Photography: Claire Pepper
It is important for women, especially in midlife, to understand what cholesterol is and why we need to be aware of its health impacts. Cholesterol is essential for all of our organs to function, but it can also be a cause of coronary heart disease. As oestrogen levels drop, cholesterol levels can rise, which can increase the risk of heart disease.
So, let’s start with the basics: cholesterol is a waxy, fatty substance used to create cells, hormones and to produce vitamin D and bile, among other things. It’s transported in the bloodstream as particles called lipoproteins. There are two types: high-density lipoproteins (HDL), aka ‘good’ cholesterol, and low-density lipoproteins (LDL), aka ‘bad’ cholesterol – which delivers cholesterol to locations in the body. (It’s a complicated process: LDL delivers cholesterol to tissues in the body, then HDL delivers excess cholesterol to the liver for processing, roughly speaking). Take the first step to protect yourself by getting a test.
Cholesterol and the menopause
Women generally have higher HDL levels than men, thanks to the protective effect of oestrogen. Cholesterol levels vary during the menstrual cycle because of it. Oestrogen protects women’s heart arteries by reducing the build-up of fatty plaque. With menopause, however, oestrogen declines so levels of LDL and total cholesterol tend to rise. As does the risk of heart and circulatory disease. At age 50-54, almost two-thirds of women have high cholesterol. This rises from 62.5% to a whopping 75.9% between the ages of 55-59.
Cholesterol testing
There are no symptoms of raised cholesterol. You may discover you have it following a blood test at your NHS health check (which you should be invited for every five years from the ages of 40 to 74). The check is designed to spot the early signs of heart disease, stroke, kidney disease, diabetes and dementia. You can also ask your GP for a test if you’ve never had one and you’re over 40, overweight, or you have a family history of high cholesterol or heart problems.
A healthy score for total cholesterol is 5 or below, although you might get separate results for your good and bad cholesterol, triglycerides (similar to bad cholesterol), and your total cholesterol to HDL ratio.
Cholesterol and heart disease
High cholesterol levels increase the risk of developing heart disease, because LDL can build up inside the walls of your blood vessels and turn into plaque – which narrows and hardens your artery walls – limiting the flow of blood. I did a little experiment using the NHS’s heart age calculator, and when I changed my cholesterol level from healthy to high my ‘heart age’ increased from 55 years to 66. Check your heart age here.
How to lower cholesterol
The approach to improving your cholesterol levels is the usual ‘healthy lifestyle’ advice. Those good habits are so… well… good for you, in so many ways!
Eat less saturated fat, found in meat, dairy products and coconut oil
And avoid trans fats, or hydrogenated vegetable oil found in processed food – like shop-bought biscuits, pizza and margarine – which both lower good cholesterol and raise bad cholesterol
Eat more oily fish, like mackerel and salmon, brown rice, wholegrain bread and wholewheat pasta, fruits and vegetables, seeds and nuts (almonds have been shown to increase HDL cholesterol levels)
Eat more oats and barley. These grains are rich in beta-glucan, a type of fibre that helps lower your cholesterol
Exercise for at least two-and-a-half hours a week
Smokers and drinkers are advised to stop smoking and cut-down on alcohol.
You can also eat foods containing plant sterols or stanols, which have a cholesterol-lowering effect. Benecol and Flora ProActiv are the best-known but supermarkets including Sainsbury’s, Lidl and Aldi have their own ranges.
If your levels don’t reduce after you’ve made lifestyle changes, you may be prescribed statins. These one-a-day tablets are among the most commonly prescribed drugs in the UK. There are a couple of alternatives to statins, including a twice-a-year injection, recently approved by the NHS.
Remember, though, that while having high levels of LDL does make you more at risk of a heart attack or stroke (in general terms), it is only one risk factor. And as always, if you are concerned about your health, please speak to your GP.
Adrienne Wyper is a health and lifestyle writer and regular TNMA contributor.
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