Many women have high cholesterol and are totally unaware of it. Nearly two thirds of women at highest risk of heart attack, and death from heart disease, are not being treated appropriately to lower their cholesterol. That is why it is so important that you know what your levels are and what they mean!

What is cholesterol?

Cholesterol is found in every cell of the body. It is important for building hormones. When there is too much cholesterol in the body it can deposit in blood vessels and cause inflammation. Eventually it can cause a build up of plaque with narrowing and eventually completely clog the vessels. This can result in a stroke or a heart attack. Cholesterol is what is called a lipoprotein. It is one of many that can cause these problems.

The main types of lipoproteins are:

LDL or low-density lipoprotein- this is called the “bad” cholesterol because it builds up on the walls of arteries and causes what we call “hardening” of the arteries.

HDL or high-density lipoprotein is called the “good” cholesterol because it picks up extra cholesterol in the body and brings it to the liver.

Triglycerides are circulating fat that give your body energy and also help to build hormones. They also contribute to hardening of the arteries. Elevated triglycerides are seen as a part of metabolic syndrome.

Lipoprotein (a) – also known as Lp(a) – is a lipoprotein that looks like LDL in composition with an abnormal protein attached. Thirty percent of those with heart disease have this factor in their blood. Elevated Lp (a)levels are considered a risk factor for heart disease.

What are the Guidelines?

The current guidelines recommend that total cholesterol should be no greater than 200 mg/dl; HDL or the “good” cholesterol is greater than 50 mg/dl; triglycerides be less than 150 mg/dl; and that LDL or the “bad” cholesterol is less than 100 mg/dl. The range for Lp (a) is specific to the laboratory that does the test and is not often part of the standard initial screening of healthy patients. Since it has a strong genetic link, it is usually ordered on those patients with a family history of heart disease or those who already have heart disease.

Who is being treated?

In a recent study of 1.1 million managed care patients, over 8000 women were identified with heart disease of risk factors for heart disease. Of these women, only 7 percent had the optimal levels of all cholesterol types at the start of the study. Only 12% had optimal levels at the end of three years and only 1/3 were on lipid lowering medications.

Why is this important?

Women with risk factors for heart disease are six times more likely to die of heart attack and stroke than women who have no risk factors.

What is the treatment?

The standard treatment of high cholesterol or hyperlipidemia is a “heart healthy” diet, rich in fruits and vegetables, healthy fats such as the omega-3 fatty acids, lean meats and fish. And, of course . . . EXERCISE! Increasing your lean body mass (muscle) and decreasing your fat mass can make a huge difference and improve your lipid profile. Therefore, both aerobic exercise and strength training are important.

For those who cannot get their cholesterol into acceptable range with diet and exercise alone, there are a wide variety of medications including the “statin” drugs (such as Lipitor and Crestor), Niacin, fat blockers such as Zetia and Xenical, and various combinations. It is interesting to note that the only medications that lower Lp(a) are Niacin and Estrogen. One of the ways to lower triglycerides is to stay away from simple sugars and alcohol. Fish oil or the omega-3 fatty acids in doses of 2-4 grams a day can also lower triglycerides.

The Bottom Line:

Heart disease is the number one killer of women. The way to avoid this fate is to prevent it. One of the best ways to prevent it is to be as fit as you possibly can be. To do this, find out what your lipid values are and then keep them at a healthy level by going to see your doctor or health care provider. Engage your provider as a partner in your health care to safely lower your lipids if they are high, or to help you to monitor them to make sure they stay at a healthy level. Take action! Be accountable! Be healthy!

Robin Miller, M.D., M.H.S. Physician

Dr. Robin Miller's career as a physician has been quite varied. She currently serves as the medical director of Triune Integrative Medicine, a highly innovative Integrative Medicine clinic in Medford, Oregon. She is also a medical reporter for KOBI Channel 5, the NBC affiliate in Medford. She has produced the award-winning health series, “Is there a Doctor in the House,” which is shown on the GE-sponsored Patient Channel nationwide. She is a medical columnist for The Daily Courier in Grant's Pass, Oregon, and the host of a teen health podcast. Robin has written the book Kids Ask the Doctor and the book Confessions of the Soul Straight from the Heart.