Metabolic Health & Your Heart- What Every Woman Needs to Know

February is Heart Health Month.  And so, I felt it is a good time to highlight one of the most pressing health concerns that affect women—cardiovascular disease. Despite increased awareness that heart disease remains the leading cause of death for women, many of us still underestimate our risk.

In this blog post, I will cover some of the latest recommendations in heart health, with a focus on cholesterol guidelines, the role of lipoprotein(a) (Lp(a)) and high-sensitivity C-reactive protein (hs-CRP), the importance of metabolic health, and what we as women can do to take charge of our heart health.

Metabolic health refers to how efficiently the body processes and utilizes energy. This is determined primarily by blood sugar regulation, insulin sensitivity, inflammation levels, and overall body composition.

A person with optimal metabolic health typically has:

• Normal blood sugar levels without insulin resistance or prediabetes
• Healthy blood pressure below 120/80 mmHg
• Optimal cholesterol and triglyceride levels
• A healthy waist circumference and body fat distribution.

Only 12% of the adult American population is deemed to have optimal metabolic health.

 

Metabolic syndrome is a condition characterized by a combination of at least three of the following criteria

• High blood pressure
• Elevated blood sugar
• Abnormal cholesterol levels
• Excess abdominal fat.

Metabolic syndrome increases the risk of developing heart disease. Women, particularly in midlife, struggle with metabolic dysfunction without realizing it.

How Metabolic Health Affects Your Heart

1. High Blood Sugar and Insulin Resistance: When the body becomes resistant to insulin, it struggles to regulate blood sugar levels. Chronically high blood sugar leads to inflammation and arterial damage, both of which increase the risk of heart disease. Women with diabetes are at a significantly higher risk of cardiovascular events compared to men.
2. Blood Pressure Control: High blood pressure forces the heart to work harder, increasing blood vessel strain. This raises the likelihood of heart attacks, strokes, and other cardiovascular complications.
3. Chronic Inflammation: Poor metabolic health is often accompanied by systemic inflammation. This results in the release of inflammatory cytokines, which can cause numerous problems, including plaque buildup in arteries, making them more susceptible to blockages.
4. Excess Visceral Fat: Unlike subcutaneous fat, stored under the skin, visceral fat surrounds internal organs and releases harmful inflammatory chemicals. Women who carry excess weight around their midsection are at higher risk for heart disease, even if their overall BMI is normal.

Updated Cholesterol Guidelines: A More Personalized Approach

• LDL-C Goals: The latest American Heart Association (AHA) and American College of Cardiology (ACC) guidelines suggest that women at high risk for cardiovascular disease aim for an LDL-C level below 70 mg/dL.
• Non-HDL Cholesterol and Triglycerides: Non-HDL cholesterol (total cholesterol minus HDL) is a strong predictor of cardiovascular risk because it includes all plaque-forming (atherogenic) lipoproteins, such as LDL, very-low-density lipoprotein (VLDL), and intermediate-density lipoprotein (IDL). High non-HDL cholesterol is particularly concerning for women with metabolic syndrome, as it reflects an overall burden of harmful cholesterol that contributes to plaque buildup in the arteries.
• The Role of Triglycerides: Triglycerides, a type of fat found in the blood, are essential to metabolic health. Elevated triglyceride levels often indicate insulin resistance and are related to excessive carbohydrate intake and an increased risk of cardiovascular disease. High triglycerides combined with low HDL cholesterol are characteristic of metabolic syndrome and contribute to forming small, dense LDL particles, which are more likely to infiltrate artery walls and cause blockages. Ideally, triglyceride levels should be below 150 mg/dL, with optimal levels closer to 100 mg/dL or lower.

• Apolipoprotein B (ApoB) as a Key Risk Marker: ApoB is a structural protein found in all atherogenic lipoproteins, including LDL, VLDL, and Lp(a). Unlike LDL-C, which measures the cholesterol content in LDL particles, ApoB provides a direct count of the total number of atherogenic particles in circulation. Because smaller, denser LDL particles are more likely to penetrate arterial walls and contribute to plaque formation, measuring ApoB is considered a more precise indicator of cardiovascular risk. Recent guidelines suggest that women with metabolic syndrome, insulin resistance, or a family history of cardiovascular disease should consider ApoB testing to better assess their heart disease risk. Optimal ApoB levels should generally be below 80 mg/dL for high-risk patients.

   Lipoprotein(a) and hs-CRP: The Emerging Markers Women Should Know

   Traditional cholesterol measures alone may not always paint the complete picture of heart disease risk. That’s where additional biomarkers such as lipoprotein(a) and high-sensitivity C-reactive protein may play a role.
• Lipoprotein(a) (Lp(a)): Lipoprotein (a) is a genetically determined lipoprotein. Elevated levels are associated with a higher risk of heart disease and stroke. A one-time blood test can be done at the age of 40. Unlike LDL cholesterol, lifestyle changes have minimal impact on Lp(a), making screening crucial, particularly for women with a family history of heart disease.
  
• hs-CRP (High-Sensitivity C-reactive protein) is a marker of inflammation. Elevated hs-CRP levels indicate an increased risk of cardiovascular events, even in women with normal cholesterol levels. Checking the hs-CRP testing can help identify women who may benefit from more aggressive prevention strategies.

                 Improving Metabolic Health for a Stronger Heart

                  The good news is that metabolic health is largely within your control. Making targeted lifestyle changes can dramatically reduce your cardiovascular risk:

• Prioritize Whole, Nutrient-Dense Foods: Focus on anti-inflammatory foods such as leafy greens, berries, nuts, seeds, fatty fish, and olive oil. Avoid processed carbohydrates and refined sugars that can spike blood sugar and contribute to insulin resistance.
• Increase Physical Activity: Engage in a mix of strength training, cardiovascular exercise, and flexibility-based activities such as yoga. Building muscle improves insulin sensitivity and supports a healthy metabolism.
• Manage Stress: Chronic stress can lead to elevated cortisol levels, which contribute to weight gain, insulin resistance, and increased cardiovascular risk. In addition to a well-balanced exercise program, practices such as mindfulness, meditation, yoga, qi-gong, and deep breathing exercises can be beneficial.
• Prioritize Sleep: Poor sleep disrupts metabolic processes, increases inflammation, and elevates the risk of heart disease. Aim for at least 7-8 hours of high-quality sleep per night. 

Take Action: Your Next Steps for Heart Health

Understanding heart health is just the first step—taking action is what truly makes the difference. Here’s what you can do today to prioritize your cardiovascular wellness:

1. Schedule a Heart Health Check-Up: If you haven't had your cholesterol, blood pressure, or metabolic health markers checked recently, now is the time to schedule an appointment with your primary care physician.
   

2. Request Advanced Testing: Ask your doctor about additional cardiovascular risk markers, such as Lp(a), ApoB, and hs-CRP, especially if you have a family history of heart disease.

3. Focus on Lifestyle: Adopt heart-healthy habits, including a balanced diet, regular physical activity, stress reduction, and quality sleep.