Special Focus:  Cholesterol and Women
Cardiovascular disease is the leading killer of American women, causing almost 500,000 deaths every year. As with men, elevated cholesterol levels signal danger for a women's health, putting her at risk for both heart disease and stroke. According to the American Heart Association (AHA), over 50 million American women have borderline to high cholesterol levels.

The first goal of cholesterol management is assessment of the LDL or “bad” cholesterol. LDL cholesterol contributes to the development of atherosclerosis or fatty plaque deposits in arteries. Blockage of arteries or rupture of the atherosclerotic plaque can result in myocardial infarction (heart attack) or stroke. Early evaluation of cholesterol levels and intervention can decrease a women's risk for cardiovascular disease (CVD).

A cardiovascular risk assessment can determine a woman's current and future risk of heart disease. Risk assessments look at a variety of factors, including the patient's age, presence of heart disease, family history, hypertension, cholesterol levels and lifestyle factors such as diet, exercise and smoking. Some risk factors indicate a higher level of risk than others, such as age and smoking. The more risk factors a patient exhibits, the greater their risk.

Women are particularly at risk after menopause, when their HDL (“good”) cholesterol levels drop and their LDL (“bad”) cholesterol levels increase. Over half of postmenopausal women need to reduce their total cholesterol levels. Women also need to carefully monitor another type of fat in the blood, triglyceride.

Men and women's cholesterol levels are measured by the same set of blood tests: a lipid profile (or cholesterol blood test). A lipid profile is a simple blood test that identifies the types, amount and distribution of fats (lipids) found in the blood. These fats, including cholesterol travel in the bloodstream on special carriers called lipoproteins. Two types of lipoproteins are the high-density lipoproteins (HDL or “good” cholesterol) and low-density lipoproteins (LDL or “bad” cholesterol). Triglycerides are a naturally occurring fat found in our body and bloodstream. A diet high in saturated fat or simple carbohydrates may contribute to high levels of triglycerides.

The criteria for healthy cholesterol levels are different among men and women, partly because of hormonal changes that occur throughout a woman's life. Low levels of HDL cholesterol may be a stronger predictor of heart disease in women over 65 than in men over 65. Changes that occur due to menopause cause HDL levels to drop in women. Therefore, physicians may approach cholesterol screening differently for women.

Another difference is that a high level of triglycerides may be a more important risk factor among women than men. Your physician may also screen for a specific component of cholesterol called apolipoprotein B (apoB). Studies indicate that measuring apoB levels may be a better indicator of heart disease than calculating LDL cholesterol alone.
The National Institutes of Health recommend that men and women have their first cholesterol screening by age 20. Some experts recommend cholesterol screening before age 20 for women who are taking birth control pills. Women should repeat cholesterol levels every five years if their cholesterol is in an acceptable or normal range. If the initial test reveals high cholesterol levels then cholesterol should be monitored at least annually until levels fall within a normal range. Some physicians recommend more frequent testing after menopause.

Unlike men, women tend to have different cholesterol levels at various times in their lives because of the effect of estrogen. After puberty when a women's ovaries begin producing estrogen, the HDL “good” cholesterol rises and the LDL “bad” cholesterol tends to fall. This appears to have a cardio-protective effect until a woman reaches menopause.

As estrogen levels decline with menopause, HDL levels tend to drop and LDL and triglyceride levels rise. Other changes start to occur with women at this time that increase her cardiovascular risk along with rising LDL levels. Women may begin to experience increasing blood pressure, fat accumulation in the abdomen and weight gain.

With menopause, a woman's factors for developing heart disease change. Prior to menopause her main risk factor is high total cholesterol. After menopause, her risk factors become low HDL cholesterol and high triglycerides. LDL cholesterol levels are less important for postmenopausal women's risk of heart disease.

The American College of Cardiology encourages women to maintain HDL levels of at least 45 mg/dL which is 5mg/dL higher than recommended for men. Recommendations also call for triglyceride levels below 150 mg/dL. LDL cholesterol goals may vary depending on number and types of risk factors. However, the optimal goal for LDL cholesterol is less than 100 mg/dL.

To determine your risk of cardiovascular disease, please contact the Women's Heart Center for your free cardiovascular risk assessment. Lipid profile screenings are available at a minimal cost along with a personal evaluation of your risk.