Controlling Good, Bad Cholesterol

Dr. Steven Hong
Internal medicine physician at Kaiser Permanente’s Honolulu Medical Office

Where did you receive your schooling and training?

I received my medical degree and completed my internal medicine residency at the University of Hawaii John A. Burns School of Medicine.

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Dr. Steven Hong

How long have you been in practice?

Twenty-five years. I am an internal medicine physician at Kaiser Permanente’s Honolulu Medical Office, and also serve as Kaiser Permanente Hawaii Region guidelines director and as physician chairman for Kaiser Permanente Hawaii’s Pharmacy and Therapeutics Committee.

What got you interested in internal medicine?

Internal medicine allows me to treat different types of patients with a broad range of medical conditions. It’s a challenging field by virtue of its scope of practice, but it’s a challenge that I enjoy and find very fulfilling.

What is cholesterol?

Cholesterol is a fatty substance that all of us have in our blood. It plays various essential roles in our bodies. There are different types of cholesterol, and different patients may have different proportions and amounts of the types of cholesterol depending on their genetic makeup (heredity) and lifestyle.

We hear about “good” and “bad” cholesterol. Is there really such a thing as good cholesterol?

The science of cholesterol is complicated. In simple terms, “good” and “bad” cholesterols have been deemed as such based on the risk of cardiovascular disease with which they are associated. Cardiovascular disease is the No. 1 cause of death in the U.S. Low-density lipoprotein cholesterol (LDL) has become known as the “bad cholesterol” because higher LDL levels have been associated with an increased risk of cardiovascular disease, which can cause heart attacks and strokes. High-density lipoprotein cholesterol (HDL) has become known as the “good cholesterol” because higher HDL levels have been associated with a lower risk of cardiovascular disease.

What can people do to increase their good cholesterol?

Some of the ways to help increase your HDL include weight loss (if you are over-weight), exercising regularly, quitting smoking, and reducing or eliminating saturated and trans fats from your diet. Saturated fats are often found in butter, cheese, ice cream, whole milk, beef, pork and palm oil, and can increase your risk of cardiovascular disease. Trans fats, like saturated fats, can raise your “bad” LDL levels and lower your “good” HDL levels. Trans fats are often found in fast foods, store-bought baked goods, such as doughnuts, and margarine made with partially hydrogenated oil. Checking a product’s nutritional label is a good way to see if it contains saturated and trans fats.

There are familial conditions that can result in very high cholesterol. One of these conditions, called familial hypercholesterolemia, can trigger high levels in young people and increase their risk for early heart attacks. This condition is sometimes identified earlier in life because a parent or other close family member had a heart attack at a young age.

What lifestyle changes can reduce bad cholesterol and thereby reduce risk of cardiovascular disease?

Healthy eating is a great way to help reduce your risk of cardiovascular disease. A healthy diet includes lots of vegetables, fruits and whole grains. Low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts also are recommended. Many of these foods are part of the plant-based Mediterranean diet, which has been shown to improve health and can reduce the risk of cardiovascular disease. Foods that you want to limit your intake of are sweets, sugar-sweetened beverages, red meats and the previously mentioned saturated fats and trans fats.

Aerobic physical activity can also reduce LDL cholesterol. Try to incorporate three to four 40-minute sessions of moderate to vigorous physical activity into your week. It’s a good idea to check with your doctor to discuss your optimal exercise intensity, especially if you have underlying medical problems such as cardiovascular disease.

High blood pressure, or hypertension, also is a risk factor related to cardiovascular disease. If you have high blood pressure, be sure to work with your doctor to address and manage this condition.

Last, if you are a smoker, stop smoking. Quitting smoking not only will reduce your risk of coronary artery disease and suffering a heart attack, it also will reduce your risk of several types of cancers.

Are there physical symptoms when someone’s cholesterol is too high?

Generally, high cholesterol itself does not have symptoms until it contributes to the development of cardiovascular disease, such as stroke, heart attack or peripheral vascular disease. It is a good idea to have your cholesterol levels tested by your doctor, so you can know what your results mean and if you need to make changes to improve those levels.

Anything else you’d like to mention?

If lifestyle changes are not enough to improve cholesterol, you and your doctor should evaluate and discuss your cholesterol levels along with other risks you may have for cardiovascular disease. If the risk for cardiovascular disease is high enough, it may warrant taking a cholesterol-lowering medication.

The latest American Heart Association/American College of Cardiology prevention guideline tools suggest using a risk calculator called Pooled Cohort Equations to estimate a patient’s risk for stroke or heart attack. This risk calculator can be accessed at my.americanheart.org/cvriskcalculator.