Women’s Heart Health: Cholesterol, Menopause, and Hidden Risks of Statins
For decades, cholesterol has been a focal point in conversations about heart health, especially as we cross the threshold of 50. If you’re a woman navigating perimenopause, menopause, or postmenopause, you’ve likely faced more than one conversation about “bad cholesterol numbers” and treatment options like statins. But how much of this advice really fits the unique physiology of women? In this deep-dive companion to Alan Ogden’s recent podcast episode, we’ll explore the twists and turns of cholesterol guidance, the controversies surrounding statins—especially for women—and why a more nuanced approach could mean all the difference for your heart health in your second 50 years.
Changing Guidelines and Their Impact
The History of Cholesterol Guidelines
Alan Ogden recalls being right in the middle of the cholesterol debate while earning his Bachelor of Pharmaceutical Sciences—an era when both plant-based medicine and conventional drugs were part of the pharmacy curriculum. As Alan highlights, “all of a sudden we needed to get fat out of food,” leading to widespread, top-down policy shifts. “Unfortunately, we now know that the replacement was sugar, which had more devastating effect than actually the cholesterol or the fat in the food at the time,” Alan says.
The original research driving these guidelines was selective, according to Alan. He explains, “what [the lead researcher] had done is he had cherry-picked just a few studies… and then they came up with these guidelines that if you are over a certain level of LDL cholesterol, then you needed therapy.” Alan’s pharmacology professor questioned this approach, noting that the guidelines were built on a narrow slice of available research rather than an objective meta-analysis.
The main point: the guidelines set decades ago were built with a limited lens, and yet those standards have shaped millions of lives—often without distinction for gender or the influence of aging and hormones.
Why the Guidelines May Miss the Mark for Women
The ever-tightening of “acceptable” cholesterol levels is another major trend Alan discusses. “The levels, allowable levels, pre-sort of therapy have dropped. They continue to drop,” Alan points out. Decades ago, very few people met the threshold for therapy. Today, many more—especially older women—find themselves suddenly labeled at risk once those thresholds shift.
Crucially, Alan emphasizes that “the original application for the use of cholesterol [medications] was very specific. It was for people who were genetically subject to something called apolipoprotein A.” That means the intervention was meant for a select few, not a general population—and certainly not for women, who were completely excluded from the foundational research on statins.
The original approval for this drug, you had to be a male, you’d had to have already had a heart attack, they would start you on a statin drug, or you had to have genetically high cholesterol.
Statin Controversies: The Research Gaps for Women
No Original Statin Trials in Women
One of the most significant points Alan raises is the glaring absence of women in early statin research. According to him, “a very small study had been done on preventing secondary heart attacks in men. So there was no original research done on women with statin drugs.” Yet, decades later, women are routinely prescribed these medications—even though their bodies, hormones, and heart disease patterns differ dramatically from men’s.
Estrogen, Menopause, and Cholesterol: The Untold Story
Alan explains that women experience a natural rise in LDL cholesterol as they reach menopause. “It was pretty well known that as women go through menopause and they become postmenopausal, their LDL cholesterol naturally rises,” he says. In earlier eras, many women lived well into their 80s and 90s without suffering heart attacks despite higher LDL cholesterol.
This leads Alan to question, “Why are women not so subject to cardiovascular disease?” The answer, he suggests, lies at least partly in the “cardioprotective mechanism” of the estrogen-progesterone cycle, a benefit lost in menopause. Alan also notes, “Women usually have one heart attack where men might get away with, you know, one and another one and have this intervention.” The implication: risk patterns, heart symptoms, and underlying mechanisms are different for women—but treatment plans rarely reflect that fact.
The Scope and Limitations of Routine Cholesterol Testing
Alan highlights that routine checkups often paint an incomplete picture for women: “You check your HDL, you check your LDL, you check your triglycerides. That’s basically as far as your doctor goes. And from that they make this decision about statin therapy.” The nuance of cholesterol’s actual impact—especially its subtypes and how they interact with female hormones—rarely gets a thorough review in the standard clinical setting.
To illustrate, Alan shares the personal example of his wife Donna. She received a high LDL cholesterol result, and her doctor immediately raised the possibility of a statin. Alan suggested a deeper dive—a lipoprotein panel—which later revealed her cholesterol particles were not dangerous, despite the “high” LDL. “Even though the LDL is high, it’s not damaging. It’s not doing the damage that originally this research that was done in the 60s, 70s was indicating that it was doing because of this cherry picking of the information,” Alan explains.
Side Effects and Downstream Effects
Statins impact the liver’s cholesterol production, but cholesterol is also the foundation for key hormones like estrogen, progesterone, and testosterone. As Alan puts it, “upstream from many of the activities in our body is something called cholesterol. And so when we start interrupting that pattern, then we are going to get downstream effects from cholesterol.” This is especially relevant for women entering menopause, when hormone production is already in flux.
The downstream effects of statin-induced cholesterol reduction in women—including its impact on hormone synthesis—have not been thoroughly researched or addressed in major guidelines. Alan notes that new cholesterol drugs now act in the intestinal tract instead of the liver, reflecting a slow shift in medical thinking. Still, the lack of gender-specific research remains a striking gap.
Women’s Heart Health: More Than Just a Number
Personalizing Your Plan
Alan’s approach, grounded in both pharmaceutical science and genetics, advocates for a process-oriented evaluation before jumping into medication. At his practice, Alan describes a series of steps before considering drug intervention:
- Genetic testing for cholesterol metabolism predispositions
- Examining dietary patterns (especially saturated fat intake)
- Assessing liver, kidney, and bowel function
- Reviewing extended cholesterol panels (including HDL, LDL subtypes, triglycerides, lipoproteins)
“If we still see high LDL cholesterol, our first response to that is not a statin drug. We look at their dietary pattern… all their liver enzymes… even kidney function… and finally, their bowel function,” Alan says. Only after exploring these layers would medication be considered, and then usually only if genetic findings or personal risk factors suggest it is warranted.
Alternatives and Prevention
For those who discover elevated cholesterol, there are still intermediary steps. Alan points to “natural” approaches, such as specific dietary modifications and supplements. In Donna’s case, they leveraged a product called Stericol (which Alan notes as approved by Health Canada for cholesterol management), as well as a close review of her saturated fat intake. For many women, especially those nearing or post-menopause, this can be a highly effective path when guided by careful testing and ongoing monitoring.
The Bigger Industry Picture
Alan also reminds us that the current cholesterol field is shaped by massive economic forces. “You have to remember, you know, the other thing we have to remember is we’re fighting a $35 billion a year industry right now in cholesterol,” Alan comments. That context means the rush to medicate may reflect more than pure patient well-being; it is part of a historic cascade shaped by business, convenience, and legacy research—all of which tend to downplay the subtleties, especially when it comes to women’s heart health.
Conclusion: A Roadmap for Empowered Women’s Heart Health
Alan Ogden’s perspective offers a crucial reminder: women’s cholesterol, heart disease risk, and the appropriateness of statin therapy cannot be reduced to one-size-fits-all guidelines—especially when so much of the foundational research simply excluded women and their unique physiology. He underscores that cholesterol is not the enemy; it’s a vital building block for the hormones that run your body, particularly through menopause and beyond.
Before starting or continuing statin therapy—or becoming anxious over “bad” cholesterol results—Alan recommends personalized testing, lifestyle assessment, and, when possible, consulting a practitioner who understands both genetics and women’s health. The real measure of cholesterol women heart health is not a lab number, but a comprehensive, respectful approach that addresses the full picture.
Want to dig deeper? Listen to the full Your Second 50 podcast episode and explore the resources at LiveYourDNA.com for more guidance on understanding your unique cardiometabolic risk—and writing your healthiest next chapter.