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 seem to understand 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 700,000 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 after age 65.

Postmenopausal Changes in Cholesterol

For reasons that aren't clear, women rapidly catch up with men with respect to heart disease during menopause . At this time the ample levels of HDL (good cholesterol) 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. Compared to men, however, women and older people less often receive treatment to lower their cholesterol. In one study of postmenopausal women with heart disease, 91% of the women had high cholesterol levels, yet less than half were being treated for it. Similarly, elevated cholesterol levels in elderly people are frequently not given the attention they deserve.

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 fasting blood test for total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

Do you know your cholesterol levels? Have you had them tested recently? Check out the tables below to see what the normal and desirable ranges are for each type of cholesterol and triglycerides.

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 or higher (6.2 mmol/L)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 or higher (1.6 mmol/L)Desirable

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

Triglycerides
Less than150 mg/dL (1.7 mmol/L)Normal
150-199 mg/dl (1.7-2.2 mmol/L)Borderline high
200 or higher (2.3 mmol/L)High
500 or higher (5.7 mmol/L)Very high

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

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 are the factors:

  • Age: Men over 45 and women over 55
  • Cigarette smoking
  • High blood pressure (even if controlled)
  • HDL (good) cholesterol less than 40 mg/dL (1.0 mmol/L)
  • Family history of premature heart disease (in a brother or father under age 55, or a sister or mother under age 65)

I hope you will take my advice to heart: Ask your healthcare provider about your cholesterol. It really counts—for women and men of all ages—when it comes to preventing heart disease.