Women’s Heart Health 101

Surprise, cholesterol isn’t all bad. Your body uses it to make hormones, vitamin D, and substances that aid digestion. But that doesn’t mean you should make a run for the turkey bacon. That’s because your body makes all the cholesterol it needs on its own, without any extra-fatty foods eaten by you.

More than half of adults have too much cholesterol flowing around in their bloodstreams, a problem that, frighteningly enough, often carries back to their childhoods. Once your total cholesterol reaches 200 milligrams per deciliter, your risk of heart disease increases. And with it, your risk of death from heart disease — the No. 1 killer of women.

But what you may not have heard is that women are less likely than men to keep their cholesterol under control, the American Heart Association reports. But what does your total number mean exactly?

“We’ve discovered that total cholesterol is a meaningless number, at least for women,” said Dr. Barbara H. Roberts, director of The Women’s Cardiac Center at The Miriam Hospital in Providence, R.I., and author of “How to Keep From Breaking Your Heart: What Every Woman Needs to Know About Cardiovascular Disease.” “That’s because total cholesterol is made up of several blood fats, including LDL [so-called ‘bad’ cholesterol], HDL [so-called ‘good’ cholesterol] and triglycerides. In women, high levels of triglycerides and low levels of HDL are more significant risk factors for atherosclerosis [aka hardening of the arteries] than are high levels of LDL.”

Cholesterol, called plaque, can build up in your arteries, the vessels that carry blood full of oxygen and nutrients from your heart and lungs throughout your entire body. High cholesterol has a negative impact on this healthy travel: it encourages the arteries to narrow and block. LDL, the bad type, causes cholesterol to build up in the blood.

Your goal? Keeping your LDL down.

“To lower your cholesterol the drug-free way, eat a plant-based diet, quit smoking, do lots of aerobic exercise, keep your weight under control and don’t fall for the low-fat diet fad,” Roberts said. “Eating low-fat is counterproductive for women because it lowers your HDL; that is, your good cholesterol.”

How to Make Healthy Cholesterol

Forget low-fat diets, and make room for monounsaturated fats in the foods you eat.

“The best type is olive oil,” Roberts said. “If your HDL is low, you should eat between two to three tablespoons per day — either straight from the spoon or drizzled on salads or cooked vegetables, substituting it for saturated [animal] fats like butter or polyunsaturated fats like corn oil.”

And women actually need more of this healthy cholesterol than men do. The lower limit of normal HDL in women is 50 milligrams per deciliter, while in men it’s only 40 mg/dl.

It’s Good to Be a Girl

If you’ve ever blamed your hormones for tears and moodiness, here’s one thing to say “thank you” for: Estrogen may actually help protect you against heart attacks, says Dr. Robert H. Eckel, spokesman and former president of the American Heart Association. From the time your body starts producing it at puberty until production falls in your mid-50s, you’ll have higher levels of HDL than the men around you. Because women make estrogen and men make androgens, women are less likely to have a heart attack than men are (until they reach menopause, that is, when both estrogen and HDL levels drop).

And the Number Is…

“Once you’ve reached your 20th birthday, your doctor should order a full cholesterol panel,” Roberts said.

This is nothing more than a fasting blood test (you can’t eat or drink anything with calories for 12 hours before), but it shows your doctor crucial numbers for assessing your risk of heart disease: your LDL, HDL and triglyceride levels. If your doctor hasn’t ordered one, go ahead and ask about it yourself. Having a family history of heart disease makes knowing your numbers even more essential.

Take a look at your numbers with your doctor, and set a goal level as to where your LDL should be. If you have no risk of heart disease, yet your cholesterol numbers are less than optimal, your goal should be 160 milligrams per deciliter; if you have more risk factors, such as a family history of heart attacks, your goal should be 130 milligrams per deciliter. And if you already have heart disease, your goal should be 100 milligrams per deciliter at the very highest.

Change Your Lifestyle First

Before you blindly pop the cholesterol-lowering pills your doctor prescribes (likely statins, the go-to med for high cholesterol), consider changing your lifestyle first. According to a study from Mount Sinai School of Medicine, 71 patients who had been prescribed statins to bring their “bad” cholesterol down weren’t eating any more saturated fat six months later, as many medical professionals assumed they might (perhaps counting on the medication to make up for a steak or two). Some patients also said they would have preferred to try lifestyle changes before taking the drugs.

And in many cases, lifestyle changes may be all it takes to make a difference. In a five-year study of 535 premenopausal women, researchers from the University of Pittsburgh’s Graduate School of Public Health found that lifestyle changes, such as exercising and following a healthy high-fiber diet were able to control increases in LDL cholesterol.

As a Last Resort

If your LDL still hasn’t dropped after one month to six weeks of a high-fiber diet it may be time to try statins, Eckel says, but keep in mind that once you start taking them, you’ll probably have to stay on them for life. Before your doctor writes up a prescription, take a test to make sure you don’t have kidney, thyroid or liver disease, all of which can also mimic high cholesterol.

Jenny Stamos writes about health, nutrition, psychology, work, money and love for magazines such as Self, Shape, Glamour, Women’s Health, Prevention and Woman’s Day.