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 artery disease is the leading killer of women (and men). About equal numbers of both sexes contribute to the toll of about 610,000 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. During menopause, the body produces less estrogen. At this time, the ample levels of HDL that seem to protect younger women decrease. Other blood fats, such as triglycerides and LDL (bad) cholesterol may start to rise. As a result, most women over age 55 have unhealthy levels of cholesterol as compared to their younger counterparts. 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. Screening guidelines vary among professional organizations. Age, along with other heart-related risk factors, are assessed for overall cardiovascular disease (or event) risk. Depending on your situation, risk assessment can start as early as age 20. Talk to your doctor about how often you should be assessed. Testing includes a blood test for total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

Do you know your cholesterol levels? Do you know how often they should be tested? Though hard numbers are not as much of a focus as the 10-year risk assessment, they are an important component over the overall picture. 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)

Triglycerides
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 doctor 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 cardiovascular disease. This includes people with the following conditions:

    
  • Established coronary artery disease
  • Hardening of the arteries—atherosclerosis
  • 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.