Photographed by Ben Ritter.
When most of us think about cholesterol, visions the AARP set and fibrous cereal commercials come to mind. When it comes to cholesterol messaging, women are rarely in the picture. And, while heart disease — the leading killer of American adults that is strongly connected to cholesterol — affects everyone, young women's risk is a bit overlooked.
Statistics do show that men tend to be at higher risk of heart disease than women of childbearing years. But, some new trends are emerging: Research also shows that chronic heart disease-related death rates in American women aged 35-54 are on the upswing after decades of being stable (likely due to the rise in obesity). And, cardiovascular-disease awareness among women is strikingly absent. A 2010 American Heart Association survey found that just 53% of women said they would call 9-1-1 straight away if they thought they were having a heart attack.
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There’s still lots of literature out there that doesn’t chronicle cholesterol as a young woman’s problem. And, perhaps because traditional wisdom assumes that women aren’t at risk when it comes to high cholesterol and heart disease, some of us aren’t getting the early diagnosis or treatment we need. This, despite the AHA’s findings that cardiovascular disease still kills approximately one woman every minute in the United States.
Maybe it’s high time we get smart about cholesterol and learn how it affects our bodies:
Cholesterol is an oily fat that travels throughout the bloodstream as lipoproteins — fat particles housed in protein shells. The more lipoproteins in our bodies, the more congested our bloodstream can become, and the more likely these particles will penetrate the artery walls. When particles penetrate the artery walls, they release their cholesterol — a process that happens in everyone. In a healthy person, the cholesterol is then gobbled up by a type of white blood cell, then transported out of the blood vessel. In compromised systems, our bodies can’t keep up with the traffic of incoming particles and get rid of the cholesterol in the artery walls.
Smoking, having diabetes, being overweight, or having a disease like HIV or hepatitis can all compromise our systems and contribute to the inability of our artery walls to properly deal with incoming cholesterol particles.
Not all cholesterol is believed to be the same. Low Density Lipoprotein, often referred to as the "bad cholesterol," is more difficult for our bodies to get rid of. And, when we have too much of it, it can take residence in the artery walls where it can potentially cause heart failure. High Density Lipoprotein (LDL) is often referred to as the “good cholesterol." It’s still cholesterol all right, but this stuff can actually help remove the LDL from artery walls to be processed by the liver and then expunged from our bodies.
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Photographed by Ben Ritter. Women typically tend have higher HDL, the “good cholesterol," levels — this relates to why we women are so often underdiagnosed, according to Dr. James Underberg, a lipidologist and specialist in cholesterol and preventive cardiovascular medicine who
also serves as a Clinical Assistant Professor of Medicine in the Division of General Internal Medicine at NYU Medical School.
“When I talk about ‘good’ cholesterol, I use that term in airquotes, because there’s nothing really that good about it. We don’t know, per se, that having more of that HDL cholesterol protects you against having a lot of the bad (LDL) cholesterol.”
“Many women are mistakenly are told not to worry. So, there are lots of women walking around out there who have high levels of LDL cholesterol, but because they also have high levels of HDL cholesterol, they’re told not to worry. You can’t know that that’s the case unfortunately.”
Why? Well, despite the fact that women tend to carry more so called “good cholesterol,” there’s a question as to how much it benefits us in the long run: After menopause, we become more at risk of heart disease than men. With this in mind, it’s hard not to wonder how well the “good” cholesterol is really protecting us. Obviously there's a lot going on.
“This where a lot of the misunderstanding comes in and where we start to see people writing things like ‘cholesterol doesn’t matter’ or ‘cholesterol doesn’t make a difference for women,’” he says.
Underberg notes that some women can reach higher risk levels while still not really being considered at risk or receiving deeper testing.
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“But, what happens with women is this: All too often their HDL might be high and the LDL might be high-to-normal, but their triglycerides — which represent fat — are elevated, often from obesity or diabetes, and that creates a condition in which too many particles come in [to the artery walls]. And, the problem is that many people never get the number of particles measured. And, so they never really know what their real associated risk of heart disease is — because they’re not really looking at the appropriate measures of risk." He continues, "That’s why I think that a lot of women still being undertreated. They never even get to the point where someone knows they are at risk.”
To help women get more detailed cholesterol counts and a better assessed risk of their heart disease, the American Heart Association has issued an update to its guidelines for women that focuses more on real-world research than clinical research. There’s also plenty of information about what we can do to lower our cholesterol levels through simple lifestyle changes.
Photographed by Ben Ritter. Eating right, that modern-day cure all, certainly applies to those who wish to lower their cholesterol levels. Soluble fiber can be particularly beneficial, as it slows down absorption of cholesterol in the gut and may have some other lipid-lowering effects.
And, easing up on the smokes can make for some significant changes as well: “Observational data shows that smoking increases the risk of cancer and heart disease. No question about it. If you look at people who smoke, their risk is greater than those who do not. If you stop smoking today, in one year you will have reduced your risk of having a cardiovascular event by 50%,” offers Underberg. “I have to put a patient on a cholesterol-lowering medicine for five years to reduce risk of a heart attack by 35%. Here's something that an individual can do that has a far greater likelihood of reducing the risk of heart attack in a much shorter period of time than anything doctors can do with a drug that has side effects.”
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Lifestyle changes can go far in reducing cholesterol levels (check out this guide from the National Heart, Blood, and Lung Institute for other lifestyle changes that can lower cholesterol); But, sometimes young women who live healthfully may still be high cholesterol targets.
“The one thing I think that younger people have to be aware of is that there are some conditions that are not entirely related to lifestyle causes. There are genetic or inherited abnormalities associated with cholesterol that...do need to be treated,” Underberg explains.
He suggests patients talk to their doctors about any family history of cardiovascular disease and ask whether their doctors are taking other risk factors into account, such as weight gain, increased blood pressure, and changes in age. When considering these things, it might be helpful to ask your doctor questions like: “Are the basic tests enough?” and “Should we be doing some other things beyond looking at standard testing to better assess my risk?”
In many cases, specialized testing won’t be necessary. But, by opening up a dialogue with your doctor you’ll be advancing not only your personal health while also helping to unearth the buried conversation of women and cholesterol as a whole.