High Cholesterol: The Gender Gap

Heart disease is the leading killer of both women and men, but when it comes to cholesterol, the sexes were not created equal. The skinny:

  • Before menopause, naturally high levels of estrogen can help women maintain healthy cholesterol levels and protect them from heart disease. When estrogen starts to decline during the years preceding menopause (average age of menopause 51) or by removal of the ovaries, High-density lipoproteins (HDL, or "good" cholesterol) typically drop, too.
  • HDL levels of 60 milligrams/deciliter and above are considered optimum for both men and women. Men are considered to have low HDL cholesterol at less than 40 mg/dL. Women have low HDL cholesterol at less than 50 mg/dL.
  • The National Heart, Lung and Blood Institute recommends that both men and women begin having their cholesterol tested every five years in their 20s. One exception? Young women who take birth control pills may need earlier and more frequent testing because the hormones in oral contraceptives may affect cholesterol levels and may enhance coagulation (blood clotting). The estrogen in oral contraceptives appears to increase HDL, triglycerides and total cholesterol levels, yet it decreases low-density lipoproteins (LDL, or "bad" cholesterol). Progestin in oral contraceptives seems to have the opposite effect. If you take oral contraceptives, discuss cholesterol testing and other risk factors with your physician.
  • Cholesterol medications appear to work differently in men and women. In several studies of statins, for example, women seemed to reap fewer benefits than men.

Reviewed By: Kerry Prewitt, M.D., FACC

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