When talking about overall good health, we often hear doctors advising to lower cholesterol levels. But what exactly is cholesterol, and what levels are ideal? In observance of National Cholesterol Education Month, we talked to Cindy Pau, M.D., a specialist in endocrinology, diabetes, and metabolism, to understand what cholesterol is, why it’s important, and how to manage it.
Q&A with Cindy Pau, M.D.
What is cholesterol, and why are education and awareness so important?
Cholesterol is a waxy, fat-like substance found in every cell of your body. It’s essential for making hormones, vitamin D, and substances that help you digest food. Your body produces the cholesterol it needs, but you can also get it from foods.
There are several important measures of blood lipids:
- Total cholesterol: The overall amount of cholesterol in your blood, which includes LDL, HDL, and a portion related to triglycerides.
- LDL (“bad” cholesterol): Can build up in artery walls and increase heart disease risk.
- HDL (“good” cholesterol): Helps remove excess cholesterol from the bloodstream.
- Triglycerides: A type of fat found in your blood. When you eat, your body converts extra calories into triglycerides and stores them in fat cells and sometimes in the liver, which can contribute to fatty liver. High levels, especially when combined with high LDL or low HDL, can raise your risk of heart disease and pancreatitis.
Education is key because high cholesterol and triglycerides usually have no symptoms, and many people don’t know they’re at risk until they’ve already had a heart attack or stroke. Knowing your cholesterol numbers early gives you the chance to make changes before problems develop.
What are the risks of high cholesterol?
When LDL cholesterol is too high, it can combine with other substances in the blood to form plaque, a sticky deposit that narrows or blocks arteries. This condition, called atherosclerosis, raises the risk of:
- Heart attack.
- Stroke.
- Peripheral artery disease (narrowing of the arteries).
- Atherosclerosis (reduced blood flow to vital organs, which can lead to serious health problems).
Over time, high cholesterol can silently damage your arteries, so the sooner you get it under control, the better.
What causes high cholesterol?
High cholesterol can be caused by a mix of genetics, lifestyle, and other health conditions. Common causes include:
- Diets high in saturated fats (e.g., fatty cuts of meat, processed meats, fried foods).
- Low intake of heart-healthy foods like fresh fruits, vegetables, whole grains, and omega-3-rich fish.
- Low or no physical activity.
- Smoking.
- Excess weight or obesity.
- Certain medical conditions (e.g., diabetes, hypothyroidism, kidney disease).
- Genetic disorders like familial hypercholesterolemia.
What are some ways to prevent and manage cholesterol?
- Lower saturated fat: Choose lean protein like fish, tofu, or skinless chicken breast instead of fatty meats or fried plate lunch options.
- Increase unsaturated fats: Use avocado, macadamia nut, or olive oil instead of butter or shortening.
- Add plant sterols/stanols: Enjoy local fruits and vegetables such as papaya, mango, and leafy greens; also available in fortified foods.
- Increase soluble fiber: Include poi/taro, oats, beans, lentils, and fresh island produce.
- Eat omega-3-rich fish: Salmon, aku, sardines, and mackerel are excellent choices.
- Exercise regularly: Canoe paddling, surfing, hula, walking, or hiking are great ways to stay active.
- Quit smoking: This improves HDL and overall heart health.
What is statin therapy? Is it effective?
Statins are the most widely prescribed medications for lowering LDL cholesterol. They work by blocking the liver enzyme needed to make cholesterol. Statins are effective, safe for most people, and reduce the risk of heart attack, stroke, and death from heart disease.
For those who are statin intolerant or need additional LDL-lowering, other options include:
- Ezetimibe: Reduces cholesterol absorption in the intestine.
- Cholestyramine: A bile acid sequestrant that helps remove cholesterol from the body.
- PCSK9 inhibitors (e.g., evolocumab, alirocumab): Injections that dramatically lower LDL.
- Bempedoic acid: Works in the liver to reduce cholesterol production, which is especially helpful for statin-intolerant patients.
- Inclisiran: A newer injection that lowers LDL by targeting cholesterol production at the genetic level, given only twice a year.
What should people do during National Cholesterol Education Month? What is the call to action?
- Get your cholesterol checked if you haven’t already.
- Learn your cholesterol numbers and what they mean.
- Talk to your health care professional about your personal risk and management options.
- Make lifestyle changes such as eating a heart-healthy diet, exercising, and avoiding tobacco and excess alcohol.
- Spread awareness to friends and ohana: Encourage them to screen and reduce their risk, too.
Anything else you’d like to share?
Cholesterol management is not one-size-fits-all. Some people need only lifestyle changes, while others require medications. In Hawaii, we’re fortunate to have access to fresh local produce and outdoor activities year-round, all of which can support a heart-healthy lifestyle. With education and the right approach, you can take charge of your health and lower your risk of heart disease. Stay proactive: Healthy habits today can protect your heart for years to come.
A knowledgeable resource
Be sure to check out the other articles Dr. Pau has helped us with, including the benefits and risks of supplements and thyroid awareness month.
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