Cholesterol ApoB and Lp(a): What Every Woman in Menopause Needs to Know About Heart Health

By Dr. Daniela Steyn

Wellness MD

Menopause is a profound biological transition and one of the most important times to understand your cardiovascular health. As estrogen declines, the body undergoes predictable metabolic shifts that can increase cholesterol levels, raise ApoB, elevate triglycerides, and accelerate plaque formation.

This is not about fear. It is about knowledge, prevention, and power.

At Wellness MD, we help women navigate this stage with clarity and confidence using advanced testing that goes far beyond the traditional cholesterol panel.

Let us break down what these markers mean for you during menopause. I will use Canadian values for this blog. My patients often come to me with US research, or US Influencer Instagram reels ;-) Not to worry, the values below are Canadian values you can use to compare to your last lab values.

Why Cholesterol Changes During Menopause

Estrogen has a protective effect on the cardiovascular system. As levels fall, several changes occur:

• LDL cholesterol tends to rise

• HDL may decrease

• Triglycerides often increase

• ApoB rises in many women

• Insulin resistance becomes more common

• Body fat redistributes toward the abdomen

These shifts can happen even if your diet and lifestyle have not changed. That is why midlife is the perfect time to get a deeper look at your lipid profile.

HDL Cholesterol Good Cholesterol

HDL helps remove cholesterol from the arteries. During menopause, HDL may decline slightly, but it is only one small piece of the puzzle.

Canadian values ideal:

• Greater than 1.3 mmol/L for women

Higher HDL is helpful but it does not cancel out high ApoB or Lp(a).

LDL Cholesterol Bad Cholesterol

LDL carries cholesterol through the bloodstream. Traditional LDL C measures the amount of cholesterol inside LDL particles not the number of particles.

During menopause LDL C often rises due to hormonal changes. But LDL C alone is not the best predictor of heart disease.

Canadian targets:

• Less than 2.0 mmol/L for high risk individuals

• Less than 3.5 mmol/L for the general population

Still LDL C is only part of the story.

Triglycerides TGL

Triglycerides often increase during menopause due to changes in insulin sensitivity and carbohydrate metabolism.

Canadian optimal:

• Less than 1.7 mmol/L

High triglycerides often accompany small dense LDL particles raising ApoB and increasing risk.

ApoB The Most Important Marker for Women in Midlife

ApoB apolipoprotein B is the single most accurate predictor of cardiovascular risk especially for women in menopause.

Why Because every atherogenic particle LDL VLDL IDL Lp(a) carries exactly one ApoB molecule.

ApoB tells us how many artery penetrating particles are circulating.

The more ApoB particles you have the more likely they are to slip beneath the artery lining and begin forming plaque.

Canadian ApoB interpretation:

• Optimal less than 0.80 g/L

• High risk greater than 1.00 g/L

• Very high risk greater than 1.20 g/L

At Wellness MD we test ApoB routinely because it gives us the clearest picture of your true cardiovascular risk especially during menopause when particle number often rises even if LDL C looks normal.

How Women in Menopause Can Lower ApoB Naturally

Some women can significantly reduce ApoB with targeted lifestyle changes:

1. Shift from saturated fats to monounsaturated fats

• Extra virgin olive oil

• Avocados

• Macadamia nuts

• Almonds

2. Reduce refined carbohydrates

Especially if triglycerides are elevated.

3. Prioritize strength training and daily movement

Exercise improves insulin sensitivity and reduces VLDL production.

4. Support metabolic health

Midlife insulin resistance is common and reversible.

If lifestyle changes are not enough, we discuss evidence-based medications.

Medications I often prescribe:

• Statins available in Canada include Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin).Beyond statins women now have access to:

• Ezetimibe (Ezetrol)

• PCSK9 inhibitors Repatha (generic name: evolocumab) and Praluent (generic name: alirocumab)

• Bempedoic acid (Nexletol)

These therapies can dramatically reduce ApoB and cardiovascular risk when used appropriately.

Lp(a) The Genetic Risk Factor Every Woman Should Know About

Lp(a) is one of the most important hereditary risk factors for premature heart disease.

Key facts for women:

• Levels are genetic, not lifestyle-driven

• They do not respond to diet or exercise

• About 10 to 20 percent of Canadians have elevated levels

• Women with high Lp(a) face an increased risk after menopause

• You only need to test it once

• 
  

Canadian interpretation:

• Ideal less than 75 nmol/L

• High risk greater than 125 nmol/L

• Very high risk greater than 200 nmol/L

There is currently no direct treatment for Lp(a). PCSK9 inhibitors can lower it by about 30 percent, but this has not yet been proven to reduce events.

So what do we do

We aggressively manage every other modifiable risk factor, especially ApoB, blood pressure, insulin resistance, weight, and smoking.

The Wellness MD Approach for Women in Menopause

Menopause is not a decline; it is a transition. And with the right information, it can be one of the most empowered stages of your life.

At Wellness MD, we:

• Test ApoB and Lp(a) for all women entering midlife

• Use Canadian guidelines to interpret results

• Create personalized plans that blend lifestyle medicine with advanced therapies

• Address hormonal, metabolic and cardiovascular health together

• Help you understand your numbers so you can take control of your future

• Support and follow-up from a Medical Doctor, Certified Nutritionist and Menopause Certified Naturopathic Doctor.

Your heart health in menopause is not determined by age, it is shaped by awareness, prevention, and action.

Book your appointment today and take the next step toward feeling your healthiest, most empowered self. info@wellnessmdhealth.com