Go Red! Women and Cholesterol

Dr. Kang Health Pro
  • February is not only a time for us to focus on our romantic hearts but also on our biologic ones as well.  February has been designated heart awareness month by the American Heart Association, and during this month numerous campaigns are launched in the hopes of increasing our awareness and education about heart disease, the #1 killer in our country.

    Many people often think of heart disease as a man’s disease, but in fact heart disease is an equal opportunity killer.  More women die from heart disease in the US than other disease, such as breast cancer.  Go Red is a special campaign by the AHA to focus specifically on women’s cardiovascular health.  Heart disease seems to be different in women and men, and part of this difference may be explained by differences in cholesterol.

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    Women in general have better cholesterol profiles than men.  Women of childbearing years have higher good HDL levels (average levels ~55-60mg/dl) and lower bad LDL levels.  Women do tend to have higher triglycerides, though.  The main reason for this difference is estrogen.  Estrogen is known to have a potent effect in raising HDL levels, even when it is taken as a supplement in post-menopausal women.

    Once menopause occurs, estrogen levels fall, and a woman’s cholesterol profile may begin to resemble that of a man.  The risk of heart disease increases at this time, and this post-menopausal change in cholesterol is one explanation as to why women develop heart disease on average 10-15 years later than men.


    Does this mean that a woman’s cholesterol should be treated differently than a man’s cholesterol?  The answer is no – both men and women should have abnormal cholesterol levels treated with equal aggressiveness using any treatment that is currently available.  Identifying high cholesterol obviously precedes treatment and cholesterol screening for women is no different than for men.

    One interesting fact is that by the age of 45, more women than men have total cholesterol levels >200mg/dl, a level associated with an increased risk of heart disease.  One word of caution about total cholesterol levels: although total cholesterol is a good way to screen for high cholesterol, it’s the cholesterol profile including HDL and LDL levels that really determines risk for heart disease.  Since women have higher levels of HDL, their total cholesterol levels could be high yet still be acceptable if much of that total cholesterol is good HDL.


    A heart healthy diet, exercise, and not smoking are equally important in men and women.  If cholesterol cannot be controlled with these lifestyle changes, then the same medicines such as a statin can be used in both men and women with the primary goal of lowering LDL.  With respect to HDL, some scientists think that a woman’s target HDL should be >50mg/dl vs. the 40mg/dl for a man.  Studies have shown that if a woman’s HDL level falls below 50mg/dl, then the risk of a heart attack may increase 3 fold.

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    For post-menopausal women, one might logically think that estrogen replacement therapy is a good idea since it raises HDL.  However, studies have not shown any benefit for hormone replacement therapy in post-menopausal women with regards to heart disease.  In fact, there is some evidence that this type of treatment may actual increase the risk of heart attack and stroke, as well as blood clots and breast cancer.

Published On: February 28, 2007