Cholesterol: Fact versus fiction

Women need to know about cholesterol

Cholesterol is a fatty substance in your blood. Your body makes its own cholesterol and it’s also in some foods. Cholesterol helps to digest food, and make hormones and vitamin D.

But having high cholesterol is risky to your health. It’s one of the biggest risk factors for having a heart attack, and it increases the risk of stroke – two of the top killers of women in Australia.

Your hormones have an impact

For women, certain life stages can have important impacts on cholesterol.

Around the time of menopause, the hormone oestrogen drops. This change can cause cholesterol levels – especially the ‘bad’ type of cholesterol – to rise, says Natalie Raffoul, Healthcare Programs Manager with the Heart Foundation.

She recommends women have their cholesterol checked regularly from the age of 45, and 30 or older if they are Aboriginal or Torres Strait Islanders.

“We know that women who reach menopause prematurely [before the age of 40] have a higher risk of heart disease than women who reach it at the average age [from 45 to 55 years]. We recommend they see their GP and have regular screening of both cholesterol and blood pressure.

“We also recommend earlier screening of women who have had gestational diabetes, pre-eclampsia or high blood pressure during pregnancy.”

Knowing your numbers is important

You can’t tell what someone’s cholesterol levels are just by looking at them. And there aren’t any obvious symptoms when you have high cholesterol. A blood test is the only way to measure your levels.

There are a few different types of cholesterol that get measured when you have your blood test. These include:

• total cholesterol
• the ‘bad’ type of cholesterol (known as LDL)
• the ‘good’ type of cholesterol (known as HDL)
• triglycerides (another type of fat in your blood).

If your total cholesterol is above 5.5 mmol/L, this is considered too high, increasing your risk of heart disease.

“It’s also important to look at the ratio of total cholesterol to ‘good’ cholesterol, aiming for a ratio of less than 4.5,” explains heart specialist Associate Professor Sarah Zaman.

She recommends asking your doctor to talk through all your results, and keeping track of your numbers in case they change over time.

There’s more to high cholesterol than a bad diet

One of the greatest myths out there is that high cholesterol is solely caused by an unhealthy diet. It is an important factor but it’s not the whole picture. Other causes include smoking, high stress, drinking too much alcohol and not doing enough physical activity.

In some women, genetics plays a major role too. “If you have a family history of high cholesterol, or a genetic condition known as ‘familial hypercholesterolaemia’, then you should be having checks before the age of 45,” says Ms Raffoul.

Healthy fats and fibre are key

For healthy cholesterol levels, Associate Professor Zaman recommends a diet rich in fruits and vegetables as well as nuts, seeds, oily fish (such as salmon, tuna, sardines), olive oil, avocados, legumes (such as lentils and chickpeas) and seafood.

This is because healthy fats and fibre keep your cholesterol levels in check and the ‘bad’ type of cholesterol at low levels.

Saturated fats – in foods like processed meats, fatty meats, pastries, biscuits, deep-fried foods and butter – increase the ‘bad’ type of cholesterol so these should be limited.

Some simple foods swaps are:

• Spread avocado or hummus on your toast instead of butter.
• Snack on a handful of nuts instead of chips or crackers.
• Swap white bread and white rice for brown or wholemeal varieties.

There was a time when full-fat milk, cheese and yoghurt were frowned upon for heart health. But we now know that these foods don’t increase the risk of heart disease in healthy people. After all, these foods provide good sources of calcium and protein – two important nutrients for women’s overall health.

However, if you have heart disease or high cholesterol, it’s recommended to avoid full-fat dairy and eat the reduced-fat versions of these foods instead.

Medication can be life-saving

“In many instances, high cholesterol can be reversed by adopting a healthy diet and exercise,” says Associate Professor Zaman.

“But I’d encourage women to understand that while they are making lifestyle changes, there may come a time when medication may be necessary.”

The gold standard for treating high cholesterol is with medications known as 'statins’, explains Associate Professor Zaman.

“[Women] need to know that these medicines can lower the chance of a heart attack.”