your risk of having unhealthy cholesterol levels, consider these key questions:
If you answered “yes” to any of these, it might be time to schedule a check-up. A simple lipid panel test could be the first step toward a healthier future.
At the same time, understanding the risk of ASCVD — heart attack and stroke — is crucial for taking proactive steps toward prevention.
“I think it’s important for our countrymen to have a deeper understanding of their risk. Sa totoo lang, nakakasawa na po yung makakita ng pasyente na sayang—sayang kung naprevent [yung heart attack or stroke],” said Del Rosario.
(Honestly, it’s disheartening to see patients whose conditions could have been prevented.)
“This is really an advocacy that I think all of us should take part in, and I believe it can help the public gain a better understanding,” he added.
In today’s highly digital and connected world, a quick and convenient way to assess your risk is by visiting Unblocked | A Movement for Heart Health, an initiative by Novartis. This platform aims to “bring patients, their loved ones, healthcare professionals, and healthcare systems together in a shared mission to ‘unblock’ barriers to heart health.”
As part of this advocacy, Novartis has developed an interactive online risk assessment tool that helps individuals determine their cardiovascular disease (CVD) risk level — ranging from low to very high.
The tool also estimates the age at which a person’s risk for a heart attack begins to rise and the potential age of their first event based on their LDL-C (bad cholesterol) levels.
The website provides a user-friendly way to explore how accumulated LDL-C exposure contributes to plaque buildup and the possible timeline for heart-related events. You can access the risk assessment tool .
Unblocked Movement shows cardiovascular risk levels with target LDL goals based on individual risk factors.
A screenshot from Unblocked Movement estimates the age of a person’s first heart attack based on their LDL-C levels.
While the tool offers valuable insights, Novartis underscores the importance of seeking professional medical advice: “Consult your doctor to discuss your current cholesterol levels, set targets, and develop a personalized plan for prevention.”
By taking proactive steps and working with healthcare professionals, individuals can improve their heart health and overall well-being.
With resources like the Novartis risk assessment tool and greater public awareness, the goal is not just to educate Filipinos but to empower them to protect their families and take charge of their heart health.
High bad cholesterol and ASCVD remain among the leading yet often overlooked causes of heart attacks and strokes in the Philippines. In response, Novartis Philippines is urging Filipinos to take action before it’s too late — starting with a simple yet powerful reminder:
ACT NOW!
Prevention begins with awareness, but real change happens when people take action. The best way to protect yourself is by knowing your numbers, making heart-healthy lifestyle changes, and consulting a doctor about the right treatment options.
Taking control today can mean preventing a life-threatening event tomorrow.
Christine Fajardo, Novartis Philippines’ Country Public Affairs, Communications & Engagement Head, put it simply: “No heart is gone too soon,” emphasizing the vital need for prevention.
Novartis Philippines Country President Joel Chong also underscored the importance of turning knowledge into action:
“Bruce Lee said, ‘Knowing is not enough; you must also take action.’ But I feel this quote is incomplete. A lot of people have heard about eating healthy before — nobody really takes that seriously,” Chong said.
“What’s missing is caring. Moving from knowing to acting comes from caring — ‘I care about this; it’s important to me.’ Beyond educating Filipinos, we need to make them care about their families so they truly understand and are willing to take action,” he added.
This article is part of the Unblock Your Heart Health Reporting initiative, supported by the Philippine Press Institute and Novartis, to improve health literacy on cardiovascular diseases. Know your numbers, understand your risks, and consult your doctor — so no Filipino heart is lost too soon.
Take control of your heart health today. Visit for more information.