There’s good cholesterol (HDL) and bad cholesterol (LDL). While a high HDL number on a screening is usually good news, it may not tell the whole story for some women.
HDL particles in cholesterol usually help protect against the bad LDL that can build up plaque in the arteries. But a new study suggests HDL may do just the opposite in middle-aged women who’ve gone through menopause. High HDL levels may not protect them from heart disease.
“What they believe is happening is that these particles during menopause are interacting and causing cholesterol buildup early,” said Dr. Tulika Jain, a cardiologist with Texas Health Dallas and Texas Health Physicians.
Jain says the study results aren’t cause for alarm but rather awareness and prevention.
“What I want women to understand is that if your HDL’s high, I don’t want them to have a false sense of security," she said. "They need to understand there’s other factors to look at. The most important thing is the LDL number. Even if you have an excellent HDL reading, the LDL needs to be independently looked at.”
The problem for middle-aged women after menopause: Because menopause is an inflammatory state, the body’s changing many ways: Hormones are changing. Body fat is changing. Inflammation is changing. And they believe the HDL particles are being modified, and instead of behaving in a protective way, something’s interacting and leading to higher plaque within the arteries.
What this means: Previously, a lot of individuals and patients might have felt a false sense of security that a high HDL is protecting them, but that’s not the whole story. They have to understand that their LDL level is very important. Just having a high HDL cholesterol doesn’t mean everything’s fine.
What can be done about this: There’s very clear guidelines on who needs to be treated to reach a goal with LDL with medications, which is usually statins. But for HDL, risk factor modifications are very important: exercising, eating a diet with lots of fruits and vegetables, not smoking, modifying your diabetes and hypertension. For some people, it’s just genetic. So those lifestyle modifications help, but it’s important to see your doctor to know what your goals are.
How specialized testing can help: When you see your doctor, the general cholesterol panel includes HDL, LDL and triglycerides. But there are places where we can study these particle sizes and determine if someone has genetic cholesterol disorders or the way their body processes cholesterol in their body, if those disorders are affecting their cholesterol profile. So you can talk to your doctor about those options.
Who should get specialized testing: There are risk factor calculators that put together risk factors like hypertension, diabetes, but also your own personal history of heart disease, stroke, peripheral vascular disease (artery blockages in the legs, kidney or neck), plus your family history. People who might have a tendency for genetic disorders might good candidates to have these particles checked.
Who else may need specialized testing: People who have an abnormal basic cholesterol panel probably don’t need specialized testing because they already have indications. But we know that some people have evidence of premature heart disease or cardiovascular disease or other symptoms and have a normal basic cholesterol profile. Those are the people that we’re looking for other explanations for what’s going on, and those are people who might want to consider doing the specialized profile.
The study is not cause for alarm: It’s all about awareness and prevention. What I want women to understand is that if your HDL’s high, I don’t want them to have a false sense of security. They need to understand there’s other factors to look at. The most important is the LDL number. Even if you have an excellent HDL reading, the LDL needs to be independently looked at.