One in three women will die from cardiovascular disease. 1
Not one in ten. Not one in twenty. One in three — making it the single greatest threat to women’s health in the United States, and one that still doesn’t get the attention it deserves.
However, the encouraging fact remains: most cardiovascular disease is preventable. Knowing your risk, asking the right questions, and catching the warning signs early can change the outcome — for you and for the women in your life.
Awareness is the first gap. Heart disease is often thought of as a men’s health issue, so many women don’t recognize their own risk; or don’t know that their symptoms can look different than the “textbook” version. That gap shows up in the data: women are underdiagnosed, undertreated, and underrepresented in the very research meant to protect them.
Main Characters of Your Cardiovascular Story
Cholesterol is a type of fat normally found in the bloodstream. Cholesterol builds up quietly for years before it ever causes a symptom, and the way it builds up in women’s bodies changes with hormones, pregnancy, and menopause. Low-density lipoprotein cholesterol (LDL-C), triglycerides, and lipoprotein(a) [Lp(a)] are three cardiovascular risk factors that can change the most throughout a woman’s lifetime and understanding their role in your story is the first step toward protecting your heart health.
LDL-C
LDL-C can build up in your blood vessels over time and lead to blockages.
When LDL-C levels are too high, it increases your risk of heart disease and stroke.
For more information on cholesterol, click
Triglycerides
Triglycerides are a type of fat found in the blood that provides your body fuel. When levels get too high, they could increase your risk of heart disease and stroke.
For more information on triglycerides, click
Lp(a)
Abnormally high levels of Lp(a) – with or without elevated levels of LDL-C – have an increased risk of developing cardiovascular disease.
For more information on Lp(a), click
Why These Risk Factors Matter
#1
cause of death for women in the U.S. is heart disease — more than all cancers combined. 1
22%
of women aged 21 to 60 have ever had their cholesterol checked. 2
45%
of women over 20 are living with some form of cardiovascular disease. 3
90%
of cardiovascular disease cases in women are preventable. 1
Change Can Occur at Every Stage of Life
From pregnancy and menopause to family history and cholesterol, understanding your personal risk is the first step toward lifelong heart health.
Every stage outlined below is a good opportunity to check in with your clinician about your LDL-C, triglycerides, and Lp(a) levels. Most guidelines recommend that adults have these numbers tested at least once every five years; though certain life stages may call for more frequent monitoring. 4
Hormones Move the Numbers
Pregnancy and hormones, like estrogen, impact cardiovascular risk factors, meaning a woman’s risk can change throughout her lifetime. Below are important times to consult with your clinician about getting tested.
How Often Should You Test?*
| Who? | Age Range | Suggested Testing Interval | Additional Information |
|---|---|---|---|
| Children | 9–11 years of age |
Once4 |
Children with a family history of (1) hypercholesterolemia or (2) early cardiovascular disease should have lipids tested as early as 2 years of age. |
| Young Adults | 17–18 years of age |
Once4 |
|
| Adults without CVD risk factors | 19+ years of age |
At least every 5 years4 |
|
| Adults with a history of CVD or CVD risk factors | 19+ years of age |
At least every 1 year4 |
|
| Individuals on Lipid-Lowering Medicine | All |
4–12 weeks after starting lipid-lowering medicine4 |
To check if the medication is working and being taken. |
| Individuals on Lipid-Lowering Medicine | All |
6–12 months4 |
To make sure the medication is working and being taken. |
| Pregnancy without CVD risk factors | 20–39 years of age |
Every 5 years |
Cholesterol and triglycerides rise naturally during pregnancy to support the baby's growth and development. However, levels that climb beyond the expected range can increase the risk of complications such as preeclampsia, gestational diabetes, and preterm birth. These complications can potentially increase the risk of heart disease later in life. |
| Pregnancy without CVD risk factors | 40+ years of age |
||
| Perimenopause | Any |
Every 1–2 years |
The steepest average shift in LDL-C, HDL-C, and Lp(a) occurs during perimenopause. It is recommended to check levels every 1–2 years. |
| Menopause | Any |
Every 1–2 years |
As estrogen levels decline during the menopausal transition, LDL-C, triglyceride, and Lp(a) levels often shift in ways that can increase cardiovascular risk. Total cholesterol and LDL-C tend to rise, while HDL-C loses some of its protective effects. These changes make routine lipid monitoring an important part of care during and after menopause. |
*Life events don’t always follow a timeline. These are general guidelines, always consult your clinician about what’s right for you.
Special Conditions/Circumstances
Polyendocrine Metabolic Ovarian Syndrome (PMOS)
PMOS, formally referred to as polycystic ovary syndrome (PCOS), can cause abnormal levels of blood sugar, cholesterol, and triglycerides. The metabolic changes associated with PMOS — particularly when they lead to pre-diabetes or abnormal cholesterol levels — may raise the risk of heart disease over time. Because PMOS can be a complex condition to manage, working with a lipid specialist may be an important part of your care.
Pregnancy Considerations
Small changes in blood cholesterol and triglycerides are expected during pregnancy. Levels first fall and then rise during pregnancy to provide energy for the growing fetus and for maternal milk production. If your blood cholesterol or
triglycerides are high during your pregnancy, you will require periodic testing. If you had preeclampsia or gestational diabetes when you were pregnant, you might be at a higher risk for cardiovascular issues later in life.
Talk with your clinician if you are at high risk, have a family history of heart disease, or are currently taking a lipid-lowering medication.
Hormonal Birth Control
Some formulations modestly raise triglycerides or blood pressure. Before starting hormonal birth control talk with your physician about your heart history.
So Now What?
Taking in all of this information can feel like a lot, and it’s okay if you’re not sure where to start. The most important next step is a conversation with your clinician. Knowledge is only as powerful as what you do with it, and bringing these topics to your next appointment is how awareness becomes action.
Here are some questions worth asking — and information worth sharing — at your next visit:
· Do I have any risk factors I should know about, even ones that seem minor?
· Does my family history change my risk category?
· What are my LDL-C, triglyceride, and Lp(a) levels, and what should they be?
· What pregnancy complications should I be aware of that could affect my long-term heart risk?
· Should my menopause status or age at menopause factor into my risk assessment?
· What should I know about hormone replacement therapy?
· What lifestyle changes would you recommend for my stage of life?
References: