Hypercholesterolaemia in Malaysia is proving far from a niche concern. It is a pervasive, largely silent threat. The most recent National Health and Morbidity Survey (NHMS) 2023 delivers new, more detailed evidence. It expands assessment beyond total cholesterol to a full lipid profile. The result: a clearer, sharper view of who is at risk, where the problems concentrate, and what must change to protect lives.

Hypercholesterolaemia is a medical condition characterised by abnormally high levels of cholesterol in the blood. Cholesterol is a fatty substance essential for building cells and producing hormones, but excessive amounts can increase the risk of cardiovascular diseases, such as heart attack and stroke.

The headline figure is stark. One in three Malaysian adults now has raised total cholesterol. That equates to a prevalence of 33.3 per cent. Women fare worse than men. Older adults fare far worse than younger ones.

Yet the survey also exposes a worrying gap: nearly one in five adults have raised total cholesterol and do not know it. Undiagnosed disease lives in the community, quietly nudging up cardiovascular risk.

The NHMS 2023 reached 10,852 adults aged 18 and over. Researchers combined a validated questionnaire adapted from the WHO STEPS instrument with point-of-care finger-prick lipid testing, using a recognised 3-in-1 device to measure total cholesterol, LDL, HDL and triglycerides. This matters. Earlier national surveys relied mainly on total cholesterol. Full lipid panels give clinicians and public health planners better grounds for risk stratification and targeted action.

Clear, uniform definitions allowed consistent measurement. Known hypercholesterolaemia meant the participant had previously been told by a doctor or assistant medical officer that they had high cholesterol.

Undiagnosed cases were those not previously informed but found by the survey to have total cholesterol at or above 5.2 mmol/L. Raised LDL used a threshold of greater than 2.6 mmol/L. Raised triglycerides meant levels above 1.7 mmol/L. Low HDL was defined by sex-specific cut-offs: less than 1.0 mmol/L for men and less than 1.2 mmol/L for women. These thresholds align with contemporary clinical practice and help translate findings into management priorities.

Geography and demography reveal pronounced differences. Women recorded a higher prevalence of raised total cholesterol than men: 36.3 per cent versus 30.5 per cent. Age is a dominant factor. Adults aged 60 and above show the highest burden, with 62.8 per cent having raised total cholesterol.

State-level variation is striking. Perak, Perlis and Sarawak occupy the highest ranks for overall raised total cholesterol. In contrast, the Federal Territory of Kuala Lumpur reports the lowest prevalence for this indicator. Rural populations bear a heavier burden in many lipid measures. In part, inequalities of access, health literacy and differing dietary patterns are likely contributors.

Known hypercholesterolaemia increased markedly compared with earlier surveys. The proportion of adults who already knew they had high cholesterol is now 15.2 per cent. That figure reflects real progress in detection and awareness since 2011.

Still, knowledge is uneven. Nearly half of people aged 60 years and above with raised cholesterol were aware of their condition. By contrast, younger adults account for the bulk of undiagnosed cases. The age group 18 to 29 years shows the largest share of people with raised cholesterol who remain unaware. This is a key public health signal. Young adults can be viewed as both a reservoir of future cardiovascular risk and an opportunity for early intervention.

Undiagnosed hypercholesterolaemia remains too common. The NHMS found 18.1 per cent of adults with raised total cholesterol were unaware. That is nearly one person in five. State-level hotspots for undiagnosed disease included Pahang, Sabah, Kelantan and Terengganu.

Urban centres such as Kuala Lumpur had lower rates of undiagnosed disease, underscoring the rural–urban gap. Targeted screening in rural districts is therefore not optional. It is essential.

Beyond total cholesterol, the expanded lipid panel exposes deeper problems. Raised LDL cholesterol affects four in ten adults. That is 40.9 per cent, and it is a key driver of atherosclerotic cardiovascular disease. Raised LDL prevalence was particularly high in Pahang. Women demonstrated a higher prevalence for raised LDL than men, reinforcing the need to factor sex differences into public health responses and clinical practice.

Raised triglycerides and low HDL paint a mixed but concerning picture. Raised triglycerides affected 23.2 per cent of adults. Men had higher rates than women. Low HDL affected 27.3 per cent overall, with little sex difference. These lipid abnormalities interact, and together they shape cardiovascular risk beyond what total cholesterol alone can show. Clinicians need to consider the broader profile when assessing risk and selecting therapy.

Trends over time tell a nuanced story. Overall raised total cholesterol peaked in 2015, then declined steadily through 2019 and 2023. That downward movement is encouraging. Yet the rise in known hypercholesterolaemia is arguably more notable. Awareness and diagnosis climbed from 8.4 per cent in 2011 to 15.2 per cent in 2023.

That suggests improved screening, better health-seeking behaviour, and perhaps greater clinical attention. Meanwhile, the proportion of people with raised cholesterol who remain undiagnosed declined from its peak in 2015 to 18.1 per cent in 2023. Progress is evident, but far from complete.

What of management among those who do know they have hypercholesterolaemia? The NHMS shows most are receiving conventional advice and treatment. More than four in five people reported taking oral medication in the two weeks before the survey.

Healthcare personnel appear active in counselling: nearly nine in ten reported receiving dietary advice, three quarters were advised on weight loss, and roughly the same proportion were urged to increase physical activity. Traditional medicine use is present but limited; about 11.8 per cent reported using herbal or traditional remedies.

These management figures demand balanced interpretation. High reported rates of counselling and medication are positive. Yet widespread treatment does not automatically translate into optimal control.

Adherence, medication choice, dosing, follow-up, and patients’ ability to sustain lifestyle changes all affect outcomes. Moreover, the presence of traditional medicine use, while not dominant, points to cultural practices that can influence adherence to recommended therapies.

Inequalities emerge across social strata. People with lower education, those in the bottom income quintiles, retirees and those who are separated, widowed or divorced show higher prevalence rates for various lipid measures.

These groups often face multiple barriers: limited access to healthcare, constrained resources for healthy food, less time or safe spaces for exercise, and lower health literacy. A universal policy approach will fall short. Targeted outreach and community-level interventions are needed.

What follows from these findings? Several practical priorities arise, grounded in evidence and common sense.

First, broaden and deepen screening. The NHMS confirms that full lipid profiling pays dividends. Primary care services should incorporate lipid panels more consistently, especially for older adults, people with other cardiovascular risk factors, and those in high-prevalence states and rural areas.

Second, bridge the diagnosis-to-treatment gap. High rates of counselling and medication are encouraging. Yet systems must ensure that diagnosed patients receive guideline-concordant therapy, appropriate intensity of lipid-lowering drugs when indicated, and regular follow-up to measure response. Quality improvement programmes in primary care can close this loop.

Third, focus on young adults. Early detection and lifestyle modification in younger people can prevent decades of elevated cardiovascular risk. Public health messaging must reach campuses, workplaces and digital platforms where younger adults engage. Screening opportunities could be moved into non-clinical settings to capture those who seldom visit health facilities.

Fourth, tackle social determinants. Interventions that ignore poverty, education and geographic barriers will succeed only partially. Subsidised screening, community health worker programmes, mobile clinics and culturally sensitive education are practical steps. Collaboration with local leaders and community organisations increases reach and trust.

Fifth, reinforce lifestyle support. Counselling works best when it is practical and supported. Access to healthy food, safe public spaces for exercise, workplace wellness programmes and structured weight-loss interventions amplify the impact of clinical advice. Policy measures, such as incentives for healthy food availability and urban planning that promotes active travel, add population-level benefit.

Sixth, strengthen surveillance and research. The move to comprehensive lipid assessment in NHMS 2023 was wise. Continued surveillance with consistent methods will track trends, monitor equity, and assess the effectiveness of policies. Research that examines barriers to control, medication adherence, and the real-world impact of differing treatment strategies will inform better practice.

Finally, policies should align with global best buys for non-communicable diseases. Legislative and fiscal measures, including tobacco control and regulation of unhealthy food marketing, have proven cost-effective. They complement clinical strategies and reach those who do not engage with healthcare.

The NHMS 2023 results matter because they shape choices. They show problems that are known and modifiable. They point to progress in diagnosis. They warn of remaining blind spots. Above all, they call for an integrated response: screening, evidence-based treatment, lifestyle support, and policies that address the upstream forces shaping health.

Malaysia faces a substantial but surmountable challenge. Importantly, many of the tools required are available now. Deployment needs focus and urgency. Public health leaders, clinicians, policymakers and communities must act in concert. The prize is considerable: fewer heart attacks, fewer strokes, and longer, healthier lives. The data are clear. The opportunity is present. The time to respond is now.