Woman heart disease image Most people know that middle-aged men with high cholesterol levels are prone to heart attacks. What many people don't recognize is that cholesterol is just as dangerous for women and people over age 65.

In the US, coronary heart disease is the leading killer of women, as well as men. About equal numbers of both sexes contribute to the toll of over 500,000 deaths each year from heart disease. There are some differences, though. For instance, men tend to develop heart attacks earlier, while women usually don't experience them until later in life.

Postmenopausal Changes in Cholesterol

Women rapidly catch up with men with respect to heart disease during menopause. The female sex hormone estrogen tends to raise HDL (good) cholesterol. A woman produces the most estrogen during her childbearing years. When she enters menopause, her body produces less estrogen. At this time the ample levels of HDL that seem to protect younger women take a nosedive. Other blood fats such as triglycerides and LDL (bad) cholesterol may start to skyrocket. As a result, about 75% of women over age 55 have unhealthy levels of cholesterol as compared to only 25% of younger women. These changes at least partly explain why a woman's risk of heart attack more than doubles after menopause.

Better Care for Women and Seniors

Research suggests that cholesterol treatment is at least as effective in preventing heart disease in women and seniors as it is in younger men. It is just as important for women and seniors to monitor their cholesterol levels and make the lifestyle changes that will help them to lower their LDL cholesterol and raise their HDL cholesterol. Lifestyle changes include a heart healthy diet and regular exercise. If you smoke, there are many successful programs that can help you quit. Your doctor may also prescribe medications that lower cholesterol.

Detecting and Controlling High Cholesterol

Current guidelines recommend aggressive drug therapy and lifestyle changes for seniors, with careful attention to individual circumstances. In addition, the National Cholesterol Education Program (NCEP) advises all adults aged 20 years or older to have their cholesterol checked at least once every five years. This should include a blood test for total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

Do you know your cholesterol levels? When was the last time you had them tested? Check out the tables below to see what the normal and desirable ranges for people without other heart disease risk factor.

Total cholesterol
Less than 200 mg/dL (5.2 mmol/L)Desirable
200-239 mg/dL (5.2-6.1 mmol/L)Borderline high
240 mg/dL (6.2 mmol/L) or higher High

mg/dL = milligrams per deciliter (mmol/L = millimoles per liter)

LDL (bad) cholesterol
Less than 100 mg/dL (2.6 mmol/L)Optimal
100-129 mg/dL (2.6-3.3 mmol/L)Near optimal/above optimal
130-159 mg/dL (3.4-4.0 mmol/L)Borderline high
160-189 mg/dL (4.1-4.8 mmol/L)High
190 mg/dL (4.9 mmol/L) or higherVery high

mg/dL = milligrams per deciliter (mmol/L = millimoles per liter)

HDL (good) cholesterol
Less than 40 mg/dL (1.0 mmol/L)Low
60 mg/dL (1.6 mmol/L) or higher Desirable

mg/dL = milligrams per deciliter (mmol/L = millimoles per liter)

Less than 150 mg/dL (1.7 mmol/L)Normal
150-199 mg/dL (1.7-2.2 mmol/L)Borderline high
200-499 mg/dL (2.3 mmol/L)High
500 mg/dL (5.7 mmol/L) or higher Very high

mg/dL = milligrams per deciliter (mmol/L = millimoles per liter)

If you have other risk factors for heart disease such as diabetes, your docotor may recommend lower target cholesterol levels. Discuss your risk factors and cholesterol goals with your doctor.

Factors That Worsen Cholesterol Risk

If you have unhealthy amounts of cholesterol or other fats in your blood, the guidelines advise treatment based on your level of risk. The most aggressive therapy is warranted for those at highest risk for heart disease, says NCEP. This includes people with the following conditions:

  • Established coronary heart disease
  • Hardening of the arteries
  • History of a stroke or warning stroke
  • Diabetes

Lifestyle changes or cholesterol-lowering drugs are also recommended if you have two or more factors that accentuate your risk. These factors include:

  • Increasing age for men over 45, and women over 55
  • Cigarette smoking
  • Controlled or uncontrolled high blood pressure
  • HDL (good) cholesterol less than 40 mg/dL (1.0 mmol/L)
  • Family history of premature heart disease, such as with a brother or father under age 55, or a sister or mother under age 65

Ask your doctor about your cholesterol. It really counts, for women and men of all ages, when it comes to preventing heart disease.