Both men and women have a higher risk of heart disease if they have high cholesterol. But women need to be aware of a few key differences — mostly related to hormones — as they monitor their cholesterol levels.

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

According to a 2023 report from the American Heart Association, 36% of females had total cholesterol levels higher than what’s recommended.

Read on to learn more about why cholesterol contributes to heart disease in women and how to manage it.

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): Sometimes referred to as “bad cholesterol,” LDL brings cholesterol to where it is needed in the body.
  • HDL (high-density lipoprotein): Also called “good cholesterol,” this cholesterol goes back to the liver where it’s broken down.

Having high cholesterol is known as hypercholesterolemia or dyslipidemia.

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

If you have too much LDL cholesterol in your blood, it can accumulate inside the walls of blood vessels. HDL helps to remove cholesterol from your bloodstream, but if your levels are too low, there won’t be enough to remove the buildup of LDL.

Over time, the buildup of LDL within your blood vessels can turn into a substance known as plaque, which can narrow and harden your arteries. This limits blood flow. When this happens, it’s called atherosclerosis and is considered one type of heart disease.

In general, higher cholesterol levels — particularly LDL — mean you may have a higher chance of having a heart attack or stroke during your life.

Women generally have higher levels of HDL cholesterol than men. This is due to a female sex hormone called estrogen.

According to research from 2023, cholesterol levels in females can vary depending on the phase of their menstrual cycle.

When women go through menopause around ages 50–55, many experience a change in their cholesterol levels.

At menopause, total and LDL cholesterol levels tend to rise, and HDL cholesterol typically falls. Therefore, even women who had ideal cholesterol values during most of their lives may have higher cholesterol later in life.

Having certain pregnancy complications may also increase your risk of heart disease.

Pregnancy can cause total cholesterol levels to rise, but these typically return to normal after pregnancy. It’s important to be aware of certain complications during pregnancy such as preeclampsia and gestational diabetes.

Overall, 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.

Risk factors include:

  • older age
  • a family history of heart disease
  • smoking
  • lack of exercise
  • having obesity or overweight
  • poor diet, such as a diet high in saturated and trans fats
  • familial hypercholesterolemia (FH)
  • diabetes
  • high blood pressure
  • polycystic ovarian syndrome (PCOS)
  • early menopause
  • 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.


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


For women, it may be recommended that LDL levels be:

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

While these cutoffs were used in the past, they’re not as commonly used anymore. If you have high cholesterol, a doctor will help you reduce your LDL by a percentage based on your risk of heart disease.

Most women over age 20 should have their cholesterol levels measured about every 4–6 years.

People who have risk factors for heart disease should have cholesterol screenings every 6–12 months.

It’s very important for women to monitor their cholesterol levels following menopause. The National Heart, Lung, and Blood Institute recommends cholesterol screenings every 1–2 years for women ages 55–65. If you’re older than 65, you should get 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 these 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 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 weight for your body.
  • Stop smoking, if you smoke.
  • Exercise for 150 minutes of moderate physical activity a 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.
  • Limit alcohol intake.

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

Premenopausal women are likely to have higher levels of HDL cholesterol compared with men due to the hormone estrogen. But for many women, levels of LDL cholesterol tend to rise after menopause, while 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 any risk factors for heart disease like high cholesterol, the less likely you are to develop heart disease.

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