When people meet Claire Blocker of Charlotte, N.C., they often say, “but you don’t look like someone who has heart disease.” Blocker is slim, she doesn’t smoke, she exercises regularly — and she’s a woman. Yet, at age 47 she suffered a stroke, followed by a heart attack and quadruple bypass at 51.
So why would a seemingly healthy woman be at risk for such devastating events in the prime of her life?
Well, as Blocker later found out, some people inherit a tendency for high cholesterol — and the problem does not affect men alone.
Regardless of whether inherited or acquired through diet, age or other factors, high cholesterol increases the risk for cardiovascular disease, which despite what many people might think, is the number one killer of women in the United States.
Yet even after suffering a stroke, Blocker was not aware she had elevated cholesterol. “No one checked my cholesterol. No one said you have high cholesterol,” she says.
Then, in 1998, while in the hospital recovering from minor hand surgery, she had a heart attack. After discovering that multiple areas of her coronary arteries were 90 percent to 95 percent blocked, her doctors recommended emergency heart surgery.
“So a week after I had my hand surgery, I was having my chest cracked open to have a quadruple bypass,” Blocker recalls.
Know your lipoprotein profile
Cholesterol is a fatty substance found throughout the human body. “Your body manufacturers cholesterol in the liver, and you also get it from the fats in your diet,” explains Dr. Kristin Newby, associate director of the Cardiac Care Unit at Duke University Medical Center.
While health experts recommend keeping total cholesterol levels under 200 milligrams per deciliter of blood (mg/dL), this cut-off sometimes causes confusion in women, says Dr. Margo Denke, an endocrinologist and panel member of the National Cholesterol Education Program.
In general, women have a 10 mg/dL to 12 mg/dL higher level of HDL (the “good” cholesterol) than men, Denke explains. When a woman has a total cholesterol level slightly over 200 mg/dL, she may think she has an increased risk for heart disease. However, the excess above 200 may simply reflect her higher HDL cholesterol.
To more precisely evaluate their risk, women should get the breakdown of LDL (the “bad” cholesterol) and HDL, Denke says. A fasting blood test called a complete lipoprotein profile provides this breakdown.
The profile also measures triglycerides, another indicator of heart disease risk. Ideally, women and men should keep their triglycerides under 150 mg/dL.
Risk increases after menopause
Women should get their first lipoprotein profile at age 20, then once every five years if they have no additional risks for heart disease.
“In everyone — men and women — cholesterol increases as we age,” says Newby. “But, in women, the change is very dramatic at the time of menopause.” Therefore, it’s important for women to keep close tabs on their cholesterol levels after menopause.
“Certainly folks at risk for heart disease or with a family history of high cholesterol should be screened early and yearly,” Newby says.
Diabetes and smoking are two risk factors associated with early onset of heart disease in women, so women with these risk factors should be extra vigilant about cholesterol testing.
If you’re pregnant or breastfeeding, do not get your cholesterol checked, advises Denke. Pregnant or lactating women often have high cholesterol, but the baby needs cholesterol from the mother, she says.
If your LDL is too high, your doctor may recommend that you make some lifestyle changes. Excess LDL can build up along artery walls, blocking blood flow to the heart and brain. This disease process, known as atherosclerosis, can be life-threatening if it leads to heart attack or stroke.
For some women, lifestyle changes alone won’t improve LDL levels enough, so doctors may also prescribe an LDL-lowering medication, such as a statin drug.
Today, Blocker is getting the care she needs to keep her cholesterol in check. And she encourages both women and men to proactively manage their health, including asking for a heart disease risk assessment that includes a complete lipoprotein profile.
Don’t be afraid to learn about your disease risks, she says. Embrace them, manage them and live with them.
Marie Karns is a freelance writer in Portland, Ore.