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The Half of It
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A leading expert looks at women and heart health
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By Sid Kirchheimer
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MediZine's Healthy Living Fourth Quarter 2007
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 | Lori Mosca, M.D., Ph.D., director of preventive cardiology at New York-Presbyterian Hospital in New York City.
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Heart disease and stroke kill almost 500,000 American women a year. Yet women are less likely than men to be treated for high cholesterol or be aware they may have this risk factor for heart attack and stroke. Among those leading the effort to change that is Lori Mosca, M.D., Ph.D.
Roughly one in two women older than 50 have high cholesterol. Convincing research shows that if a woman can reverse high cholesterol, she can reverse her risk of heart disease.
High cholesterol plays an even more important role in women’s risk for stroke than was previously thought. As women get older, their risk for stroke may exceed their risk for heart attack. A study conducted by Dr. Mosca found that having high cholesterol in her 20s significantly increased a woman's later risk of death from stroke.
Actually, it’s age, not menopause per se, that’s mostly to blame. As we age, total cholesterol levels rise each year. But estrogen tends to raise levels of good HDL. So, after menopause, when a woman’s estrogen levels decline, her HDL levels also drop a bit. As her HDLs decline, her triglycerides and bad LDLs tend to increase.
First, be aware you may have a cholesterol problem. I published research that showed 50 percent of the women we screened had no idea they had high cholesterol. And be proactive. Ask your doctor, “What are my levels of HDLs, LDLs and triglycerides?” Ask if those levels need improvement, and what you can do.
For those with low to moderate risk of heart disease and/or slightly elevated cholesterol, lifestyle changes may be enough. Lose weight, exercise regularly, don’t smoke, eat a diet low in saturated fat and high in fiber, avoid trans fats. Together, these lifestyle factors can improve cholesterol in lower risk women as much as medication can. Taking a fiber supplement and consuming sterols and stanols—substances in plants sometimes added to vegetable spreads—can lower cholesterol by 10 to 15 percent. But high-risk women (such as those with heart disease or diabetes) need medication.
Only about 40 percent of high-risk women who are candidates for medication therapy under national guidelines are receiving it, which is significantly less than high-risk men. I think that’s largely because of age bias, rather than gender bias. Women tend to be older when they have heart disease, and doctors may be hesitant to use drug therapies—which are clearly beneficial—in older, more frail patients.
Even after menopause, women tend to have higher levels of good cholesterol than men. I worry that some doctors think having higher good HDL levels “undoes” a woman’s rising levels of the bad LDL cholesterol. They may not realize that regardless of good cholesterol levels, they should also be treating the bad.
About Our Expert
Lori Mosca,
M.D., Ph.D., is the director of preventive cardiology at New
York-Presbyterian Hospital in New York City and the author of Heart to Heart: A Personal Plan for Creating a Heart-Healthy Family.
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