Cholesterol Change in Menopause
As hormone levels change during the transition to menopause, the quality of a woman's cholesterol carriers in her blood can degrade, leaving her at greater risk for heart disease, a new study shows.
Cholesterol travels through the bloodstream in small particles called lipoproteins or cholesterol carriers. In this recent study, researchers used advanced method to characterize the quality of those cholesterol carriers. Cholesterol is necessary to produce cell membranes, hormones and vitamin D and contributes to the formation of memories and neurological function. But studies show that too much cholesterol also can lead to an increased risk of heart disease.
Waxy and fat-like in appearance, cholesterol travels through the bloodstream in small packets called lipoproteins and comes in two forms: Low-density lipoproteins (LDL) and high-density lipoproteins (HDL).
HDL, considered "good" cholesterol, helps keep cholesterol away from arteries and removes excess arterial plaque, while LDL, "bad" cholesterol, builds up in arteries and forms plaque. The plaque buildup causes the arteries to become narrow and less flexible. If a clot forms in a narrow artery leading to the heart or brain, a heart attack or stroke may result.
"Higher levels of HDL, or what we know as 'good cholesterol', may not always be as protective as we had thought before," says lead investigator Samar R. El Khoudary, an assistant professor in the University of Pittsburgh Graduate School of Public Health.
El Khoudary explains that normal levels of LDL, or "bad cholesterol," do not imply normal cholesterol levels in all individuals. Rather, quality of cholesterol carriers may provide more accurate information about risk related to levels of cholesterol.
"We found that lower levels of estradiol, one of the main hormonal changes that mark menopause, are associated with low-quality cholesterol carriers, which have been found to predict risk for heart disease," she says.
"Our results suggest that there may be value in using advanced testing methods to evaluate changes in cholesterol carriers' quality in women early in menopause so that doctors can recommend appropriate diet and lifestyle changes."
Conventional blood tests show the amount of cholesterol carried by these lipoproteins, rather than the characteristics of the lipoproteins themselves.
There are two major types of lipoproteins: high-density lipoprotein (HDL), which helps keep cholesterol from building up in the arteries, and low density lipoprotein (LDL), the main source of cholesterol buildup and blockage in the arteries. Research studies have shown that the characteristics of LDL and HDL particles, including the number and size of these particles, significantly predict risk of heart disease.
Previous studies evaluating the associations between sex hormones and cardiovascular disease as women went through menopause looked only at cholesterol measured through conventional blood tests. El Khoudary and her colleagues used nuclear magnetic resonance spectroscopy to measure the size, distribution and concentration of lipoproteins that carry cholesterol in the blood.
The team found that as estrogen levels fall, women have higher concentrations of low-quality, smaller, denser LDL and HDL particles, which are associated with greater risk of heart disease. The conventional blood tests often don't pick up on such a nuance in particle size.
As a woman transitions to menopause, many biological changes take place that can put her at greater risk of many conditions, including osteoporosis and heart disease. Our most recent study underscores the importance of having clinicians aware of these risk factors and prepared to work with their patient to help her best mitigate these risks.
El Khoudary is collaborating with other scientists to identify funding to study a larger sample of women over time to definitively tie changes in hormone levels and the quality of cholesterol carriers with heart disease.
The National Institutes of Health supported the study, which was published in the Journal of Lipid Research.
There are many options for helping lower your cholesterol. Changing from an unhealthy diet to a healthy diet can reduce a cholesterol level. However, dietary changes alone rarely lower a cholesterol level enough to change a person's risk of cardiovascular disease from a high-risk category to a lower-risk category. However, any extra reduction in cholesterol due to diet will help.
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