For women: controlling your cholesterol can save heartache

By James Wang, MD Baystate Wesson's Women's Group Heart disease is the single leading cause of death in American women, claiming nearly half a million lives each year more than all cancers combined. More women die from heart attacks than men, but we don't here as much about heart health for women. Prior to menopause, women generally have better cholesterol levels than men. This is largely attributed to the protective effects of estrogen. Once in menopause, women have 2 to 3 times the rate of heart disease compared to premenopausal women. About cholesterol Cholesterol studies are performed to monitor the level of different types of fats or lipids in the blood. Abnormalities of these lipids are associated with an increased risk of heart disease. There are four values comprising a cholesterol or lipid profile total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and triglyceride (TG). The total cholesterol essentially represents the combination of the HDL and LDL. The normal and desirable level is less than 200 mg per deciliter (mg/dL). Total cholesterol values between 200 and 239 mg/dL are considered borderline elevated, and values of 240 mg/dL and above are elevated. The LDL is considered the "bad" cholesterol. LDL increases plaque formation and can lead to reduction of blood flow through arteries. Disruption of fatty plaques can lead to further vessel damage, blood clots, and heart attacks and strokes. The best LDL levels should be less than 100 mg/dL. LDL values of 100 to 129 mg/dL are "near best"; 130 to 159 mg/dL are borderline elevated; 160 to 189 are high, and 190 mg/dL and greater are very high. The HDL is considered the "good" cholesterol. HDL helps to clear the bad cholesterol from the blood and reduce plaque formation on the blood vessels. Values for HDL are preferable higher than lower. HDL levels of 60 mg/dL and greater are desired. Values less than 40 mg/dL are undesirable or low. Triglycerides are another type of fat. Elevated levels of triglyceride present significant risk factors for heart disease. Normal TG levels should be less than 150 mg/Dl. Borderline high levels are 150 to 199 mg/dL; high levels 200 to 400 mg/dL; very high levels are over 500 mg/dL. Why triglycerides matter Although most attention has focused on total cholesterol and LDL levels, research from the Framingham Heart Study, a decades long study, TGs are also associated with an increased risk of heart disease. Several studies showed the elevated TG levels are a more important risk factor for heart disease in women compared to men. A recent study suggests TG risk for heart disease may be gender neutral. Nevertheless, the risk of heart disease is directly associated with increases in TG levels. Elevated TG levels are particularly important in women with diabetes or metabolic syndrome since these two disorders are already associated with an increased risk for heart disease. The most common lipid abnormalities in women with type 2 diabetes (non-insulin dependent) are elevated TG levels and decreased HDL levels. Why diet & exercise matter Therapy for lipid management has expanded focus from treatment of elevated LDL values (and total cholesterol) to treatment of elevated TG and decreased HDL. The National Cholesterol Education Program, American Heart Association, and American Diabetes Association recommend guidelines that aggressively strive to lower TG levels and increase HDL levels. Initial treatment for borderline and high levels of TG is dietary change. Weight loss tends to decrease the TG level. Exercise is an important part of lifestyle change as well. Dietary restriction of simple sugars (sweets and fruit), saturated fats and salt is recommended, as is avoidance of alcohol. Medications may be prescribed for those whose levels do not adequately respond to diet and exercise or those who have very high levels to start. Medications traditionally used to lower LDL and total cholesterol have some effect on lowering TG levels. It is important to follow good dietary and exercise habits to help keep cholesterol levels down. Diets should focus on high fiber (vegetables and fruits) and complex starches (whole grains and root vegetables). Low fat diets are recommended, and saturated fats should be avoided. Exercise, including just walking, helps reduce cholesterol. Regular work-outs should be done at least three times a week. Know your numbers! Finally, it is important to know your complete lipid profile values. Different national organizations recommend cholesterol screening at different ages. Some recommend cholesterol blood testing starting at age 20. Others advocate for testing at age 45. The general consensus is regular testing every five years. Earlier or more frequent screening may be recommended if there is a personal history of diabetes, high blood pressure, smoking, or a family history of heart disease. Most elevated levels should be treated, and medications are not always necessary. If your practitioner does not discuss management of high lipid values, ask for more information. James Wang, MD is a physician with Baystate Wesson Women's Group , Obstetrics and Gynecology, with offices at 3300 Main Street, 4th Floor Springfield, MA. Tel 413-794-7045 www.baystatehealth.com/bmp