by Dr. Jon Avery Go
Cholesterol is a fat-like, waxy substance found in every cell of the body. It plays a vital role in building cell membranes, producing hormones (such as estrogen and testosterone), synthesizing vitamin D, and forming bile acids to aid in fat digestion.
While cholesterol is essential for health, too much or too little can cause medical problems. The body produces cholesterol naturally, but it also comes from animal-based foods such as meat, dairy, and eggs.
Cholesterol does not dissolve in blood; it travels through the bloodstream in particles called lipoproteins. The two main types are Low-Density Lipoprotein (LDL) Cholesterol and High-Density Lipoprotein (HDL) Cholesterol.
LDL cholesterol is often called “bad cholesterol” because it carries cholesterol from the liver to the rest of the body.
If too much LDL is present, it can deposit cholesterol in artery walls, leading to plaque buildup and narrowing of the arteries (atherosclerosis). This increases the risk of heart attack and stroke.
High-Density Lipoprotein (HDL) cholesterol is known as “good cholesterol” as it transports excess cholesterol from the bloodstream and artery walls back to the liver for removal.
Higher HDL levels are generally protective against cardiovascular disease.
High cholesterol—especially high LDL—can be dangerous because it often has no symptoms until serious problems occur.
Long-term high cholesterol can cause atherosclerosis (hardening and narrowing of arteries), coronary artery disease, heart attacks, strokes, peripheral artery disease, and reduced blood flow to organs and tissues.
In general, healthy individuals should aim for LDL cholesterol numbers under 130 and HDL cholesterol numbers above 60.
Common approaches for high cholesterol include changes to your lifestyle, such as exercising regularly, having more vegetables and less red meat in your diet, and weight management.
The American Heart Association labels cholesterol risk categories based on a person’s 10-year risk of cardiovascular disease.
This takes into account a patient’s age, race, sex, smoking status, blood pressure reading, medication treatment, total cholesterol, LDL cholesterol, HDL cholesterol, and history of Diabetes.
Those with intermediate risk (7.5-20%) and high risk (more than 20%) of developing cardiovascular disease, medication management generally with a statin is recommended to lower risk.
Maintaining healthy cholesterol levels requires both dietary and lifestyle changes.
A heart-healthy diet includes limiting saturated fats (found in red meat and butter), avoiding trans fats, increasing the consumption of fiber-rich foods, and eating healthy fats from sources like olive oil, nuts, and fatty fish.
Exercising regularly can help in maintaining a healthy weight, where a 5-10% weight loss can significantly improve cholesterol levels. Quitting smoking and limiting your alcohol intake can positively impact your cholesterol health.
Cholesterol is vital for life, but balance is key.
High LDL increases cardiovascular risk, while low cholesterol can disrupt essential body functions.
Through healthy eating, regular exercise, and, when necessary, medication, most people can keep cholesterol levels in a range that supports heart and overall health.
Regular monitoring is essential—because cholesterol problems are often silent until they cause major health events.
Adults should have their cholesterol regularly checked every 4–6 years, or more often if they have a higher risk.
DR. JON AVERY GO is a board-certified Internal Medicine physician. He practices as a primary care doctor at Primary Care Clinic of Hawaii.
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