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Cholesterol and Women

We hear a lot about cholesterol tests and numbers for good reason - elevated cholesterol is a major, independent risk factor for heart disease, the number one killer of men and women.  But are cholesterol concerns the same for men and women? Yes.

New cholesterol guidelines released by the National Heart, Lung and Blood Institute in July 2004 made some significant changes to previous recommendations based upon new evidence emphasizing how important it is to manage cholesterol long before a person develops heart disease, especially if they have risk factors. The current recommendation for optimal triglyceride levels is now under 200 mg/dL; this is the same recommendation for total cholesterol levels. What's new is that these guidelines recommend maintaining an optimal LDL (the "bad" cholesterol) of 100 mg/dl or lower for those at the highest risk of coronary heart disease (CHD); those at moderate risk should maintain an LDL less than 130 mg/dl; and those at low risk may maintain an LDL less than 160 mg/dl before treatment is recommended. The recommendations for an optimal HDL (the "good" cholesterol) of 40 mg/dl or higher. The good news is that having a "high" HDL--more than 60 mg/dL--is now considered to be a "negative" risk factor: its presence can discount one other risk factor or remove it from the count. Premenopausal women--or menopausal women taking estrogen therapy--are more likely to have a higher HDL than men. Diabetes, however, has been added as an official, independent risk factor equivalent to having had a personal history of coronary heart disease; this condition affects more women than men.

While we know that in women, coronary heart disease (CHD) usually begins 10 to 15 years later than it does in men, it also makes sense to manage cholesterol levels earlier to prevent the development of atherosclerosis later. Most CHD in women develops at 65 years or older. However, CHD can develop in women at a younger age if they have 2 or more risk factors, including metabolic syndrome. As a result, the new guidelines emphasize that women should be treated similarly to men with preventive strategies including statin therapy if indicated.

The National Heart, Lung and Blood Institute estimates that more than half of women over age 55 need to lower their cholesterol.  This can often be accomplished with aggressive dietary changes, exercise, or medication - often, a combination of all three interventions is necessary.   Interestingly, recent studies have shown that women actually reap greater rewards from treatment than men, sometimes lowering their risk of a heart attack by twice as much.  Studies also show, however, that many women who are being treated with medicine are treated with insufficient doses to achieve the desired effect.

Created: 11/8/2004  -  Donnica Moore, M.D.

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