Heart disease continues to be the leading cause of death for men and women in the United States, according to the Centers for Disease Control and Prevention (CDC). “Heart disease” can include coronary artery disease, congestive heart failure, cardiac arrest, and other diagnoses. However, the risk of developing heart disease looks different between men and women when you compare these two genders.

For example, age can be a significant factor. One 2010 Dutch cardiology study suggested women develop cardiovascular disease seven to 10 years later than men do on average, due to female hormones before and after menopause. This gives women an extra level of “protection” for a few years in comparison to men.

Explains Dr. Norman E. Lepor, MD, FACC, FAHA, FSCAI, an attending cardiologist at Cedars-Sinai Heart Institute and professor at the David Geffen School of Medicine at the University of California at Los Angeles: for women, this comes down to the way age affects cholesterol levels.

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Estrogen levels in women can affect cholesterol numbers

“Let me start off by saying that dyslipidemia, which is … elevated levels of cholesterol—is a very prevalent issue,” says Dr. Lepor, who estimates “probably nearly 100 million people in the United States” have issues with elevated cholesterol. “Women do tend to be protected during their premenopausal years, generally because the estrogen leads to higher levels of HDL cholesterol, which people call sometimes the ‘good’ cholesterol.”

Studies have found a correlation between estrogen and cholesterol levels for a while now. In 2010, researchers from the National Institutes of Health even found that changing estrogen levels during a woman’s cycle can alter cholesterol levels. Increased estrogen levels resulted in higher levels of HDL cholesterol and decreased amount of LDL “bad” cholesterol.

HDL vs. LDL Cholesterol: What’s the Difference?

Having high levels of LDL cholesterol can clog arteries, building plaque and increasing the risk of developing coronary vascular disease. HDL cholesterol is important for “scavenging” that excess cholesterol and transferring it to the liver in order to be cleared. 

Because the liver is affected by hormones, this in turn can affect the liver’s production of HDL and LDL cholesterol, according to Dr. Lepor. So, while diet does have a significant role in cholesterol levels within the body, genes and hormones also have some control over cholesterol production in the liver.

Read Eating This Fruit Once a Day Can Decrease Bad Cholesterol, Says New Study

Menopause changes hormone levels, creating an increased risk

Nevertheless, while cholesterol levels in younger women get some assistance from relatively higher estrogen levels, that “protective layer” does disappear after a woman goes through menopause. “[It] is protective, of course, until the peri-menopausal years when things change,” says Dr. Lepor. “You will see women having their HDL levels going down significantly and their LDL levels actually going up.”

By age 70, the incidents of developing coronary vascular disease will equal the risk of men, Dr. Lepor explains. According to the American Heart Association, there is an overall increase in heart attack incidences 10 years after menopause, and one in three women end up with some form of cardiovascular disease.

“I think this is particularly important for women in many situations because we underestimate, or we remain in denial, about their risk for heart disease,” says Dr. Lepor, who suggests all patients get a regular coronary calcium screening starting at the age of 40 in order to know the state of your risk. “[It] is a very important test to show if plaque is present. If plaque is present, that means you are at risk. And sometimes women are under-assessed.”

So while the risk might be reduced for women earlier in life, Dr. Lepor suggests getting regularly tested and doing what you can to keep your risk of heart disease down, like eating a Mediterranean-style diet and engaging in regular exercise.

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