According to Radcliffe Cardiology’s US Cardiology Review, only 31 percent of women know that menopause is linked to heart disease—the same percentage of healthcare professionals who understand that women are at equal or greater risk of cardiovascular disease (CVD) than men.

And yet, heart disease kills more women than men, and a woman’s risk of heart disease is equal to a man’s, just 10 years later. Because of a fundamental misunderstanding of women’s risk, says the Review, “the extent of the problem in women is frequently underestimated and, compared with men, women are less likely to be offered interventions, are less likely to be represented in clinical trials and have a worse prognosis.”

So that’s the bad news. The good news is, once women are aware of their risks, they can take steps to minimize their chances of developing CVD and to manage it if it does occur.

Why does cardiovascular disease happen to women?

More women die from heart attack and stroke than the next five causes of death combined, and that includes breast cancer. Clearly CVD is a real danger.

Why? Well, the timing gives it away: about 10 years after menopause, a woman’s risk has increased dramatically. That’s because when her estrogen level begins dropping in perimenopause, the protective effects of estrogen on heart health go with it.

Couple loss of estrogen protection with the increase in belly fat, poor sleep, fatigue that can result in less regular or vigorous exercise, and the stresses of middle age, and we can start to understand the increased risk.

The issue we’d like to discuss in this article is cholesterol. A well-known risk factor for CVD, levels generally rise post-menopause. There is an increase in the low-density lipoprotein (LDL – the “bad” kind of cholesterol) and triglycerides, and a decrease in high-density lipoprotein (HDL – the “good” kind). According to the Review, cholesterol levels peak in women at around ages 55 to 65 – about 10 years past menopause.

To make matters worse, many existing cholesterol medications were designed for men (remember that “less likely to be represented in clinical trials”? This is why representation matters!) and don’t work as well in women.

As cholesterol is such a large factor in CVD, we have tips to help you manage your cholesterol levels. The first thing you should do is talk with a doctor and get your levels checked so you can establish where you are and how urgent your situation might be.

Second, we recommend working with our Registered Dietitian Menopause Coaches who can help you learn lifestyle behaviors that can be very effective at helping reduce risk of CVD.

Protect yourself against rising cholesterol after menopause

According to the Review, just a 10 percent reduction in LDL cholesterol can reduce risk of CVD up to 20 percent. So how do we get that LDL down?

The Review suggests looking for foods that have some key properties: namely plant sterols/stanols, beta-glucan, and soy protein.

Eat these for healthy cholesterol

Plant sterols/stanols

One of the most effective food-based measures you can take are eating foods with plant sterols or stanols. These active ingredients block absorption of cholesterol during digestion of your food, and block re-absorption of cholesterol from the liver. Just 2 – 2.5 grams of plant sterols daily may lower LDL by an average of 10 percent in less than a month. When added to a healthy lifestyle, LDL may decline by a further 5 percent. These have no effect on HDL, and they do not interfere with lipid-lowering medications such as statins.

So, where does one get plant sterols/stanols?

Barbara Gordon, RDN, LD, of the American Dietetic Association (ADA) recommends foods such as vegetable oils (olive, canola, sunflower, safflower), nuts (especially walnuts), seeds (ground flaxseed), and whole grains. Also, foods may be fortified with sterols/stanols, so check orange juice, cereals, and breakfast bars.

Beta-glucan and fiber

The ingredient beta-glucan in foods can lower LDL from 2 to 5 percent when 3 to 5 grams is eaten daily. This soluble fiber is usually found in oats, which is why oatmeal is so often recommended for heart health. Oat bran is also a great source.

Soluble fiber generally is good for heart health, so go for asparagus, Brussels sprouts, sweet potatoes, turnips, apricots, mangoes and oranges, says Gordon. Beans, lentils, whole forms of produce (apples, not apple juice or applesauce). Remember: as you increase fiber, you should also drink more water. Fiber can be constipating, and with constipation already an issue in menopause, let’s not make matters worse.

Soy products

Soy protein as part of a low-fat diet can help pull down LDL by 3 to 5 percent, says the Review, with 25 grams of daily consumption. Tofu, soy nuts, edamame, miso – all good ways to bump up your soy. And bonus, soy foods may help reduce menopause symptoms, and there’s no evidence to suggest it’s a danger for women with estrogen-positive breast cancer risk. We recommend against taking isoflavone supplements or soy supplements, as that can provide a very concentrated dose and may therefore be a risk.

Understand that eating cholesterol-healthy foods is NOT a license to eat more cholesterol-unhealthy foods. Soy, oats, and plant sterols are effective as part of a healthy diet, not despite an unhealthy one.

Avoid for healthy cholesterol

Saturated and trans fats

Meats and whole-fat dairy are particularly problematic for saturated fat. Eat these in moderation and swap them out for skim or no-fat dairy or dairy substitutes. A couple of times a week (or more), consider salmon instead of steak.

Trans fats are often added to processed foods. Often called “hydrogenated” fats on ingredient labels, this is often considered the “worst” fat you can eat, says the Mayo Clinic. Not only do trans fats raise LDL, they can also lower HDL, making them a double danger. “Partially hydrogenated” oils contain less trans fat, but because we consume so much of this in the US, they should still be avoided.

You’ll find these wicked trans fats in pre-made baked goods like cakes, pie crusts, and crackers; snacks like potato chips and even microwaved popcorn; fried foods like fried chicken, fries, and donuts; pre-made dough for biscuits, cinnamon rolls, and pizza crusts; margarine and coffee creamer can also contain sneaky trans fats, says the Mayo Clinic.

How much is “safe”? The FDA says none. Even partially hydrogenated vegetable oil is no longer considered “safe” and is being phased out of use.

Additional risk factors

What else can increase risk of high cholesterol? According to Barbara Gordon of the ADA, in addition to estrogen loss, genetics, age, some medications, being overweight, eating saturated and trans fats, not moving enough, and smoking (particularly for women!) can all raise cholesterol levels. If any or all of these describe you, you should pay particular attention to your cholesterol levels and get checked more frequently.

So what is an OK amount of cholesterol?

Twenty to 30 percent of your total daily calories should come from fat, says the Mayo Clinic. Keep saturated fat at less than 10 percent. Choose monounsaturated fats instead: nuts, fish, olive oil and foods with good omega 3 fatty acids (fatty fish).

February is heart health month. It’s also the month of Valentine’s Day. So do something for those you love the most (and that should include yourself) by taking some steps to preserve your healthy heart for the many years ahead.

Ready to get started? Join HealthFix, and get unlimited access to nutrition programs and our Registered Dietitian Menopause Coaches!

Have you dealt with heart-health issues? How are you managing? We’d love to hear your tips or heart-friendly recipes, so share in our Gennev community forums!