Q&A: Cholesterol Concerns for Women
by Peggy Rowland
Bradley Bale, MD and Amy Doneen ARNP answered my questions on cholesterol concerns for women. They specialize in the prevention of heart attacks and ischemic strokes. You can read more about them at Bale Doneen Method.
How often should women have their cholesterol checked?
Women should have their cholesterol checked at least by the time of puberty. If it is fine, it should be rechecked at least every five years until age 25. After age 25, annual lipid testing should be standard. Women should have cholesterol evaluated pre and post each pregnancy, as hormone levels can cause significant variations in lipid profiles. Women go through significant hormone variations with puberty, pregnancy, peri-menopause and menopause so it is essential that normal levels be established before these significant events.
If you feel fine is it important to know your cholesterol numbers?
Feeling fine has no bearing on when to check cholesterol, as most women feel perfectly normal right up until the time of a heart attack or stroke. Additionally, many women have cholesterol numbers that appear rather stable and yet may be at tremendous risk so it is essential to get regular medical care. It is also important to realize that many women who have a heart attack or ischemic stroke have symptoms that vary from the classic symptom of chest pain. Specifically, many women report shortness of breath, anxiety, fatigue and inability to sleep. These symptoms are often discounted and ignored, which can have detrimental effects.
My cholesterol results tell me my total cholesterol, triglycerides, HDL and LDL – which number is important?
Elevated cholesterol is a risk factor and should be taken seriously at any age. It was recently reported from the Women’s Health Study that the total cholesterol (TC) –good cholesterol (HDL) ratio (TC/HDL) is the most predictive cholesterol number. Ideally the ratio of TC/HDL should be less than 3.0. Simply relying on one of the values exclusively is often misleading.
Treating cholesterol with lifestyle and diet can be very challenging – at what point should a woman with high cholesterol consider taking medications to lower her cholesterol?
All women need to maximize their lifestyle for overall wellness. A healthy diet along with a daily exercise routine is the most important health decision we can control. Medication to lower cholesterol should be strongly considered for all women who (1) have atherosclerosis (cholesterol build up in the wall of an artery), (2) have Type 2 Diabetes or (3) cannot achieve the National Cholesterol Educational Panel’s guidelines for LDL or non-HDL levels based on their Framingham or Reynold’s risk score (FRS & RRS). Lifestyle should be initiated during all ages and many medical therapies now have FDA approval for use in the pediatric population. Pregnancy is one area where pharmaceutical intervention should be avoided. Women need to realize the FRS and RRS frequently underestimate their risk.
Any female interested in being aggressive with preventing a heart attack or stroke should consider additional screening with the painless relatively inexpensive ultrasound (US) scan of their carotid arteries known as carotid IMT (not the more commonly performed duplex US of the carotids) and having a blood test called Lp-PLA2 drawn. This blood test is the only FDA approved test for stroke and heart attack risk assessment. If any significant issues are discovered, they should seek the advice of health care providers who specialize in preventing heart attacks and strokes.