【Common Diseases】Hypercholesterolemia
A complete guide to treating hypercholesterolemia that Hong Kong residents should know
In Hong Kong, a food paradise, dim sum, siu mei, fried chicken, milk tea, and egg tarts are almost readily available. Coupled with busy work and a fast pace of life, many people tend to eat a high-fat, high-sugar, low-fiber diet. As a result, hypercholesterolemia (high cholesterol) has become one of the common health problems in the city.
According to the Hong Kong Department of Health, approximately half of adults in Hong Kong have elevated blood cholesterol levels. Many only discover these levels during health checkups, often without experiencing any obvious symptoms. I often hear friends say, "High cholesterol doesn't hurt, so I don't need to worry about it!" This approach is actually very dangerous, as long-term high cholesterol significantly increases the risk of heart disease, stroke, and atherosclerosis .
1. What is hypercholesterolemia?
Cholesterol is a lipid that is important to the human body and is used to produce cell membranes, hormones, and vitamin D. However, if there is too much cholesterol in the blood, it will deposit on the blood vessel walls to form plaques , causing the blood vessels to become narrower and affecting blood flow.
Common values in medical examinations:
- Total Cholesterol : Ideal value < 5.2 mmol/L
- Low-density lipoprotein cholesterol (LDL-C, commonly known as "bad cholesterol") : ideal value < 3.4 mmol/L
- High-density lipoprotein cholesterol (HDL-C, commonly known as "good cholesterol") : Ideal value ≥ 1.0 mmol/L (male) / ≥ 1.3 mmol/L (female)
- Triglycerides : ideal value < 1.7 mmol/L
2. Causes of high cholesterol
Common reasons in Hong Kong include:
- Unhealthy diet – Foods high in saturated fat and trans fat (such as barbecued meats, fried foods, cream, mayonnaise).
- Lack of exercise – Long-term lack of physical activity can lower "good cholesterol".
- Obesity – Excessive waist circumference and high cholesterol often go hand in hand.
- Genetic factors – Familial Hypercholesterolemia.
- Other diseases – hypothyroidism, diabetes, kidney disease, etc.
3. Why treat high cholesterol?
High cholesterol itself is not painful or itchy, but it is the main driver of atherosclerosis , which can narrow or even block blood vessels, causing:
- Coronary heart disease (angina pectoris, myocardial infarction)
- Ischemic stroke
- Peripheral arterial disease (PAD)
In Hong Kong, cardiovascular disease is one of the leading causes of death, so controlling cholesterol is key to preventing cardiovascular and cerebrovascular diseases.
4. Treatment Directions
The treatment of high cholesterol mainly consists of two directions: lifestyle improvement and drug treatment , and in many cases both are needed together.
4.1 Lifestyle improvement (first step)
The Hong Kong Department of Health and guidelines around the world agree that lifestyle improvements are the foundation of cholesterol control.
1. Healthy diet (fat loss + fiber gain)
- Eat less saturated fat : reduce red meat, whole milk, cream, coconut milk, etc.
- Avoid trans fats : eat less pastries, some packaged snacks, and hydrogenated oil products.
- Eat more unsaturated fats : for example, salmon, mackerel, olive oil, and avocado.
- Increasing dietary fiber : oatmeal, whole wheat bread, beans, vegetables and fruits can help lower LDL-C.
- Control cholesterol intake : Eat egg yolks and offal in moderation.
💡 Editor's Tip: You can make some small changes to the menu at Hong Kong's cha chaan teng (tea restaurants), such as ordering buns without butter, choosing steamed fish instead of fried fish fillets, and drinking unsweetened lemon tea instead of milk tea.
2. Regular exercise
- At least 150 minutes of moderate-intensity exercise (brisk walking, swimming, cycling) per week.
- Exercise can increase HDL-C and help remove cholesterol from blood vessels.
3. Control your weight
- Losing weight can improve blood lipid levels, especially reducing abdominal fat.
4. Limit alcohol and quit smoking
- Excessive alcohol consumption can increase triglycerides, while smoking can lower HDL-C.
4.2 Drug treatment (second step)
When lifestyle changes are not enough to lower cholesterol to target, or when the patient is at high risk (such as those with pre-existing cardiovascular disease, diabetes, or familial hypercholesterolemia), the doctor may recommend medication.
Commonly used medicines in Hong Kong include:
- Statins – inhibit the liver’s production of cholesterol and are the drug of choice (e.g. Atorvastatin, Rosuvastatin).
- Cholesterol absorption inhibitors (Ezetimibe) – reduce the absorption of cholesterol from the intestine.
- PCSK9 inhibitors – injections for patients at high risk or who don’t respond to statins.
- Fibrates – primarily lower triglycerides.
- Niacin – can increase HDL-C (now less used).
💡 Editor's note: Doctors in Hong Kong select medications based on blood lipid levels, overall cardiovascular risk, medication side effects, and financial considerations. Medication selection and pricing may differ between private clinics and public hospitals.
5. Regular testing and monitoring
- Blood lipid test : It is generally recommended that adults have a blood lipid test every 1-3 years, and high-risk individuals (obese, smoking, diabetes) should have a blood lipid test more frequently.
- Drug monitoring : People taking statins need to have their liver function tested regularly to ensure safety.
- Self-monitoring : Pay attention to changes in diet, exercise, weight and lifestyle habits.
6. Hong Kong’s medical resources
- Public hospitals and general outpatient clinics : Blood lipid tests and long-term follow-up are available at low costs, but waiting times are longer.
- Private clinics and specialists : examinations are quick and offer more options, but the cost is higher.
- Community health centers : Some offer free or low-cost cardiovascular risk assessments.
Editor's summary
Hypercholesterolemia is extremely common in Hong Kong and can be a silent disease. Don't wait until you have a heart attack or a stroke to realize you have high cholesterol. While lifestyle changes take time and perseverance, they are undoubtedly the safest long-term approach. If medication is necessary, follow your doctor's instructions and do not stop or reduce it on your own. Remember, controlling cholesterol isn't just about looking good; it's about protecting cardiovascular health and avoiding future visits to the emergency room.
Disclaimer : This article is for reference only and does not constitute any medical advice. The source is referenced from major medical articles.
