Your biological sex comes with its very own set of risk factors for a large number of diseases and conditions—including high cholesterol, which affects women and men differently. Risk factors for certain diseases may weigh more heavily for women or for men, based on the sex organs and hormones they were born with—and in many cases, on certain sociocultural differences between women and men.

High cholesterol is a major risk factor for heart disease, which is the number-one cause of death in the U.S., accounting for one in four deaths. Understanding your cholesterol numbers—and knowing what your cholesterol levels are—helps you stay on top of your risk and take better control over your heart health. 

High cholesterol occurs differently for each sex. More than 59 million men and 71 million women in the United States have high (over 200 mg/dL) or very high (240 mg/dL or higher), and understanding how your sex affects your risk—and what you can do to mitigate those risks—is central for protecting your heart health. 

Here, we dive into how high cholesterol affects you, whether you’re from Venus or from Mars.

What are normal cholesterol levels for women and men?

Recommended cholesterol levels for men and women are the same, except for “good” HDL cholesterol:

Total cholesterol: 125 to 200 mg/dL—the lower, the better.

“Bad” LDL: Less than 100 mg/dL—or less than 70 mg/dL if you have heart disease or a significantly increased risk for developing it.

“Good” HDL for women: 50 mg/dL or higher—above 60 mg/dL is ideal

“Good” HDL for men: 40 mg/dL or higher—above 60 mg/dL is ideal

Triglycerides: Below 150 mg/dL

Male vs Female: Sex hormones and cholesterol levels

Sex hormones like estrogens (estradiol and estrone) and androgens (testosterone and androstenedione) affect cholesterol levels differently in men and women. Your body needs cholesterol to make important steroid hormones like estrogen and progesterone as well as vitamin D.

In general, between the ages of 20 and 55 years, men tend to have higher LDL and lower HDL cholesterol levels than women. However, after the age of 55, women’s HDL cholesterol levels decrease rapidly, and LDL levels rise. This is due to menopause. 

Sex hormones and cholesterol in men

Testosterone, the male sex hormone, may have an impact on cholesterol levels in men. Although the effects of testosterone on cholesterol aren’t completely clear, the risk of cardiovascular disease increases in men as their testosterone levels decrease with age. However, testosterone replacement therapy doesn’t appear to reduce the risk—in fact, it may increase the risk for heart disease in men. 

In a study of young men, researchers found that estradiol was associated with higher total cholesterol and lower “good” HDL cholesterol, and estrone was associated with higher total cholesterol and higher “bad” LDL cholesterol. Men who have high levels of these estrogen hormones at a young age may have a significantly elevated risk of high cholesterol and related heart diseases when they get older.

Sex hormones and cholesterol in women

In women, the very same estrogen sex hormones that increase men’s heart disease risk are considered a factor that may lower the risk for high cholesterol and heart disease in women. Estrogen in women causes higher levels of “good” HDL cholesterol. When women’s estrogen levels rise during their monthly cycle, their HDL also rises, peaking during ovulation, and their LDL declines, reaching a low point just before menstruation. 

During pregnancy, a woman’s risk of heart disease may increase, in part due to increases in total cholesterol levels. After pregnancy, these levels typically return to normal. 

During menopause, around the age of 50 to 55, women’s cholesterol levels generally change as their hormones change. Total and LDL cholesterol levels tend to rise, while HDL cholesterol tends to decline. Even women who have had healthy cholesterol levels their whole lives may develop high cholesterol after menopause. 

These changes are due to a couple of overarching factors. First, estrogen levels decrease during and after menopause, removing the protective factor that increases HDL and lowers LDL. Additionally, women gain an average of eight to 10 pounds after menopause and tend to become more sedentary—and weight gain and lack of physical activity are major contributors to high cholesterol.

Are risk factors for high cholesterol different for men and women?

Women and men share many risk factors for high cholesterol, including a family history of high cholesterol or heart disease, a poor diet, unhealthy habits like smoking or heavy drinking, and other diseases and conditions like diabetes or high blood pressure. Hypothyroidism, lupus, and corticosteroid medications may increase triglyceride levels in both men and women.

But some risk factors are unique to women, and some shared risk factors have a greater impact on women than on men. 

High cholesterol risk factors for women

Risk factors for high cholesterol unique to women include pregnancy-related high blood pressure and gestational diabetes, as well as polycystic ovarian syndrome (PCOS), which is a hormonal disorder in which women have higher levels of male hormones. 

Some shared factors for high cholesterol weigh more on women’s risk than on men’s:

  • Women with diabetes are more likely than men with diabetes to develop high cholesterol and heart disease.
  • Stress and depression has a stronger effect on women’s hearts than on men’s. 
  • Smoking is a stronger risk factor for high cholesterol in women than in men.
  • Low estrogen levels after menopause significantly increase women’s risk of developing high LDL cholesterol and heart disease in smaller blood vessels.
  • Complications of pregnancy, including high blood pressure and gestational diabetes, increase a woman’s long-term risk for high blood pressure, type 2 diabetes, and heart disease.
  • A family history of early-onset heart disease may be a stronger risk factor for women than for men.

A few factors also increase women’s risk for high triglyceride levels:

  • Birth control pills that contain estrogen
  • Pregnancy, which may temporarily raise triglycerides
  • Menopause
  • PCOS
  • Oral estrogens and hormone replacement therapy
  • Prescription medications that target estrogen levels, known as SERMs

Cholesterol medications for women and men

While cholesterol-lowering medications like statins help lower cholesterol and prevent heart attack and heart disease in both women and men, women are 10 percent less likely to be prescribed statins by their physician. Moreover, when they are prescribed for women, it’s typically at lower doses than the guidelines recommend.

Although more women have high cholesterol than men, historically, women are treated less aggressively for high cholesterol than their male counterparts. While the reasons for this discrepancy isn’t well understood, researchers have a few theories based on studies to date:

  • Women aren’t offered statins for high cholesterol as often as men are.
  • Women may be more likely to decline statin therapy when their doctor recommends it due to concerns about medications.
  • Women are more likely to discontinue statin treatment after starting, due to side effects.
  • Women and men perceive cardiovascular risks differently—women worry more about heart attacks and strokes than men do, but they’re less likely than men to believe that high cholesterol will contribute to one.
  • Women have different symptoms than men that aren’t recognized or addressed early enough. 

Researchers recommend that physicians provide more robust patient education about the safety and effectiveness of statins. Women should also feel free to bring up the topic of statin medications if their doctor doesn’t. If you feel like your doctor doesn’t take your symptoms or condition seriously—or you feel rushed during appointments or uncomfortable asking questions, it may be time to find a new primary care provider.

Are cholesterol screening recommendations the same for women and men?

For the entire population, the first cholesterol screening a person gets should be between age 9 and 11, and the next should be between age 17 and 21. Children and young adults should have a cholesterol test every five years after the initial screening, unless their physician recommends more frequent screening due to high cholesterol or significant risk factors. 

Men who are between 45 and 65 and women who are between 55 and 65 should have a cholesterol test every one to two years, depending on their risk factors. Both men and women over the age of 65 should get a cholesterol test every year.

What are the warning signs of high cholesterol?

High cholesterol has no symptoms, which is why regular cholesterol screenings are so important. Known as a lipid panel, cholesterol screening is a blood test that determines your “bad” LDL and “good” HDL cholesterol, your total cholesterol, and your triglyceride levels. 

How does high cholesterol affect the heart?

Too much cholesterol in your blood may lead to atherosclerosis, a disease caused by the buildup of plaque on the wall of your arteries. This plaque hardens and narrows the arteries, reducing—and eventually stopping—the flow of blood. Depending on which arteries are affected, this may lead to a heart attack or stroke. Learn more about how high cholesterol affects your heart and heart disease risk

Can high cholesterol be reversed?

Yes—in most cases, you can lower your cholesterol naturally—without medication—by making healthier lifestyle choices. If your high cholesterol is caused by a genetic mutation passed down by a family member, it’s likely that lifestyle changes won’t lower it. However, a number of medications can keep your cholesterol at healthy levels to help prevent heart disease. If your high cholesterol is largely due to an unhealthy lifestyle, you can lower it by improving your diet, exercising regularly, and reducing your stress.

Take control of your cholesterol with Forward

Forward’s holistic and preventive approach to healthcare helps our members take a more proactive role in preventing and managing diseases. Our healthy heart program is open to all members and includes a full lipid panel to check cholesterol, genetic testing for heart disease risks, and clinical and lifestyle assessments that can predict your short- and long-term risk of heart disease, heart attack, and stroke. 

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