5 things women should know about cholesterol

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Do you know your cholesterol numbers?

If not, here’s a good reason to learn them.

Unhealthy amounts of cholesterol in the blood are a major risk factor for heart disease. And heart disease is the leading cause of death for women (and men) in this country.

“It’s critical to know what your numbers are,” says Suzanne Steinbaum, DO, a cardiologist and spokeswoman for the American Heart Association (AHA).

Still, don’t feel too bad if your answer to the question above was no. Many women probably couldn’t rattle off all four of their cholesterol numbers.

Maybe it would be easier if we only had one number to remember. Or if the only thing we had to know was whether our numbers should all be low or all be high.

Even a heart specialist like Dr. Steinbaum can relate.

“I think women are incredibly overwhelmed with health information,” she says.

But, being a doctor, she has a remedy: a list of five important things women should know about cholesterol.

1. A high HDL (good cholesterol) level doesn't let you off the hook.

“There’s a belief that if your HDL is high, then your total cholesterol is good. That’s not exactly the truth,” Dr. Steinbaum says.

HDL stands for high-density lipoprotein. Like all cholesterol, HDL is a type of blood fat — but it’s good fat. HDL works like a broom, sweeping bad forms of cholesterol out of your arteries.

Having an HDL of 60 mg/dL or higher may help protect you against heart disease, according to the National Heart, Lung, and Blood Institute (NHLBI).

Thanks to the hormone estrogen, women tend to have higher HDL levels than men. So if you’re a premenopausal woman and your HDL level is high — well, that’s to be expected, says Dr. Steinbaum.

“But it doesn’t mean that your cholesterol profile is OK,” she says.

2. Menopause hurts both your good and bad cholesterol levels.

As estrogen levels drop with menopause, so does a woman’s HDL. At the same time, her levels of LDL (low-density lipoprotein, the bad cholesterol) begin climbing.

It’s a bad double whammy, says Dr. Steinbaum.

“All that protection we had against heart disease changes with menopause,” she says. “So women really need to pay attention to all the components of their cholesterol profile before menopause hits.”

LDL is harmful because it can build up inside artery walls, thickening them, impeding the flow of blood and oxygen, and forming hard deposits of plaque. If one of these deposits breaks apart, it can throw a clot into the bloodstream that causes a heart attack or stroke.

An optimal LDL level is less than 100 mg/dL, according to the NHLBI.

3. Low HDL is always a risk—even if your LDL levels are healthy.

For both women and men, a high HDL is a good thing.

But a low HDL is a greater risk factor for heart disease in women at any age than it is for men, says Dr. Steinbaum. “If you have a low HDL — even if your LDL isn’t super high—you have an increased risk for heart disease,” she says.

4. High triglycerides are also always a risk.

Triglycerides are another type of unhealthy blood fat. And, like LDL, high triglycerides pose a greater risk to women’s hearts than to men’s, according to Dr. Steinbaum.

“High triglycerides also are often associated with low HDL,” she says. “When you have that combination, the LDL particles tend to be small and dense.”

Smaller, denser LDL particles appear to burrow more easily inside artery walls than their larger cousins. They also seem more likely to turn into plaque.

5. Unhealthy cholesterol levels contribute to metabolic syndrome.

Metabolic syndrome is a cluster of conditions that increase your likelihood for heart disease, diabetes and other health problems. Low HDL levels and high triglyceride levels are both among the risk factors that make up metabolic syndrome.

“Metabolic syndrome is epidemic in women right now,” Dr. Steinbaum says. “But it’s important to know that this is a lifestyle disease that can be changed with diet and exercise.”

What you can do

Cholesterol levels in general can be controlled by lifestyle changes—such as increasing physical activity; quitting smoking; and switching to a diet that’s low in saturated fat and cholesterol and that emphasizes fruits, vegetables and whole grains.

If you don’t know your cholesterol numbers, talk with your doctor about having a blood test called a fasting lipoprotein profile. It measures total cholesterol, LDL, HDL and triglycerides. Both the AHA and NHLBI recommend it for all adults after their 20th birthday and about every 5 years following.

“You can actually do something about these numbers,” says Dr. Steinbaum. “And with heart disease being the No. 1 killer, it’s important that you do.”

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