Whatever you were expecting from your blood test results, "your cholesterol is too high" wasn't it. Or maybe it was — maybe a parent or sibling had heart problems and you've been half-expecting this conversation. Either way, you're here now, and that's actually a good place to be.
Here's what high cholesterol actually means, and what to do about it.
The Most Important Thing First
High cholesterol is not an emergency. It is a long-term risk factor. This means it increases your risk of cardiovascular disease over time — it doesn't mean something is about to happen today or this month. You have time to address this calmly and carefully.
Most people with high cholesterol live completely normal lives on a small, cheap tablet taken once a day.
What to Do Right Now
1. Understand what your numbers actually mean. Your doctor should give you your LDL-C (low-density lipoprotein — "bad cholesterol"), HDL-C ("good cholesterol"), triglycerides, and total cholesterol. Ask for these numbers and what they mean for your personal risk level. Your target LDL-C depends on your overall cardiovascular risk — not just your cholesterol reading.
2. Ask your doctor about a statin. If your doctor recommends starting a statin, this is good medicine. Statins are among the most studied medications in history. Generic statins in SA cost R45–80/month. They reduce cardiovascular events significantly. Side effects (muscle aches, elevated liver enzymes) occur in a small minority of patients and are monitored with annual blood tests.
3. Register for CDL 006. Your medical scheme must fund your statin treatment from the risk benefit under CDL 006. This is not optional for your scheme — it's a legal requirement under the Medical Schemes Act. Registering means your medication and GP visits for cholesterol management don't eat into your savings or day-to-day limits. Ask your doctor's rooms to help you register.
4. Consider lifestyle factors — but don't let perfect be the enemy of good. Dietary changes (less saturated fat, more soluble fibre, less processed food) can lower LDL-C by about 10–20%. Exercise raises HDL-C and lowers triglycerides. These changes matter. But if your LDL-C requires medication, lifestyle alone won't get it to target. Do both.
5. Ask about a family history pattern. If a parent, sibling, or child had a cardiac event before 55 (men) or 65 (women), mention this to your doctor. This pattern may suggest Familial Hypercholesterolaemia (FH) — a genetic condition that requires more intensive treatment and a different medication approach. FH is underdiagnosed in South Africa.
Your Questions, Answered
"Do I really need medication if I change my diet?" Diet is important, but the evidence shows that for most people with clinically elevated LDL-C, medication is needed to reach target. You can try a 3-month lifestyle trial first if your risk is low and your LDL-C is only mildly elevated. But if your doctor recommends starting a statin, the evidence behind that recommendation is very strong.
"Statins have side effects. Should I be worried?" Muscle pain (myalgia) affects about 5–10% of statin users. Severe muscle problems (rhabdomyolysis) are very rare. Liver enzyme elevation is usually mild and resolves. The cardiac risk reduction from statins is substantially larger than the side effect risk in most patients. If you experience persistent muscle aches, tell your doctor — there are alternative statins and dosing strategies.
"Will I be on a tablet forever?" Probably, yes — cholesterol management is usually lifelong, as the underlying risk doesn't disappear. This is not a failing. Think of it the same way as wearing glasses: you take the thing that helps, and it becomes unremarkable.
"My cholesterol is only slightly high. Does it really matter?" LDL-C below 2.0 mmol/L significantly reduces cardiovascular risk. Even modestly elevated LDL over decades causes progressive atherosclerosis. Whether to treat a mildly elevated LDL depends on your overall cardiovascular risk profile, not just the number — your doctor should use a risk calculator to put the number in context.
What the Next 3 Months Look Like
If a statin is started: follow up at 6–8 weeks for repeat fasting lipid profile and liver function tests. This confirms the medication is working and you're tolerating it.
Once on target: annual fasting lipid profile. GP review twice yearly initially, then annually if stable.
What Your Medical Aid Should Cover
All registered South African medical schemes must fund: - Generic statin therapy from the risk benefit (CDL 006) - GP visits for cholesterol management - Annual fasting lipid profile and liver function tests
If you're being asked to use your savings account or day-to-day money for statin prescriptions without having registered for CDL, speak to your scheme directly. Registration is what turns the entitlement into a paid claim.
One Last Thing
You found out. That's what matters. The people who don't know about their high cholesterol for years, who don't take the R45/month tablet, who skip the annual check-up — those are the people the statistics are written about. You're not going to be one of them.
The path from here is simple: a conversation with your doctor, a cheap generic tablet, and a blood test once a year. That's it.
What does your scheme cover for high cholesterol? Check on AURA →
This article is for educational purposes. Speak to your doctor about your individual situation.