Heart disease is the No. 1 killer of women (more than all forms of cancers combined). In addition to maintaining a health weight through diet and exercise, your cholesterol levels are also important. But not all cholesterol is created equal.
A cholesterol test usually includes different forms of cholesterol. Of particular interest are the high-density lipoproteins (HDL) and low-density lipoproteins (LDL). It can be confusing, so here’s the abridged version. HDL is the “good” (Healthy) cholesterol. Yes, good. We actually need cholesterol for the membranes of our bodies’ cells. And, the HDL appears to act as cholesterol scavengers, picking up excess “bad” cholesterol (LDL) in your arteries and taking it back to your liver where it’s broken down. So, theoretically, the higher your HDL level, the less “bad” cholesterol (LDL) you’ll have potentially building up as plaque in your arteries, particularly the coronary arteries in your heart. Thus, reducing the LDL cholesterol and increasing HDL cholesterol may lower your risk of heart disease.
According to 2004 guidelines, an HDL level of 60 or above is protective against heart disease, and below 40 makes you vulnerable to it. Additionally, the ratio of total cholesterol to HDL is also important – the smaller the number, the better. For example, someone with a total cholesterol of 200 and an HDL of 60 would have a ratio of 3.3 (200 ÷ 60 = 3.3). If that person’s HDL was low — let’s say 35 —the total cholesterol-to-HDL ratio would be higher at 5.7. The Framingham Heart Study suggests that for women a ratio of 4.4 signifies average risk. If you have a high level of total cholesterol, it may be less alarming if your total-to-HDL ratio is low.
How do you raise your HDL? Fortunately for us, the female sex hormone, estrogen, tends to raise HDL cholesterol. As a rule, women have higher HDL cholesterol levels than men. Estrogen production is highest during the childbearing years, and this may help explain why premenopausal women may be protected from developing early heart disease. Perhaps now you can see why there has been much debate in recent years over hormone replacement therapy (HRT). While HRT may provide some benefits to women with osteoporosis or other medical conditions associated with menopause, the American Heart Association (AHA) recommends that HRT not be used for cardiovascular prevention. The HERS trial of women who had previously had a heart attack showed that these women did not benefit from HRT. Recent clinical trials appear to confirm that HRT does not appear to reduce risk of cardiovascular disease or stroke in postmenopausal women.
So if not hormones, how else? There are many ways to increase your HLD, but overall your lifestyle has the greatest impact. Don’t smoke, and if you’re smoking make earnest efforts to quit. Lose weight. For every 6 pounds (2.7 kilograms) you lose, your HDL may increase by 1 mg/dL (0.03 mmol/L). Increase your physical activity. Within two months of starting, frequent aerobic exercise can increase HDL cholesterol by about 5 percent in otherwise healthy sedentary adults. The AHA recommends you get at least 2½ hours per week moderate-intensity aerobic physical activity (e.g., brisk walking) and 2 days per week muscle-strengthening activities. And last but not least, choose healthier fats. A healthy diet includes some fat, but there’s a limit. In a heart-healthy diet, between 25 and 35 percent of your total daily calories can come from fat — but saturated fat should account for less than 7 percent of your total daily calories. Avoid foods that contain saturated and trans fats, which raise LDL cholesterol and damage your blood vessels.
Despite your best effort to make therapeutic lifestyle changes (TLC), your cholesterol may continue to put you at risk for a cardiovascular event. You can, and should, calculate your 10-year risk of having a heart attack with the Framingham Risk Assessment Tool. This tool is designed for adults aged 20 and older who do not currently have known heart disease or diabetes. Go here to find your risk score. Each woman must decide her acceptable level of risk and discuss the options with her healthcare provider. The American Heart Association recommends LDL cholesterol-lowering drug therapy for women meeting the new Adult Treatment Panel (ATP) IV guidelines published November 2013. You should use the Framingham Risk Assessment Tool and the newest ATP IV guidelines while talking with your healthcare provider about treatment options. Medications have their risks and side effects, but so do unhealthy cholesterol levels. Be informed. Go Red!