Currently 40 percent of women older than fifty-five have elevated cholesterol levels. Because this condition is so common, I recommend that midlife women have a baseline lipid profile measuring total cholesterol, triglycerides, LDL, and HDL cholesterol so they know where they stand. Then get the lipid profile repeated at least every five years. If your blood sugar is high, get the test repeated more frequently.

Ask your doctor to give you a copy of your lipid profile so that you can get to know your numbers. It’s very motivating to watch your lipid profile improve every year when you commit to becoming healthier than ever before at midlife.

Though interpretation of lipid profile results will vary from lab to lab, a total cholesterol level as high as 225 to 240 does not necessarily indicate that a woman is at increased risk for heart disease if her HDL cholesterol is also high (45 or above). Because most of the studies of heart disease and blood lipid levels have been done on men, we still don’t know exactly what levels of blood lipids are optimal for women. What we do know is that women can have higher total cholesterol levels than men and not be at increased risk for heart disease.

And we know a healthy diet and adequate exercise can go a long way toward creating healthy blood lipids.

The following blood lipid levels are optimal; values outside of these ranges indicate cholesterol problems:

• Total Cholesterol: Below 200. (Note: If your cholesterol is slightly higher than 200, don’t worry about it if your HDL is sufficiently high.)
• HDL (High-Density Lipoprotein): HDL—the "good" choles-terol—should be 45 or higher; 67 or above is ideal. Low HDL cholesterol has been shown to be a more potent risk factor in women than it is in men. Women with low levels of this cholesterol subtype (a reading of 35 or less) have a sevenfold increase in heart disease risk compared to those whose HDL levels are normal. Low HDL is one of the first indicators of insulin resistance.
• LDL (Low-Density Lipoprotein): LDL—the "bad" cholesterol— should be 130 or below. LDL undergoes free-radical damage and forms plaques in the arteries. It rises after menopause in many women, a fact that was the basis for promoting estrogen replacement, which decreases LDL levels. If your LDL is greater than 150 mg/dl (some doctors use even lower numbers), you’re considered at high risk for coronary artery disease.

  Note: The level of LDL cholesterol that is considered "normal" has been continually reduced over the years, largely because of the behind-the-scenes influence of the pharmaceutical industry, which supplies the majority of research grants to academic medicine. The American Heart Association’s 2004 recommendations for "normal" LDL were lowered to 70, which I consider ridiculous.

• Triglycerides: This number should be 150 or lower. Triglycerides are an independent risk factor for women. An ideal triglyceride level for a woman is around 75. A woman with a triglyceride level of greater than 200 has a 14 percent risk of developing coronary artery disease. High triglycerides are associated with toxic abdominal fat and glycemic stress in part because the liver, as well as other areas of the body, stores excess blood sugar as triglycerides.
• Relationship of Total Cholesterol to HDL: Divide your total cholesterol by your HDL cholesterol. If the resulting number is 4 or less, you are at low risk, regardless what your total cholesterol number is. This ratio is a much better predictor of risk than simply your total cholesterol number. Remember that neither type of cholesterol is inherently bad or good—both are necessary for good health and they need to be balanced in the body.

See Heart Disease.

I am very concerned about the overuse of statin drugs (such as Lipitor, Crestor, Zocor, etc.), which are being prescribed to millions of women to lower LDL cholesterol levels. High LDL cholesterol is not a disease, and simply lowering LDL cholesterol will not prevent heart disease—at least half of all people who get heart disease don’t even have high cholesterol! Despite all the hype about statins, many large studies failed to show any benefit in reducing overall number of deaths.

In the largest study in the world to use Lipitor (the ALLHAT clinical trial, announced in 2002), the subjects in the group who took Lipitor did, in fact, lower their LDL cholesterol significantly compared to the control group, but there was no reduction in death rate from heart attack. Several other studies yielded similar results, and a 2003 meta-analysis of forty-four clinical trials involving 9,500 patients found that the death rate for those taking statins was identical to those taking no drugs. Results also showed that 65 percent of those taking statins experienced adverse side effects serious enough to cause many to withdraw from the study.

The serious side effects resulting from statins include muscle weakness and fatigue, liver damage, brain and nerve damage and depression. Statins may also promote cancer and even heart disease! This is because of the way they work. Statin drugs block cholesterol production by inhibiting the enzyme HMG-Co-A reductase, but in so doing, statins also block production of two vital nutrients--coenzyme Q₁₀ and substances called dilochols, both of which are absolutely essential for proper cell health.

Dilochols direct proteins to the areas of the cells that need repair. Without them, the cells can’t carry out their genetic programming for cellular functioning and restoration. Statins therefore wreak potential havoc with cellular repair. Coenzyme Q₁₀ is necessary for producing energy in the form of ATP in the part of the cell known as the mitochondria. ATP carries energy for cellular function much like gasoline powers the engine of a car. Without it, nothing can run. The heart, in particular, requires an enormous amount of energy and CoQ₁₀ to function efficiently. CoQ₁₀ is also necessary for the vital role played by cell membranes (the actual "brain" of the cell) and also for the formation of collagen and elastin that make up the connective tissue in skin, muscles, and blood vessel walls. Because every cell in the body requires coenzyme Q₁₀ to function properly, depletion of this enzyme from statin drugs causes problems throughout the entire body.

Dietary change and a good supplement program can lower cholesterol significantly and quickly (getting regular exercise and stopping smoking also helps, as well). If you cannot or will not institute lifestyle improvements, at least take omega-3 supplements (such as ground flaxseed, either in capsule form or one-quarter cup of fresh ground flax seeds eaten three to seven days per week and mixed with soup, yogurt, or other foods) and consider taking garlic, which has antioxidant properties. (Either lightly cook fresh garlic, or take a garlic supplement with A 10 mg of alliin, or a total allicin potential of 4,000 mcg).

Other helpful supplements include the tocotrienols (50 mg per day daily for a month, and then lower the dose to about 30 mg--two capsules per day--thereafter) and policosanol (20 mg/day).¹ For more helpful supplements, see the Hypertension section.

Also add soy to your diet. The American Heart Association officially recommended a daily diet containing soy-based foods after 38 studies found soy protein reduced total cholesterol and LDL. Soy also raises HDL and lowers triglycerides.² Consuming 50 grams of soy protein daily can lower LDL cholesterol by as much as eight percent.