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Cholesterol that builds up in the arteries of the heart is a major risk factor for heart disease, which is the number one cause of death in women.

Higher blood cholesterol levels can increase your risk for developing heart disease or having a heart attack.

Nearly half of American women over the age of 20 had high cholesterol as of 2013. And many women don’t even know what their cholesterol values are.

Both men and women are at a high risk of heart disease due to high cholesterol. But women need to be aware of a few key differences — mostly related to hormones — as they monitor their cholesterol levels throughout life.

Cholesterol is a waxy fat that your body uses to make cells, hormones, and other important substances like vitamin D and bile (a fluid that helps with digestion). Cholesterol is packaged and carried through your bloodstream as particles known as lipoproteins.

There are two main types of lipoproteins:

  • LDL (low-density lipoprotein) cholesterol, sometimes referred to as “bad cholesterol,” brings cholesterol to where it is needed in the body.
  • HDL (high-density lipoprotein) cholesterol, sometimes referred to as “good cholesterol,” carries cholesterol back to the liver, where it’s broken down.

Having a high level of cholesterol is known as hypercholesterolemia, or dyslipidemia.

People who have an LDL cholesterol level that’s higher than normal and an HDL cholesterol level that’s too low may be at a higher risk of heart disease.

If you have too much LDL cholesterol in your blood, it can accumulate inside the walls of blood vessels.

HDL cholesterol helps remove cholesterol from your bloodstream. But if HDL levels are too low, there won’t be enough of it to help remove the buildup of LDL cholesterol from your blood vessels.

Over time, the buildup of LDL within your blood vessels can turn into a substance known as plaque. Plaque can narrow and harden your arteries and limit blood flow. This is called atherosclerosis and is considered one type of heart disease.

In general, higher cholesterol levels — particularly LDL levels — means you have a higher chance of having a heart attack or stroke during the course of your lifetime.

Women generally have higher levels of HDL cholesterol than men, due to a female sex hormone known as estrogen.

According to the National Institutes of Health, research also suggests that cholesterol levels in women vary depending on the phase of the menstrual cycle, due to changes in estrogen levels.

As estrogen levels rise, HDL cholesterol also rises, peaking at the time of ovulation. On the other hand, LDL and total cholesterol levels decline as estrogen levels rise, reaching a low just before menstruation.

When women undergo menopause around ages 50 to 55, many experience a change in their cholesterol levels.

At menopause, total and LDL cholesterol levels tend to rise and HDL cholesterol tends to fall. For this reason, even women who had good cholesterol values during most of their lives may have high cholesterol later in life.

In addition, pregnancy can increase a woman’s risk of heart disease, especially certain complications during pregnancy such as preeclampsia and gestational diabetes.

Pregnancy can also cause total cholesterol levels to rise, but levels typically return to normal after pregnancy.

In general, men are at a higher risk of having heart disease than women. However, several risk factors can increase a woman’s risk, particularly during pregnancy and following menopause.

These include:

  • old age
  • family history of heart disease
  • smoking
  • lack of exercise
  • being overweight or obese
  • poor diet, such as a diet high in saturated and trans fats
  • familial hypercholesterolemia (FH)
  • diabetes
  • high blood pressure
  • polycystic ovarian syndrome (PCOS)
  • high blood pressure during pregnancy (preeclampsia)
  • gestational diabetes during pregnancy

High cholesterol means having a total cholesterol level above 200 milligrams per deciliter (mg/dL). This applies to both men and women over age 20.

HDL

For women, an HDL level less than 50 mg/dL is considered a major risk factor for heart disease. HDL levels above 60 mg/dL can lower the risk for heart disease.

LDL

For women, it’s recommended to try to keep your LDL levels:

  • below 100 mg/dL if you don’t have heart disease
  • below 70 mg/dL if you have heart disease or a number of risk factors for heart disease, such as diabetes, being over 55 years old, smoking, high blood pressure, or family history of heart disease

Women over age 20 should have their cholesterol levels measured about every 5 years. Women who have risk factors for heart disease should have cholesterol screenings more often.

It’s very important for women to monitor cholesterol levels following menopause. The National Heart, Lung, and Blood Institute recommends cholesterol screening every 1 to 2 years for women ages 55 to 65. Older women should be screened every year.

Getting your cholesterol levels checked by a doctor is the first step to understanding your risk of heart disease.

There are several ways to lower cholesterol, including medications that your doctor can prescribe.

Statins are the most common drug prescribed to treat high cholesterol. If statins don’t work, your doctor may prescribe a different medication, especially if they think you’re at a high risk of having a heart attack or stroke or if you have familial hypercholesterolemia.

Diet and lifestyle are also extremely important for lowering cholesterol levels. Here are a few lifestyle tips to help you lower or maintain healthy cholesterol levels:

  • Maintain a healthy body weight.
  • Stop smoking, if you smoke.
  • Exercise for at least 30 minutes per day for 5 or more days per week.
  • Eat a heart-healthy diet rich in fruits, vegetables, lean protein, fiber, and monounsaturated and polyunsaturated fats, such as those found in fatty fish (salmon, trout, tuna) and nuts.
  • Avoid foods high in sugar, like candy, soda, and fruit juices.
  • Consume alcohol in moderation.

Though high cholesterol and heart disease tend to occur later in life for women compared to men, heart disease continues to be the leading cause of death for American women.

Premenopausal women are likely to have higher levels of HDL cholesterol compared with men, due to a hormone known as estrogen. But for many women, levels of LDL cholesterol tend to rise after menopause, and HDL levels tend to fall.

High cholesterol has no signs or symptoms, so the only way to know if you have it is to get your cholesterol checked by a doctor on a regular basis, especially after you go through menopause.

The earlier you treat risk factors for heart disease like high cholesterol, the less likely you are to develop heart disease.