While good cholesterol has traditionally been known to be good for heart, a new study claimed that higher levels of the cholesterol may not always benefit middle-aged and post-menopausal women. The findings showed that the traditional measure of the good cholesterol one that carries fat away from heart, reduces the build-up of plaque and lowers potential for cardiovascular disease fails to portray an accurate depiction of heart disease risk for postmenopausal women. It is because older women are subject to a variety of physiological changes in their sex hormones, lipids, body fat deposition and vascular health as they transition through menopause. “There are two types of cholesterol in the body, good and bad. The bad one is Low-Density Lipoprotein (LDL) and that is what gets deposited. The good cholesterol is like a scavenger. Whatever is getting deposited it eats it back from the arterial walls, which is why the ratio is important. Good cholesterol is protective and normally it is high in women before menopause. That is why they are naturally protected from cardiac diseases. However, post-menopause, hormones change and the risk of coronary artery disease increases. And at that stage, the good cholesterol is not protective. The balance tilts towards the other side,” said Dr NN Khanna, cardiologist at Apollo Hospitals. The decrease of oestrogen a cardio-protective sex hormone and other metabolic changes can trigger chronic inflammation and alter the quality of high-density lipoproteins (HDL) particles, the researchers explained. The findings bring into question the current use of total HDL cholesterol to predict heart disease risk. “We have been seeing an unexpected relationship between HDL cholesterol and postmenopausal women in previous studies, but have never deeply explored it,” said lead author Samar El Khoudary from the University of Pittsburgh in the US. “High total HDL cholesterol in postmenopausal women could mask a significant heart disease risk that we still need to understand,” he added. For the study, published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, the team included data from 1,138 women aged between 45 and 84 years. At higher levels, HDL cholesterol was also associated with atherosclerosis a condition of fat and cholesterol build up in the artery walls risk in older women at menopause and who were 10 years or more into menopause. But a higher concentration of total HDL particles was associated with lower atherosclerosis risk, while a high number of small HDL particles benefitted post-menopausal women. While the large HDL particles were linked to high risk of cardiovascular disease near menopause, as women move further away from transition, the good qualities of HDL may restore, the researchers said. “Identifying the proper method to measure active ‘good’ HDL is critical to understanding the true cardiovascular health of these women,” the researchers said. “One of the ways to increase good cholesterol is through decreasing bad cholesterol with diet and exercise. In women, the heart disease risk factor is different for women post menopause and the way it progresses and manifests is also different,” said Khanna. “The symptoms are different as well. We can detect through screening, lipid profile, TMT, chest test or angiography. Other ways are to pay attention to small symptoms. Men would have typical chest pain in most cases but women would have atypical chest pain. They would have a feeling of impending doom, perspiration and breathlessness and it is passed off as not a cardiac issue. Women and their families are neglectful because women are usually more concerned about their family. Others don’t recognise the symptoms as they are not used to taking care of the women. It requires a mindset change for family and women themselves since post-menopause is when they have to be live a healthier, active life with proper diet, exercise and periodical checking,” he said.