Women and Cholesterol

Do you know what causes heart disease in women? You hear it all the time: know your numbers, watch your cholesterol, HDL is good, LDL is bad. But what does it all mean? Here are some startling facts. Cardiovascular diseases and strokes cause 1 out of every 3 women’s deaths each year, killing approximately one woman every 80 seconds compared to 1 out of every 31 women who die of breast cancer each year.

An estimated 44 million women in the U.S. are affected by cardiovascular diseases. Women have a higher lifetime risk of stroke than men, and fewer women than men survive their first heart attack. And finally, approximately 90 percent of women have one or more risk factors for heart disease or stroke.

So what causes heart disease in women? One main source is cholesterol. Cholesterol itself isn’t bad. In fact, cholesterol is just one of the many substances created and used by our bodies to keep us healthy. It comes from two sources: your body and food. Your liver and other cells in your body make about 75 percent of blood cholesterol. The other 25 percent comes from the foods you eat, and cholesterol is only found in animal products.

There are two types of cholesterol: “good” and “bad.”  It’s important to understand the difference and to know the levels of “good” and “bad” cholesterol in your blood. Too much of one type—or not enough of another—can put you at risk for coronary heart disease, heart attack, or stroke. We have called the LDL cholesterol the “bad” cholesterol. If there’s too much LDL cholesterol in the blood, it can lead to plaque formation in the arteries, so we don’t want the LDL cholesterol to be too high.

HDL, on the other hand, is what we call the “good” cholesterol. When you have a high HDL, it is protective. It actually shuttles the LDL out of the arteries and protects the lining of the arteries from developing plaque. The female sex hormone estrogen tends to raise HDL cholesterol, and as a rule, women have higher HDL (good) cholesterol levels than men. Doctors usually like the HDL levels to be over 40mg/dL.

A third component of cholesterol is triglycerides, which are the most common form of fat in the body. Many women who have heart disease or diabetes have high triglyceride levels >150mg/dL. A high triglyceride level combined with low HDL cholesterol or high LDL cholesterol seems to speed up atherosclerosis, which is the buildup of fatty deposits in artery walls. Atherosclerosis increases the risk for heart attack and stroke.

Older women tend to have higher triglyceride levels. Triglycerides go up due to being overweight/obese, physical inactivity, cigarette smoking, excess alcohol consumption, other diseases such as type 2 diabetes, some drugs, genetic factors, and/or a diet very high in carbohydrates (60 percent or more of calories).

The cholesterol treatment guidelines advise doctors to consider a patient’s overall health in making a treatment plan. And that’s why one of the biggest changes in the cholesterol guidelines could lead to more people taking cholesterol-lowering drugs called statins. For many years now, doctors have prescribed statins based on a cholesterol number, particularly the level of LDL (bad) cholesterol.

Now the guidelines advise assessing factors such as age, gender, race, whether a patient smokes, has high blood pressure and whether it’s being treated, whether a person has diabetes, as well as blood cholesterol levels in determining their overall risk for a heart attack or stroke. They also suggest that healthcare providers may want to consider other factors, including family history. Only after that very personalized assessment is a decision made on what treatment would work best.

According to the new guidelines, statin therapy is the recommended therapy for the following groups: people without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for having a heart attack or stroke within 10 years, people of any age with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization), people 21 and older who have a very high level of “bad” cholesterol which is considered 190 mg/dL or higher, and people with Type 1 or Type 2 diabetes who are 40 to 75 years old.

In order to lower your cholesterol or triglycerides, you must maintain an appropriate weight, have regular physical activity, reduce the saturated and trans fats in your diet, and stop smoking. However even by doing all of these things, you cannot escape your family genetics. In order to assess your cardiovascular risk factors, you should contact your primary care, family care, or internist for a physical exam.

Melissa Waddell, WHNP, is a nurse practicioner at Atlantic Ob/Gyn located in Va. Beach and Chesapeake. Please call 757-463-1234 or visit www.atlanticobgyn.com.

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