It is common knowledge that high cholesterol levels contribute significantly to heart disease. This can be bad news for older women, especially those who have entered menopause. The oestrogen levels of women who have begun menopause will decline, leading to an increase in the levels of “bad” cholesterol.

Heart disease is rarely seen in younger, pre-menopausal women, apparently because oestrogen lowers lowdensity lipoprotein (LDL, commonly called “bad” cholesterol) levels, while raising high-density lipoprotein (HDL, or the so-called “good” cholesterol) levels.

As their oestrogen levels decline, postmenopausal women eventually face similar risks of cardiovascular disease as men of the same age. This is a natural process and there is no specific medical intervention to prevent it, said Dr Tan​ Hong Chang, Consultant at the Department of Endocrinology, Singapore General Hospital (SGH), a member of the SingHealth​ group.

He said: “Compared to men, cardiovascular disease, specifically coronary artery disease, is less common in pre-menopausal women. However, their incidence of the disease increases after menopause, to levels similar to men of the same age.” Dr Tan added that weight also tends to increase with age due the slowing of metabolism and this is often worsened by sedentary lifestyle. In addition, the incidences of other chronic medical illness such as hypertension and diabetes are also greater at the older age. These factors collectively contribute towards the higher incidences of heart disease in women after menopause.

A holistic approach to reducing the risk of heart disease

“It is important to remember that high cholesterol levels are only one of the many risk factors of cardiovascular disease,” said Dr Tan. “To reduce the risk, all factors need to be addressed. “The first line of intervention is lifestyle changes. For example, those who are obese will need to lose weight. Losing as little as 5 to 10 per cent of body weight can lead to an improvement in cholesterol levels.”

Everyone, not just women, should adopt a "heart healthy" diet. This include limiting processed red meds, ultra-processed foods that are rich in refined starch, added sugars, transfat and sodium (e.g. cookies, cakes and frozen pizza) said Dr Tan. Instead they should eat food that are rich in healthy fats (e.g. monosaturated and polyunsaturated fatty acids), vitamins, flavinols such as nuts, seeds, plant oils, fish, fruits, non-starchy vegetables, legumes and minimally processed whole-grain products.

Exercise can also help to increase “good” cholesterol levels and help with weight loss. Dr Tan suggested doing exercise of moderate intensity, such as brisk walking and swimming, on a regular basis for 20 to 30 minutes per day, at least five times per week. Women should also have their cholesterol levels checked regularly. The American Heart Association advises people over 20 to get their cholesterol checked once every five years.

Women who are over 50 and have high cholesterol levels or other risk factors should speak to their doctors to find out how frequently they should have their cholesterol levels examined. Some women may not be able to bring their cholesterol levels down to a healthy range despite lifestyle changes. Medication, such as a statin, may then be prescribed. Dr Tan said: “Medication for high cholesterol levels is often for the long term, often because the underlying causes for high cholesterol, such as ageing and menopause, are not reversible or modifiable.”

“The dosage can be adjusted when there is a significant fall in cholesterol levels, but it’s rare for a patient to discontinue medication completely.”

HDL versus LDL cholesterol

Cholesterol is a waxy substance found in all cells in the body. It is needed to make hormones, vitamin D and substances that digest food. The body makes all the cholesterol it needs. Cholesterol travels in small packages called lipoproteins. There are two kinds:

High-density lipoproteins (HDL) are small, dense molecules that transport cholesterol to the liver, which then removes cholesterol from the body. That makes HDL “good” cholesterol.

Low-density lipoproteins (LDL) transport the majority of cholesterol in the body to individual cells. Compared to HDL, LDL enters the wall of blood vessels and clog arteries, leading to heart disease. That makes LDL “bad” cholesterol.

Can food such as red yeast rice and garlic lower cholesterol levels?

While many “natural” foods may help lower cholesterol levels and are generally considered safe, their effect is often modest at best. Furthermore, such foods have not been studied extensively, nor have they been shown to reduce cholesterol. Therefore, healthy eating, exercise, weight loss, drugs like statin should continue while trying alternative "natural" treatments.

Are there side effects from taking cholesterol medication?

Cholesterol-lowering drugs are very effective in lowering blood cholesterol but side effects, varies from person to person. Statin is the most extensively researched cholesterol-lowering medication and multiple studies show that it consistently reduces the occurrence of cardiovascular disease.

Statin’s side effects include muscle aches and an increase in liver enzymes. However, the drug’s benefits often outweigh its risks. For patients who are not able tolerate statins, alternative cholesterol-lowering medications are available.

Ref: N18