American women need to get a clue about cholesterol. While heart disease is the leading cause of death among women, a survey released last week showed that it's far from the first thing on their minds. Instead, women are twice as likely to know their weight in high school as they are to know their cholesterol level. And fewer than half of those surveyed were worried about heart disease, which worries researchers and cardiologists because it adds to a body of research showing that women aren't thinking about their heart health. The nationally representative study randomly surveyed 524 women ages 18 to 44.
The survey, conducted by the Society for Women's Health Research, revealed that 74 percent of women do not know their total cholesterol level, LDL level, or HDL level—or even what those terms mean. Just under half could identify whether HDL cholesterol is the "good" or "bad" one. (The correct answer: HDL, or high-density lipoprotein, is the good cholesterol because levels of HDL above 50 seem to protect women against heart attacks. LDL, or low-density lipoprotein, is the "bad" cholesterol. LDL levels above 130 increase a woman's risk for heart attack and stroke.)
While this was the first study to specifically target women's knowledge of cholesterol, previous research has repeatedly shown that women underestimate the threat of cardiovascular disease. "There's a period in young women's lives where they aren't going to a health care provider for an annual check up, so they don't know these things," says Jo Parrish, vice president of the Society for Women's Health Research. "And that becomes a problem when you're middle aged or beyond and haven't taken preventive measures to keep your cholesterol in check."
Researchers say these survey results reflect a disconnect between the health threats facing American women and how they are perceived. While fewer than half of the survey respondents were worried about heart disease, almost 60 percent were worried about breast cancer. Those attitudes do not align with the numbers: Coronary heart disease killed 233,886 women in 2003. That same year 41,566 died from breast cancer.
For young women, heart disease is a distant ailment of their parents' and grandparents' generations. "I think it's something down the road that I need to be concerned about," says Kate Lenzser, a 23-year-old elementary school teacher in New York City. "Right now I'm eating well and exercising, so it's not something I really need to think about." When she considers pressing health concerns for women her age, things like body image and reproductive health come to mind; heart disease and cholesterol do not make the list. "It's easier to not think about long-term health concerns when they're not right there," Lenzser says. But experts say that's a dangerous attitude. Heart disease develops gradually over a period of decades; the time to think about it is when you're young and can take preventive measures.
In the past, the medical community has largely treated cardiovascular disease as a male condition. Tracey Stevens, an American Heart Association spokesperson and practicing cardiologist in Kansas City, Mo., recalls a 1980s AHA health campaign with the slogan "Learn CPR, Save Your Husband's Life." But women are more likely than men to die within a year of having a heart attack, and more women than men die of strokes. "It's only in the past five to 10 years that we've seen this shift to recognizing the threat of heart disease for women," says Stevens.
It falls to patients and doctors alike to increase awareness of the threat. Women need to educate themselves about their cholesterol levels. But being proactive is only half the battle. Lenzser, for example, did ask to have her cholesterol tested at her last physical, which she recalls as "one or two years ago." But she never heard back from her doctor's office with the results. "It's probably a good thing," she says. "Because if I didn't hear back from them, that means that I'm fine."
Parrish says that situations like this, where women do not receive full information about their heart health, are typical—and that doctors need to do a better job. "Unless there is something wrong that jumps out at the doctor, they usually don't point out the numbers," she says. "This is really a communication problem between women and health care providers." With your doctor, "don't ask, don't tell" is never the right policy.