HSOS #34: Heart Disease Risk in Menopause: Testing Beyond Cholesterol

A continuing education webinar drops a statistic that stops me in my tracks and sends me down a path of questioning my own heart health. When my cholesterol numbers start trending in the wrong direction, I ask my doctor a question that leads to a simple test that can actually show what’s happening inside the arteries. This episode unpacks what cardiovascular disease really is, why menopause quietly shifts our risk, and the surprising scan that gave me a much clearer picture of my own heart health.

Let’s talk.

Welcome to Her Season of Strength—where women over 40 reclaim their bodies, their energy, and their voices, without apologies. I'm Kim Duffy—registered dietitian, personal trainer, mom, and your biggest hype woman when it comes to aging like you mean it.

This show isn’t about chasing skinny or counting wrinkles. It’s about building real strength—physical, emotional, and hormonal. Each week, I’ll share straight-talking nutrition tips, sustainable fitness strategies, and conversations that help you feel powerful in your skin once again.

Menopause is not an ending, it is only the beginning. This is your season of strength.

What I Cover in This Episode:

• The statistic that made me stop and rethink heart health
• The moment my cholesterol numbers caught my attention
• The question I asked my doctor about statins
• The simple test that can reveal plaque in your arteries
• What cardiovascular disease actually looks like in the body
• Why heart research ignored women for decades
• What menopause has to do with heart disease risk
• Early life clues that can predict future heart health
• What happens during a coronary calcium scan
• The result that surprised me and what it means for my risk
• Episode # 14:  "How to Naturally Lower Your Cholesterol and Risk of Heart Disease"

Links & resources for this episode:

Fit After 50+ Program: 8-Week Nutrition Coaching & Strength Program for menopausal women.  Join the interest list today for the best discounts, bonuses and updates about the next program coming Fall of 2026!

Free cheat sheet: "20 Tips to Crushing Menopause"

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Transcript

[00:00:00] Hi there, and welcome to Her Season of Strength, where women over 40 reclaim their bodies, their energy, and their voices, without apologies. I'm Kim Duffy, registered dietitian, personal trainer, mom, and your biggest hype woman. When it comes to aging like you mean it, this show isn't about chasing skinny or counting wrinkles.

[00:00:20] It's about building real strength, physical, emotional, and hormonal. Each week, I'll share straight talking, nutrition tips, sustainable fitness strategies. And conversations that help you feel powerful in your skin. Once again, menopause isn't an ending. It's only the beginning. This is your season of strength.

[00:00:39] Hello, and welcome back to Her Season of Strength. I appreciate you taking just a minute or two to listen in. So today I think you're really going to. Find the, my discussion powerful or I hope so. I was listening to some continuing education. It's a webinar for [00:01:00] my rd. And a few days ago, and menopausal women of course, and cardiovascular health, and something shocked me.

[00:01:08] Did you know that about one in five women will die from cardiovascular disease, making it the leading cause of death in women. Yet many women still think breast cancer is the biggest threat. And what's even more surprising is that awareness of this fact. Has actually decreased over the past decade.

[00:01:31] Decade. In 2009, about two thirds of women knew that heart disease was the number one threat to their health. 10 years later, fewer than half of women recognized that, and here's the part that really got my. My personal attention is I exercise most days of the week. I strength train. I eat a high fiber diet.

[00:01:52] I don't smoke. I maintain a healthy weight, and I have good blood pressure. But over the past year, my cholesterol numbers took a turn in the wrong [00:02:00] direction and it honestly freaked me out a little. And I'm gonna share with you, my total cholesterol was 248 on the last check. My HDL or my good cholesterol was 78 a year ago, which is really good.

[00:02:14] Then I checked it six months later and it had dropped by 23 points. My LDL or my bad cholesterol was 1 63 and it went up to 1 72 6 months later. So at my yearly physical, I asked my doctor should I start on statins because I knew that I have some bad genetics. And sorry, statins are just drugs that help to lower your cholesterol and lower your risk of cardiovascular disease.

[00:02:43] And but I, I know that my genes predispose me to high cholesterol, and I also know that statins can decrease. Plaque formation, right? So I'm not gonna take my chances. I would rather take a medication that can help to, help to maintain my good health and ha and good heart [00:03:00] health if I needed to, if there's not something, that if I'm trying to do everything correctly, but still it's not bringing those numbers down.

[00:03:09] Instead of guessing. Based on just my cholesterol numbers, my doctor actually recommended a test that could actually show whether plaque was building in my arteries. So today I wanna talk about what that test was, what my results were, and why every woman over 40 should know about it. It. But before I explain that test, I wanna back up just for a sec, and I wanna talk about what cardiovascular disease actually is, because it's one of those terms we hear all the time, but many women don't really fully understand what is happening in the body.

[00:03:40] When we have cardiovascular disease, it usually refers to this really big term that is hard to say. It's called atherosclerosis, which is basically just that gradual buildup of plaque in our arteries. The plaque is made up of things like cholesterol, like calcium deposits, [00:04:00]  inflammatory cells, fatty deposits.

[00:04:05] So over time that plaque or those deposits that are building up in our air, in our arteries are going to narrow those arteries and it just reduces the blood flow that goes to the heart. And then heaven forbid if that plaque ruptures or blocks an artery, totally, it can lead to a heart attack or a stroke.

[00:04:27] And here's the key thing to understand is this process doesn't happen overnight. It usually takes it, it's very slow and it takes decades. It can often start as early as in our, like our thirties and forties, long before we feel any kind of symptoms. And this is why prevention and early awareness matters so much.

[00:04:48] Because for a long time, most of what we knew about heart disease, it was based almost entirely on research done on men because in 1977, [00:05:00] the FDA actually restricted women of childbearing age from participating in clinical trials because of concerns about birth defects. So while the intention was to protect pregnancies, the unintended consequences was that medications and treatments were developed and tested almost entirely on male bodies.

[00:05:25] It wasn't until 1993 that the National Institutes of Health finally required women to be included in clinical trials. Isn't that crazy? 93. So for decades, we were diagnosing and we were treating heart disease and women using research that wasn't even based on female physiology. That's one of the reasons awareness of heart disease risk in women has lagged behind men and why conversations like this are so important.

[00:05:57] So one of this, the reasons this [00:06:00] conversation becomes so important after for women specifically after H 40, is because there's something really significant happening in our bodies for most of our lives. We actually have something that's protective against cardiovascular disease, and that's estrogen.

[00:06:16] Estrogen keeps our blood vessels more flexible. It helps to regulate our cholesterol metabolism, and it plays a role in controlling inflammation inside of our arteries. So during, the time when we can reproduce or have children, women tend to develop heart disease later than men, but then menopause happens.

[00:06:35] Woo-hoo. And when estrogen levels start to decrease, we start to see the. Many changes happening at the same time and we are always talking about those, but we start to see those cholesterol levels begin to rise. We might start to see that our blood pressure increases the way our bodies store fat can change with, we see, more of that weight shifting towards our [00:07:00] abdomen and specifically around our organs, and we can see increase in inflammation in the body.

[00:07:07] None of this means heart disease is inevitable. We don't have to just be like, oh yeah, for sure. I'm gonna get heart disease now just because I am postmenopausal. But it does mean that our risk profile changes and we really have to start thinking about prevention a little differently than we did in our twenties and thirties.

[00:07:25] So another super interesting thing researchers have learned is that women's cardiovascular risk actually builds across her entire lifetime. For example, certain events earlier in life can actually increase our risk of heart disease later on. And these are things like gestational diabetes, is that, diabetes that can occur just during pregnancy, even if it goes away after pregnancy, we know that increases our risk of cardiovascular disease.

[00:07:57] Next is preeclampsia. Which [00:08:00] can be those dangerously high blood pressures and fluid retention during pregnancy or at the end of pregnancy. And it can sometimes even last after you have the baby. Specifically pregnancy related, high blood pressure, autoimmune diseases, and even early menopause.

[00:08:18] Because we were talking about, estrogen is a protective factor. So sometimes we can't help if maybe we need, hysterectomy or oophorectomy that, basically puts us into early menopause. We don't have that estrogen, earlier menopause, like maybe that would be considered, maybe early forties can increase our risk of cardiovascular disease.

[00:08:41] But for a long time, doctors didn't connect to these dots because women simply weren't included in enough research. Which is why, another reason awareness is so important today because heart disease doesn't suddenly appear when we hit 65 or 70. You know that groundwork is often being [00:09:00] laid decades earlier.

[00:09:02] And the good news is that, we can understand our risk, the more opportunity that we have to protect our heart health earlier on. So now I wanna go back to that test I was talking about. The test is called a coronary calcium score, and it's a super quick CT scan that looks specifically at the arteries of the heart.

[00:09:23] And what it's measuring is calcified plaque inside of the coronary arteries. The test produces a score that tells you how much plaque is actually present, so the scoring system, it usually looks like this. A zero means that there's no detectable calcified plaque. One to 99 means that they're mild plaque.

[00:09:44] A hundred to 2 99 indicates moderate plaque and 300 or higher suggest a significant plaque buildup. The test itself is actually very simple. It literally took four minutes. It was so fast. [00:10:00] You lie on a CT scanner table, right? They don't need to inject any contrast or any dye. They have you take, four or five breaths and then you have to hold your breath for just a few seconds each time, and then you can breathe and they give you a little time, and then they'll have you hold your breath.

[00:10:19] But literally it was only, four or five times we did that. And then what happens is that scan creates an image of your coronary arteries to look for those calcium deposits or those plaques. When my results came back, my calcium score was zero. Which means there was no detectable calcified plaque in my coronary arteries.

[00:10:42] And I have to tell you, that gave me a huge sense of relief because it told me that even though my cholesterol numbers had changed, my arteries were still clear of calcified plaque. It doesn't mean I'm gonna stop paying attention to my health because, it's still very important for me to continue [00:11:00] doing what I'm doing because my risk increases significantly since I hit menopause.

[00:11:06] But it really gave me some valuable information. Instead of guessing about my risk, I now have a clearer picture of where things stand and I don't have to panic because my cholesterol's 248. So instead of guessing about my risk I now have just the, a clearer picture of where things stand. And I'll definitely be following up, but I wanted to just tell women about this.

[00:11:32] I, I, who might benefit from this test. It can be really helpful for women over 40, especially even just to get the baseline, I'm all about those baseline tests. I feel like you should know you numbers. You should know where you stand and you trend, right? So if you're getting it checked every one year, five years, whatever, you trend that.

[00:11:50] If you start to see that things are changing. This is where we say, okay, I need to make some decisions here. If you have [00:12:00] elevated cholesterol, if you have a family history of heart disease, if you have mixed or confusing lab results like I did, if you want just a clearer picture of your cardiovascular risk, many doctors use it to help decide kinda whether someone truly needs medication or whether lifestyle strategies might be enough.

[00:12:20] And I still have to, chat with my doctor about it. But I have a feeling she's probably gonna say since your score is zero and since you don't smoke, you don't have high blood pressure, you don't have some of these other risk factors and you are also, active and you have good muscle and you're doing cardio I have a feeling she'll probably say we don't need a statin at this time.

[00:12:42] But I'm gonna, I'm gonna have a conversation with her, but I wanna talk about this test because then you might be asking gosh, am I gonna have to pay for this test? One of the things that surprised me is this test is actually very affordable. Now, there might be cases when [00:13:00] insurance would cover it in full because.

[00:13:05] It probably just depends on why your doctor's ordering it, but in many places it cost between 75 and $300. I believe mine literally was a hundred dollars. And I don't know if maybe they charged, like my insurance covered some of it, but I know that I'm paying about a hundred dollars out of pocket.

[00:13:21] And for me that for that piece of mind, it was worth it. Many imaging centers, like if you are paying totally out of pocket, they will offer it at a lower cost for those people. So for a lot of people it can really be an accessible tool. It's not if you think of normally like a CT scan or a other imaging being, 500 or a thousand dollars, that can be out of, that can be out of somebody's price range.

[00:13:47] Totally get it. But I wanted to share this with you because heart disease prevention is something. Every woman over 40 needs to be thinking about, not in a scary way, but just in a [00:14:00] empowered, proactive way. Like just knowing, right? We spend so much time worrying about the scale and about weight and about appearance, but our heart health deserves just as much attention, more attention, right?

[00:14:12] So in the next episode, since I don't, I could talk about this forever, but I decided to break this up into two different episodes. I wanna go deeper into something I find really fascinating and that's the other blood test specifically that we can do to give us a much clearer picture of your cardiovascular risk.

[00:14:36] 'cause the truth is total cholesterol alone, it does not tell the whole story. I wanna talk about markers like something called apo lip protein B. Which can be an indicator of genetic risk as well as lipoprotein A. We can talk about some different inflammation markers that can tell us how much inflammation is going on in our bodies, and then [00:15:00] specific metabolic health labs.

[00:15:02] And then some ratios that we can check even from those labs to determine kind of our risk factors. And I'm gonna be creating kind of a simple handout from after my, or before my next op episode to something that you can actually take. To your doctor if you wanna request some of these tests. And it's gonna give you a little information about each one and kind of the information that they can provide.

[00:15:26] And then you can, it can open up a discussion that you can have with your doctor. Because I think sometimes we don't know what to ask for and we don't know what information we need, and if your doctor says, oh, you don't need that because of this, that, and the other thing, or whatever, at least you can take notes.

[00:15:43] You can just be aware. And then also if you are interested in learning more natural ways to lower your cholesterol and your risk of heart disease. As far as nutrition and lifestyle factors, I talked about that in episode #14. It's title titled, [00:16:00] how to Naturally Lower Your Cholesterol and Risk of Heart Disease.

[00:16:03] I discuss different lifestyle strategies that can really make a difference. And if there's one thing I want you to take away from today's episodes, it's this understanding your risk of heart disease and your heart health. It's not about fear, it's about information. Because the more we know about our bodies, the more power we have to make choices that support our long-term health.

[00:16:28] So if this episode got you thinking about your own heart health, I'd love to hear from you. Have you ever had one of these coronary calcium scans? Have you ever looked deeper into your cholesterol numbers? Send me a message, share your thoughts on social media or leave a review of the show. I would really appreciate this.

[00:16:46] Or, what? If you have a friend it's you know how you reach out to your friend and you say, Hey, have you gotten your, your yearly mammogram this year? Ask your friend, what, do you know your numbers? How's your heart health? How's your risk of [00:17:00] cardiovascular illness?

[00:17:01] Because this is important. One out of five women can die from cardiovascular disease. That's scary. That's a big number that these are conversations that we need to start having earlier. Because this is about progress over perfection. We're in this for the long haul, and this is your season of strength.

[00:17:21] Have an amazing day.