High cholesterol is an important health issue for women, particularly since heart disease is the #1 killer of women in America. High cholesterol increases the risk of heart disease. Here’s how.
Cholesterol is a fatty substance your body needs to build cells and hormones. It’s carried through the bloodstream by lipoproteins. There are 2 types of lipoproteins: Low-Density Lipoproteins (LDL) and High-Density Lipoproteins (HDL).
LDLs carry “bad” cholesterol that can build up in arteries and increase heart disease risk through atherosclerosis (a condition in which plaque builds up along the inner walls of arteries). HDLs carry “good” cholesterol that helps remove LDL from the bloodstream.
Understanding high cholesterol in women
Before menopause, women have a biological advantage when it comes to cholesterol: estrogen tends to raise HDL and lower LDL, giving women some protection against heart disease. After menopause, however, estrogen drops, which can lead to higher LDL and lower HDL. This hormonal shift increases cardiovascular risk, even if weight or lifestyle hasn’t changed.
What is considered high cholesterol for a woman?
Cardiologist Dr. Sam Setareh says that when doctors look at cholesterol levels and Atherosclerotic Cardiovascular Disease (ASCVD) scores, they have to look at everything in context to determine what is normal. A normal cholesterol level for a woman depends on her age, race, ethnicity, and other risk factors. “We can’t just look at 1 person compared to the general population. We look at them more as an individual person.”
On average, in adult women, a total cholesterol level ≥ 240 is considered high, and an LDL level ≥ 160 is considered high.
If you think you may have high cholesterol, or know you have risk factors for heart disease, it is important to see a cardiologist for testing and to get a full assessment of your risk and what you can do to manage it.
Borderline high cholesterol
Cholesterol is categorized as desirable, borderline, and high. For adult women, on average, a total cholesterol level of 200-239 is considered borderline, and an LDL level of 130-159 is considered borderline.
10 warning signs of high cholesterol
High cholesterol is generally considered a “silent” condition, meaning that most people won’t notice symptoms directly from high cholesterol. Once high cholesterol leads to heart disease or poor circulation, many women begin to notice symptoms. However, there are several warning signs and subtle cues that cholesterol may be too high or already be affecting the body. Here are 10 key warning signs of high cholesterol in women.
Signs of high cholesterol in women
High cholesterol often flies under the radar, especially for women who may not notice any symptoms at all. Still, there are subtle signs your body can give you that it’s time to get your levels checked.
- Chest pain or pressure (AKA angina): When cholesterol plaque builds up in the coronary arteries, it limits blood flow to the heart. Women may feel pressure, tightness, burning, or fullness in the chest, which is sometimes mistaken for indigestion.
- Shortness of breath: Over time, LDLs can build up in the arteries, restricting blood flow to the lungs and/or heart. This reduced blood flow to the heart can make you feel winded even with mild activity. The heart struggles to pump blood efficiently, and your body reacts with breathlessness.
- Dizziness or lightheadedness: If arteries that supply the brain are affected by plaque buildup, you may experience dizziness, faintness, or confusion. This can signal reduced blood flow to the brain and an increased risk of stroke.
- Cold hands and feet (or numbness): Plaque buildup can reduce circulation in the limbs, which is known as peripheral artery disease. This can cause cold extremities, tingling, cramping, or numbness, especially during activity.
- Leg pain when walking (AKA claudication): Pain, tightness, or heaviness in the calves or thighs when walking that improves with rest can indicate restricted blood flow due to atherosclerosis in the leg arteries.
- Memory fog or cognitive changes: The brain needs steady blood flow to function well. When blood flow to the brain is reduced due to atherosclerosis, this may lead to subtle concentration or memory issues in women with long-term high cholesterol.
- Palpitations or irregular heartbeat: Plaque buildup in the arteries can affect heart rhythm or oxygen supply. You might feel fluttering, pounding, or skipped beats, particularly during exertion or stress.
Signs of high cholesterol on face and skin
There are a few warning signs of high cholesterol that can appear on the face and skin. According to Dr. Setareh, these are very rare, and only occur in cases of very high cholesterol.
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8. Yellowish patches around the eyes (AKA xanthelasma): Extremely high levels of cholesterol can lead to the formation of cholesterol deposits under the skin near the eyelids. These generally present as soft, flat, yellowish patches on the eyelids.
9. Skin changes or lumps (AKA xanthomas): Xanthomas are also cholesterol deposits, but they can appear anywhere on the body, often on the elbows, knees, or around the eyes. They present as fatty, yellowish bumps under the skin, and are also suggestive of extremely high cholesterol levels.
Can high cholesterol cause fatigue?
Fatigue is one of the main warning signs of high cholesterol in women.
10. Fatigue or low energy: Narrowed arteries from cholesterol buildup reduce blood flow and oxygen delivery. This forces the heart and muscles to work harder to pump blood, leading to tiredness, weakness, or exercise intolerance. In women, fatigue can appear months or weeks before other symptoms of heart disease.
What causes high cholesterol in women?
High cholesterol can sneak up for all sorts of reasons, and it’s rarely as simple as eating too many chips. Hormonal changes, genetics, lifestyle habits, and even certain health conditions can all play a role in how your body processes fat. Understanding these causes can help you take charge of your numbers and your long-term heart health.
What causes high cholesterol in women over 50?
Cholesterol levels often rise in women after age 50, even if diet and exercise habits haven’t changed. This shift is largely hormonal, but other age-related factors play a role too.
Estrogen helps to regulate cholesterol metabolism, giving pre-menopausal women natural protection against high cholesterol. After menopause, however, when estrogen levels drop, this protection tends to disappear, and many women see a significant increase in both total cholesterol and LDLs following menopause.
What foods cause high cholesterol in women?
According to Dr. Setareh, fatty, rich foods, fried foods, and processed meats can lead to higher cholesterol. Additionally, studies have shown that those who follow a keto diet may have elevated cholesterol levels.
Can stress cause high cholesterol?
Yes, stress can contribute to higher cholesterol, both directly and indirectly. When you are chronically stressed, your body releases cortisol and adrenaline, hormones designed for “fight or flight.” Over time, these hormones can cause the liver to produce more glucose and fatty acids, which increase LDL. It can also cause a drop in HDL because chronic stress reduces lipid metabolism efficiency.
Additionally, Dr. Setareh points out that stress can contribute to metabolic disorders, which can cause higher weights and obesity, and eventually higher cholesterol.
Does alcohol higher cholesterol?
Alcohol consumption can contribute to higher cholesterol, as well as increase your risk for heart disease. In general, alcohol is converted into sugar in the body, which is then converted into fat, Dr. Setareh explains. Higher weights and obesity are risk factors for heart disease.
Additionally, excessive alcohol consumption can directly raise cholesterol. When you drink more alcohol than your liver can process efficiently, the alcohol will be converted into acetate, a salt that your body uses as energy instead of fat. This can cause fat to accumulate in the bloodstream, leading to increased LDL.
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Interestingly, however, light to moderate alcohol consumption is associated with a lower risk of coronary heart disease. It is important to note, however, that studies that showed this were performed only in men.
Health consequences and risks of high cholesterol
High cholesterol might not make you feel unwell, but it can have a lasting impact on your health beneath the surface. When too much cholesterol builds up in your blood, it can clog arteries and strain your heart, increasing the risk of heart disease, stroke, and other complications over time. Understanding these risks is the first step toward protecting your cardiovascular health and feeling your best for years to come.
Dangers of high cholesterol in women
The main danger of high cholesterol is that it can lead to heart disease, the #1 killer of women in America. High levels of LDL cause buildup in artery walls, forming plaques that narrow and stiffen blood vessels through a process called atherosclerosis. This restricts blood flow to the heart, which can lead to angina (chest pain), heart attacks, and even heart failure.
Research suggests that women tend to downplay their symptoms and delay seeking treatment for heart disease, which may be attributed to cultural roles and expectations of women. However, health care providers may also be contributing to this problem. A 2022 study found that women who came to the emergency room with chest pain had to wait longer on average than men who described similar symptoms. It also found that women were less likely to receive an electrocardiogram (a standard test that checks for a heart attack) and less likely to be hospitalized.
What can high cholesterol cause?
High cholesterol can cause a number of serious health issues both directly and indirectly, including heart disease, stroke, peripheral artery disease, high blood pressure, metabolic syndrome, diabetes, and potentially cognitive decline.
Can high cholesterol cause high blood pressure?
Yes, high cholesterol can contribute to high blood pressure, indirectly as part of cardiovascular disease. When high cholesterol causes atherosclerosis, it makes arteries stiffer and less elastic, which increases blood pressure.
Effects of high cholesterol
High cholesterol is generally silent and won’t have any effects on the body until it has progressed into a serious health problem. That is why it is so important to get cholesterol levels checked regularly, even if you aren’t experiencing symptoms associated with heart disease. When caught early, there are things that can be done to manage and lower high cholesterol before it progresses into cardiovascular disease.
Risks of untreated high cholesterol in women
Untreated high cholesterol poses serious long-term risks for women, especially as they age or enter menopause. The most significant risk of untreated high cholesterol is heart disease. But stroke is also a serious risk. Plaque buildup in the carotid arteries can reduce or block blood flow to the brain, leading to stroke.
Women have a higher lifetime risk of stroke than men, as well as a higher stroke mortality rate, generally attributed to the longer life expectancy of women. Another potential risk of high cholesterol, particularly in midlife, is cognitive decline. Studies have found a consistent association between high midlife total cholesterol and increased risk of Alzheimer’s disease and dementia.
Managing high cholesterol
The good news? High cholesterol is manageable, and small, consistent changes can make a big difference. From nutrition and movement to medication and mindset, there are plenty of ways to bring your numbers down and protect your heart health long-term.
How to lower high cholesterol in women
Lowering high cholesterol in women usually involves lifestyle changes, and sometimes medication. Regular physical activity helps to raise HDL and lower LDL. Focusing on a heart-healthy diet that includes fruits and vegetables, whole grains, healthy fats, lean proteins, and low-fat dairy can help lower cholesterol in women.
Additionally, limiting saturated fats, trans fats, and refined carbs and sugars can be helpful. Quitting smoking and limiting alcohol intake can also help to lower cholesterol. Finally, stress management can be a great tool for lowering cholesterol.
Diet for high cholesterol
For people with high cholesterol, Dr. Setareh recommends a Mediterranean diet. “The Mediterranean diet is one of the only diets that has actually shown cardiovascular benefit in that sense,” said Dr. Setareh.
This way of eating focuses on whole, heart-healthy foods that naturally support your cholesterol balance and reduce inflammation. Think of it as a lifestyle rather than a strict plan — rich in flavour, colour, and variety.
- Fruits and vegetables: Aim for a rainbow on your plate, especially leafy greens, berries, tomatoes, and peppers.
- Whole grains: Choose oats, brown rice, quinoa, and whole wheat over refined grains.
- Healthy fats: Use extra virgin olive oil as your main fat source, and enjoy avocados, nuts, and seeds.
- Lean proteins: Prioritise fish (especially salmon, sardines, and tuna), skinless poultry, and plant-based proteins like beans and lentils.
- Low-fat dairy: Go for options like Greek yoghurt or skimmed milk if you include dairy.
- Herbs and spices: Replace salt with flavourful herbs, garlic, and spices to support heart health.
Foods to avoid with high cholesterol
Those with high cholesterol should avoid certain foods that can increase LDLs. According to Dr. Setareh, some classic examples of foods that do this are fried foods and processed meats.
High cholesterol medication
If diet and exercise fail to control high cholesterol, Dr. Setareh says that is the point at which many doctors will turn to lipid-lowering medications. He says that these medicines are generally in the statin family, and more advanced treatments could be injectable medications known as PCSK9 inhibitors.
Taking control of your cholesterol health
High cholesterol doesn’t have to define your health story. The earlier it’s detected, the easier it is to manage (and even reverse) with lifestyle shifts and, when needed, medication. Understanding your numbers gives you power, not pressure. Whether it’s choosing heart-healthy foods, getting regular exercise, or scheduling that long-overdue blood test, every small choice helps your body work in your favour.
And remember: you don’t have to do it alone. Talk to your doctor, ask questions, and advocate for yourself. Heart disease may be the leading cause of death among women, but with the right care and awareness, it’s also one of the most preventable.
Nora Rosenfeld is an editorial intern at Rescripted, studying Journalism and Global Health at Northwestern University. She is passionate about women’s and mental health and plans to pursue health and science writing.
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