Frequently Asked Questions
Expert Answers to Your Questions About Managing Lipids to Reduce Cardiovascular Risk
Q. My cholesterol raised 70 mg/dL after menopause, but my lifestyle and diet have remained the same. Why?
A. In some women there is an increase in cholesterol after menopause. Although we are not sure why this happens, there is speculation that as estrogen levels go down during menopause, the body tries to fix the problem. Since cholesterol is required for your body to make estrogen, making more estrogen requires more cholesterol.
Typically, not only does the LDL-C go up during menopause, but the HDL-cholesterol (HDL-C) also goes up. HDL-C is made primarily in the intestine. An increase in LDL-C and HDL-C after menopause is often a signal of an increase
in absorption of cholesterol. While reducing dietary cholesterol will not lower cholesterol for many people, it will in someone who was a hyper-absorber of cholesterol. Postmenopausal women should reduce their intake of foods that are high in saturated fat and cholesterol.
Because of the increase in cholesterol absorption and the reduction in estrogen levels, women’s risk of heart disease increases after menopause. There is a medication called “ezetimibe” that targets cholesterol absorption. Sometimes, women who are taking statins will also take ezetimibe after menopause to manage their risk for heart attack or stroke.
Q. Do you need LDL-cholesterol for brain function?
A. The best study to answer this question is the development of the fetus into a newborn, to infant, and to toddler. Our LDL-C is at the lowest when we are born, and that is when our brain function is developing at its most rapid rate. The brain is an independent entity, making all of the cholesterol that it needs on its own.
Every cell in the body makes cholesterol except for one – red blood cells. LDL does not cross what we call the “blood-brain barrier,” which is the ability of systemic circulation to enter the brain. So, when you lower or raise LDL-C, it doesn’t affect brain function.
Q. What is Small Dense Low-Density Lipoprotein (sdLDL) and do we need it?
A. You can measure sdLDL with a lipoprotein test, or what some call an “advanced” cholesterol test.
Your blood stream is like water in a river. And cholesterol is a fatty, oily substance that needs to be transported around the bloodstream inside “water-loving” vehicles or particles. These particles are called Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), and very low-density lipoprotein (VLDL). They carry the cholesterol around from point A to point B, kind of like boats on a river.
We can measure these particles in number and in size. Some people have smaller sized particles. Some people have larger sized particles. But the size of the particles does not determine your risk for heart disease. However, the number of particles may! When you have smaller particles, you often tend to have more of them.
But if you have too many large particles, you may develop heart disease. And if you don’t have a lot of small particles, you probably won’t. In fact, patients with familial hypercholesterolemia, a genetic cause of high cholesterol, have very large, fluffy particles, and they are still at very high risk for heart disease.
Q. Should I take dietary supplements as part of a heart-healthy diet?
A. Be cautious when purchasing dietary supplements. Supplements are not regulated by the FDA, so ingredients and effects marketed on a product’s label may not be validated. If available to you, discuss your options with a registered dietitian or your doctor.