Myths vs facts: HDL and Wechseljahre

Myths vs facts about HDL and menopause: HDL ("good" cholesterol) is widely believed to protect against heart disease. Myth: Menopause inevitably lowers HDL, increasing cardiovascular risk. Fact: HDL levels may remain stable or even rise slightly, while LDL typically increases. More importantly, HDL function—its ability to remove cholesterol from arteries—matters more than its concentration. Myth: Hormone replacement therapy (HRT) normalizes HDL and reduces risk. Fact: HRT can raise HDL, but its net cardiovascular effect is complex and not clearly protective; large RCTs have shown increased risks in some subgroups. Myth: Supplements like niacin boost HDL and prevent heart attacks. Fact: Trials that raised HDL pharmacologically failed to reduce cardiovascular events. Lifestyle interventions (Mediterranean diet, exercise, smoking cessation) improve HDL function and lower overall risk. Conclusion: HDL levels alone are an unreliable marker; focus on comprehensive risk assessment. Evidence level: moderate (observational studies, some RCTs).