Managing Cholesterol Levels for Women

All women over the age of 20 should have their blood cholesterol checked. The following sections describe the steps for managing cholesterol levels for two types of women: those who do not have coronary heart disease and those who do have coronary heart disease.

If You Do Not Have Coronary Heart Disease

Getting Your Cholesterol Checked. Blood cholesterol levels are measured by means of a small blood sample. The blood should be tested for total cholesterol and, if an accurate measurement is available, for HDL-cholesterol as well.

Understanding the Numbers. A desirable total cholesterol level for adults without coronary heart disease is less than 200 mg/dL (milligrams of cholesterol per deciliter of blood). A level of 240 mg/dL or above is considered "high" blood cholesterol. But even levels in the "borderline-high" category (200-239 mg/dL) increase the risk of heart disease.

HDL levels are interpreted differently than total cholesterol levels. The lower your HDL level, the higher your heart disease risk. An HDL level of under 35mg/dL is a major risk factor for heart disease. A level of 60 mg/dL or higher is considered protective.

Total and HDL-cholesterol are measured first. If these tests show any of the following, your doctor will want to measure your LDL level as well:

• Total cholesterol 240 mg/dL or above

• Total cholesterol 200-239 mg/dL with two or more other non-cholesterol risk factors for heart disease -- these are smoking, high blood pressure, overweight, physical inactivity, diabetes, age (55 years or older for women), and a family history of early heart disease (a father or brother stricken before age 55, or a mother or sister before age 65)

• HDL-cholesterol less than 35 mg/dL

LDL is measured with a blood test called a lipoprotein profile, which also gives the level of triglycerides, another fatty substance.

An LDL level below 130 mg/dL is desirable. LDL levels of 130-159 mg/dL are borderline-high. Levels of 160 mg/dL or above are high. As with total cholesterol, the higher your LDL number, the higher the risk.

Prevention and Treatment. If your tests show that your blood cholesterol levels are in the desirable range, keep up the good work! To help keep your levels healthy, it will be important to eat a low saturated fat, low cholesterol diet, engage in regular physical activity, and control your weight.

If your blood cholesterol levels are too high, your doctor may recommend a specific treatment program for you. For most people, cutting back on foods high in saturated fat and cholesterol will lower LDL-cholesterol, which is the main goal of treatment. Regular physical activity and weight loss for overweight persons also will lower blood cholesterol levels.

Losing extra weight, as well as quitting smoking and becoming more physically active, also may help boost your HDL-cholesterol levels. (For more specific information on lifestyle changes that can help improve cholesterol levels, see the section on "Lowering Your Blood Cholesterol.")

If your new diet and other lifestyle changes do not lower your blood cholesterol level enough, your doctor may suggest that you take cholesterol-lowering medications. If you have other risk factors for coronary heart disease, you will need to lower your cholesterol more than someone without risk factors.

If You Have Coronary Heart Disease

Women who have coronary heart disease should pay even more attention to their cholesterol levels. An individual with coronary heart disease has a much greater risk of having a future heart attack than a person without heart disease. Whether or not your cholesterol level is elevated, lowering it will greatly reduce your risk of a future heart attack and can actually prolong your life.

Getting Your Cholesterol Checked. Since you have coronary heart disease, you will need to start with a lipoprotein profile to determine not only your total cholesterol and HDL-cholesterol levels, but also your levels of LDL-cholesterol and triglycerides.

Understanding the Numbers. Your goal should be to have an LDL-cholesterol level of about 100 mg/dL or less, which is lower than for people who do not have coronary heart disease. Depending on what your LDL level is, your next steps will be the following:

• If your LDL level is 100 mg/dL or less, you do not need to take specific steps to lower your LDL. But you will need to have your level tested again in 1 year. In the meantime, you should follow a diet low in saturated fat and cholesterol, maintain a healthy weight, be physically active, and not smoke. You should also follow the specific recommendations of your doctor.

• If your LDL level is higher than 100 mg/dL, you will need a complete physical examination to find out if you have a disease or condition that is raising your cholesterol levels. Then, you should take steps to lower your LDL to 100 mg/dL or less: closely follow a low saturated fat, low cholesterol diet, be physically active, lose excess weight, and take cholesterol-lowering medicine, if it's prescribed. Of course, you also should avoid smoking.

If, in your doctor's judgment, your LDL level starts out too far above the LDL goal of 100 mg/dL, or if your LDL level stays too high after lifestyle changes, you will need to take medicine.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.