When it comes to heart health, cholesterol has long been cast as the ultimate villain. For decades, we’ve been taught that lowering cholesterol – especially LDL or “bad cholesterol” – is the golden ticket to preventing heart attacks and strokes. Statins, the most commonly prescribed cholesterol-lowering drugs, are often handed out like candy to middle-aged men. But when it comes to women? The script suddenly changes or isn’t written at all.

Despite being just as vulnerable to cardiovascular disease, women are significantly less likely to be prescribed statins than men, even when presenting with similar risk factors. According to the American Heart Association, women are under-prescribed these medications at nearly every stage of cardiovascular care. Specifically, women were not offered the medication as often as men, were more likely to decline statin therapy when it was recommended, and were more inclined to discontinue the treatment after starting it.

But this disparity begs two important questions: Why are women being overlooked? And more importantly, is high cholesterol even the enemy we’ve been led to believe it is?

The Cholesterol Myth: Is “High” Always Bad?

Before diving into gender bias, let’s take a step back. It’s worth questioning whether our current medical obsession with lowering cholesterol is as necessary or even healthy as we’ve been told.

Cholesterol is essential to human biology. It’s a fundamental building block for hormones (including estrogen and progesterone), vitamin D, bile acids, and the structural integrity of every cell in your body. It’s especially important in brain function and neurological health.

Yet we continuously see that modern medicine has zeroed in on LDL cholesterol as a primary threat, largely due to its correlation with plaque buildup in arteries. However, correlation isn’t causation, and many researchers are now pointing out the flaws in the cholesterol-heart disease narrative.

In older women, respectively, higher total cholesterol has been associated with better memory and lower risk of dementia. A 2019 review in the BMJ even found no clear benefit to statins for primary prevention in women without existing heart disease – meaning millions of women could be taking statins without strong evidence of benefit.

So Why Aren’t Women Being Treated the Same?

According to the AHA, women are less likely than men to be prescribed statins after a cardiovascular event, and less likely to have their cholesterol levels aggressively managed, even when they present with the same symptoms or medical history.

First, it’s important to address a flaw in our modern-day medical research. Most cardiovascular studies (and studies for nearly all drugs and medical treatments) for decades were conducted on male participants. This has created a biased understanding of how heart disease presents and progresses in women, leading to underdiagnosis and undertreatment. Plus, many of the cholesterol risk calculators used in medicine are modeled on male data. This can make it harder for women to qualify for statin prescriptions, even if they are truly at risk.

Additionally, women are more likely to experience “atypical” symptoms during heart events,  such as fatigue, nausea, or jaw pain, rather than the textbook chest pain more commonly reported in men. This contributes to dismissals or delays in care.

The Side of Statins We Don’t Talk About

Even when statins are prescribed, they aren’t always the miracle drugs they’re made out to be. While statins can lower cholesterol, the benefits for primary prevention (in people without prior heart attacks or strokes) are often marginal and side effects are common.

Women may also experience statin side effects more frequently than men. Studies suggest that muscle pain (myopathy), fatigue, and cognitive complaints (like memory fog or difficulty concentrating) are more commonly reported among female statin users. 

Additionally, women are at greater risk of developing new-onset type 2 diabetes while on statins, a side effect often underemphasized in conventional risk-benefit calculations. A 2012 study published in JAMA Internal Medicine found that women over 50 who used statins had nearly a 50% higher risk of developing diabetes compared to non-users. This is particularly concerning given that diabetes is itself a major risk factor for cardiovascular disease.

Additionally, given that women’s bodies are hormonally and metabolically distinct from men’s, it’s surprising how little personalized consideration goes into statin prescriptions, if they’re offered at all. Estrogen plays a significant role in lipid metabolism, and its presence – particularly during premenopausal years – can naturally help maintain higher HDL (“good”) cholesterol levels. This means that a premenopausal woman may have a different cardiovascular risk profile than a man with identical cholesterol numbers, which isn’t always reflected in how statins are prescribed or studied.

Postmenopausal women, on the other hand, experience a drop in estrogen, which may lead to a rise in LDL (“bad”) cholesterol and an increased risk of heart disease. However, most large-scale clinical trials evaluating statin effectiveness have been conducted primarily on men or postmenopausal women, leaving a knowledge gap on how younger women respond to long-term statin therapy.

So What Should Women Do About Cholesterol?

If you’re a woman who’s been told your cholesterol is “too high,” don’t panic. Start by asking deeper questions and considering the whole picture, not just your LDL number.

Instead of looking at total cholesterol in isolation, examine your HDL (good cholesterol) to LDL (bad cholesterol) ratio, and your triglyceride levels. Inflammation markers like hs-CRP and insulin resistance may be better predictors of heart disease than cholesterol alone.

A whole-food, anti-inflammatory diet (think organic vegetables, healthy fats, grass-fed meats, and minimal refined carbs) can go a long way in protecting heart health. Regular physical activity, stress reduction, and quality sleep are just as crucial.

Women’s cholesterol levels are closely linked with hormone fluctuations, especially around perimenopause and menopause. Rather than slapping a statin prescription on shifting numbers, it may be worth working with a functional or integrative practitioner who considers the hormonal and metabolic context. Some women turn to red yeast rice (a natural statin alternative), coenzyme Q10 (to counteract muscle pain), and plant sterols under guidance from a holistic practitioner.

Conclusion: Time to Rewrite the Script on Cholesterol and Women’s Health

The conventional cholesterol narrative – and the statin protocols that follow – weren’t built with women in mind. From research gaps and diagnostic blind spots to one-size-fits-all prescriptions, women have long been an afterthought in cardiovascular care. But that’s changing.

As more data emerges and more women begin asking sharper questions, we’re entering an era where hormone-aware, personalized approaches to heart health are not only possible – they’re essential. Cholesterol likely isn’t the enemy it’s been made out to be, especially when viewed through the lens of women’s biology. It’s time we shift from automatic prescriptions to thoughtful, whole-person care.

If you’re a woman navigating cholesterol concerns, don’t just take your numbers at face value. Look deeper. Ask better questions. And most importantly, work with practitioners who treat you as a whole human – not just a stat to be managed.