TODAY'S AJENDA #101

Thousands of new friends are joining us this week! Sending a big, heartfelt welcome to all of you! A quick reminder: you can catch up on past issues, share this newsletter with a friend, and even join our insiders list, Off Duty. Links are at the bottom of this email. Now, let’s get into it. We’ve got a lot to cover!

Today's Ajenda:

• Statins Reduce Inflammation?

• Tackling the #1 Killer of Women

• Your FRAX® Score And Why It Matters

• My Winter Metabolism Hack

• Recipe: Nutty Banana Oat Bowl

If you’re a woman over 50, you’ve probably had this moment: your cholesterol panel pops up in your patient portal, your LDL is “borderline,” or maybe around 120, and suddenly you’re staring down the Statin question like it’s a referendum on your lifestyle choices. The problem is, we’ve all been trained to talk about statins as if they’re just cholesterol-lowering medications. That’s the noise.

The science signal is this: statins are also anti-inflammatory drugs in the way that matters most for midlife women, meaning inflammation inside the blood vessel wall that drives plaque, rupture, heart attack, and stroke. And the menopause transition is a perfect storm for this because cardiometabolic risk shifts quickly, even when your habits haven’t changed. As estrogen levels drop around menopause, systemic inflammation rises, and that can affect everything from your joints to your arteries.

North Star lens: risk is a story, not a single lab value

One of the biggest decision-fatigue traps in women’s health is being asked to make a major medication decision based on one number (LDL) in one moment of time (a single lab draw). A better North Star approach is pattern recognition: What is your overall trajectory? Family history, blood pressure, A1c or fasting glucose, waist circumference, sleep, exercise capacity, smoking history, pregnancy history (preeclampsia, gestational diabetes), and inflammatory markers like hs-CRP…these all belong in the conversation.

That’s exactly why the JUPITER trial matters.

The JUPITER trial: the “inflammation” statin trial hiding in plain sight

JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) studied people who did not have high LDL by traditional standards (LDL <130 mg/dL) but did have elevated inflammation (hs-CRP ≥2 mg/L). Rosuvastatin 20 mg significantly reduced major cardiovascular events, with a similar relative risk reduction in women and men. 

That’s the headline for women: you can have “meh” cholesterol and still have meaningful vascular risk if inflammation and overall risk context are pointing in the wrong direction. JUPITER helped normalize a more modern frame: statins don’t just lower LDL, they lower risk.

Statins as anti-inflammatory agents: the underappreciated benefit

Statins reduce inflammatory signaling and markers like CRP, and this effect is not always tightly linked to the amount of LDL reduction. A 2024 review of lipid-lowering therapies reported that statins significantly reduce CRP concentrations, supporting the idea that the benefit profile is not “cholesterol only.” A 2025 ACC scientific statement on inflammation and cardiovascular disease also highlights that some of the earliest evidence linking inflammation to improved outcomes came from statin trials showing reduced inflammation alongside reduced events. 

This matters for women over 50 because our risk often shows up as a cluster: rising blood pressure, creeping insulin resistance, visceral fat gain, sleep disruption, and a subtle uptick in inflammatory tone. If your North Star is “reduce my chances of being the woman who has her first symptom as a heart attack,” inflammation belongs in your plan.

The diabetes question: yes, the risk is real, and yes, context matters

Here’s the con that deserves grown-up attention: statins cause a moderate, dose-dependent increase in new diagnoses of type 2 diabetes, largely reflecting a small upward shift in blood sugar. A major 2024 meta-analysis in The Lancet Diabetes & Endocrinology quantified this effect and reinforced that it’s real and dose-related, meaning the higher the dose of statin, the higher the risk of elevated blood sugar levels/ diabetes.

What to do with this info: 

Think like a doctor: don’t throw out a cardiovascular risk-reducer because it nudges glucose in a predictable subset. Instead, identify who is most vulnerable (prediabetes, metabolic syndrome, higher baseline A1c, central adiposity) and monitor intentionally. If you start a statin and your A1c rises, that’s not a moral failure. It’s a physiologic signal to tighten the basics: protein-forward meals, resistance training and cardio exercise, sleep, and maybe medication adjustments if needed.

Muscle pain: the myth, the reality, and the nocebo effect

This is where fear has wildly outpaced data.

Randomized, blinded trials show that most muscle symptoms reported on statins are not actually caused by the statin. In a large individual-participant meta-analysis, statin therapy caused only a small excess of mostly mild muscle pain, and more than 90% of reported muscle symptoms in people assigned to statins were not due to the drug. 

Even more recently, a 2024 meta-analysis of double-blinded RCTs found no meaningful difference in reported muscle symptoms between statin and placebo groups across tens of thousands of participants. And in February 2026, a large Lancet analysis of adverse effects attributed to statins concluded that most label-listed side effects are not supported by blinded randomized trial data (only a small number showed any association, and the risks were small). 

Practical translation: if you get muscle symptoms, we take you seriously, we check for other contributors (thyroid, vitamin D, training changes, drug interactions), and we problem-solve (dose, timing, switching statins, alternate-day dosing). But we don’t let misinformation make the decision for us.

So, should a woman over 50 take a statin?

The honest answer is, many absolutely should, some absolutely shouldn’t, and a lot are in the “let’s personalize this” middle. 

What I want women to stop doing is using cholesterol alone as the decision-maker. (Also, this is where a CAC CT scan is key.) A Coronary artery calcium CT scan to see if plaques in the coronary arteries have calcified, reflecting Stage 4 Atherosclerosis. Newer ultra-fast, ultra-low dose CT scans can detect Stages 1-3 Atherosclerosis even BEFORE calcification occurs.

Your North Star is in the outcomes: 

• Fewer heart attacks

• Fewer strokes

• A lower chance of you becoming another heart disease statistic

• More good years. 

Statins can be a powerful tool toward that goal, partly because of their LDL-lowering effects and partly because vascular inflammation is a target, whether we admit it or not. Sometimes a drug can be preventative, rather than therapeutic, and we are starting to see statins slide into this role.

And yes, I know, adding a daily medication can feel like crossing a line. But sometimes the most feminist, self-respecting thing you can do at 55 is prevent the crisis you never saw coming.

This week, I appeared on The View to talk about two topics that directly affect us all: heart disease and hormones. I am the daughter of a cardiologist, and thus, an interest in and awareness of cardiovascular disease is literally in my blood. Here’s a fact I need you to know: one in three women will die of heart disease. 

I want you to really sit with that for a second, because most women I talk to have absolutely no idea that is the reality. Heart disease is our biggest risk. Not breast cancer. Not a stroke. Heart disease is the number one killer of women in this country, accounting for roughly one death every 80 seconds. And yet it remains one of the most underfunded, underdiagnosed, and undertreated conditions in women's health.

As an OBGYN, I’ve always believed that some of the most important windows into a woman’s long-term health happen in those exam rooms. Pregnancy complications, menopause symptoms, and blood pressure changes are not isolated events. They are clues to disease states and opportunities to improve health. But too often there’s a big gap: cardiologists don’t understand OBGYN conditions, and OBGYNs often don’t know how best to screen for heart disease.

That gap has always bothered me, which is why I am so proud to share that my husband, Tom, and I have joined a new initiative specifically aimed at closing it through continued education and better access to cardiovascular care for women by including their OBGYNs. This work feels deeply personal to me, and I want to bring you along for it.

So let's talk about what is actually going on, because the conversation around women and heart disease is far more nuanced than most people realize.

Why Women Are Different (and Why That Matters)

For decades, cardiovascular research was almost exclusively conducted on men. The symptoms we learned to recognize, the treatments that were developed, the risk thresholds that were established, all of it was built around the male body. Women often present differently. We are far more likely to experience atypical symptoms like jaw pain, nausea, back pain, or profound fatigue rather than the dramatic chest-clutching image we have all seen on television. Because of that, women get missed. We get sent home from emergency rooms. We get told it is anxiety. We are underscreened, under tested, undertreated, and understudied. The consequences of that are fatal.

What changes after menopause is significant, too. Before menopause, women actually have a lower risk of cardiovascular disease than age-matched men. Estrogen appears to play a genuinely cardioprotective role, supporting healthy cholesterol levels, insulin sensitivity, and arterial function. Once estrogen drops, that protective advantage disappears, and CVD risk climbs sharply. This is not a coincidence.

The HRT Conversation We Need to Have

I want to talk about hormone replacement therapy (HRT) here, because the research is nuanced, the history is complicated, and too many women are making decisions based on fear rather than facts.

Most of the confusion traces back to 2002 and the Women's Health Initiative study, which for years led both doctors and patients to believe that HRT was dangerous for the heart. What we now understand is that the timing of when HRT is initiated matters enormously. The Women’s Health Initiative enrolled women with an average age of 63, many of whom already had subclinical cardiovascular disease. When researchers went back and looked specifically at women who started HRT closer to menopause, the picture looked very different. In other words, the risks involved for a woman of 46 or 50 are much different than the risks involved for a woman of 63 or 70.

A large meta-analysis showed that women who initiated HRT before age 60, or within 10 years of menopause onset, had a statistically significant 32% reduction in coronary heart disease events and meaningful reductions in all-cause mortality compared to placebo. This is what researchers now call the "window of opportunity," and another landmark analysis confirms that the earlier you act within that window, the more pronounced the benefit. The data is consistent across both randomized controlled trials and observational studies.

Then there is the question of how HRT is delivered, and this is where things get really important for the decisions you are making with your doctor. A major 2024 Swedish study published in the BMJ, drawing on data from over 900,000 women, found that transdermal forms of estrogen (meaning patches, gels, and creams) did not carry the same cardiovascular risks as certain oral combined hormone therapies, which were associated with a modestly increased risk of ischemic heart disease. Transdermal estrogen showed no clear increase in any cardiovascular outcomes, and in fact suggested a borderline reduction in both heart attack and composite CVD risk. That is a meaningful distinction and one that is not making its way into enough conversations between women and their doctors. (The lowered heart risk is likely a result of the fact that when a hormone is delivered through the skin, metabolism by the liver is bypassed, which LOWERS the risk of clotting that is seen with all hormonal formulations- including birth control pills.) 

None of this is a blanket endorsement of HRT for everyone. Route of administration, type of progestogen, dosage, timing, and your individual health history all factor in. This is not a one-size-fits-all conversation, which is exactly why you need to be having it directly with your physician rather than relying on what you heard from a friend or read online from a menopause influencer.  But I do want you to walk into that appointment informed, because the science is moving in a direction that is far more favorable than the fear-based messaging of the early 2000s suggested.

What You Can Do Right Now

Whether or not HRT is right for you, there are foundational habits that move the needle on cardiovascular health significantly, and they are things you have control over starting today. Remember: 80% of heart disease can be prevented with behavioral modification. The key is knowing what to modify! 

1. Know your numbers. Blood pressure, fasting blood sugar, and a full cholesterol panel, including LDL, HDL, and ideally lipoprotein(a), which is sometimes called the heart's quiet killer and is significantly underscreened in women. Knowing cholesterol particle size is also important and is really just beginning to be considered in risk assessment. These are not just numbers on a lab report. They are your early warning system.

2. Move your body consistently. Resistance training in particular is one of the most underutilized tools for cardiovascular health in women (and it is something we work on directly inside The Wellness Experiment.) Aerobic exercise is needed too; it’s not either / or.

3. Prioritize sleep and manage chronic stress. Inflammation is a very real cardiovascular risk factor that does not get nearly enough attention in women's health conversations. Sleep helps reduce inflammation, as do prescription medications like statins and GLP-1’s. More on this in next week’s newsletter!

4. Eat in a way that supports metabolic health. Blood sugar stability, adequate protein, fiber-rich meals, all of it feeds back into your heart health in ways that compound over time.

And please, advocate for yourself at every single appointment. Ask about your cardiovascular risk. Push for a full workup. Ask if you can get a CAC CT scan to check for calcium deposits in your coronary arteries. Do not accept "you're fine" without the data to back it up.

This is the work. And this is exactly why Tom and I said yes to supporting this initiative. I believe deeply in continued education, not just for myself but for our entire field. Medicine evolves, science evolves, and if we are not actively learning, we are falling behind for the women we are here to serve. 

This initiative is rooted in that commitment to staying current, connecting specialties, and ensuring that OBGYNs and Cardiologists are equipped with the most up-to-date cardiovascular and menopause knowledge so we can identify risk earlier, intervene sooner, and ultimately save lives and truly change the trajectory we’re on.

In short, if we reach women sooner and connect these dots sooner, we can prevent heart disease, and improve, and save lives. 

This is the work that keeps me thinking at night and gets me up in the morning. And I’m so grateful to have you here for it! More to come, but I hope this is a starting point for a conversation you carry into your next doctor's visit.

From my heart to yours, thank you. 
Xx

If you’ve ever had a bone density scan — the DXA that gives you a T-score — you may have walked away with two questions: Is this “bad,” and what do I actually do about it? The truth is, the T-score is just one piece of the story. For women over 50, understanding your FRAX® score — that ten-year fracture risk calculator — can be far more meaningful than obsessing over yet another number.

Let’s talk about what it is, why it matters, and how it helps you take action.

The problem with measuring bone density alone

A DXA scan measures bone mineral density (BMD) and compares it to a healthy young adult reference population. A T-score ≤ –2.5 defines osteoporosis, and between –1.0 and –2.5 defines osteopenia (low bone mass), according to the World Health Organization diagnostic criteria.

But here’s the catch: bone density alone does not capture true fracture risk.

Most fragility fractures occur in people with osteopenia, rather than osteoporosis, because that population is much larger. And once you start treatment, the T-score becomes less useful in isolation to assess ongoing risk. That’s where FRAX® comes in. 

What exactly is a FRAX® score?

FRAX® stands for Fracture Risk Assessment Tool. It was developed by researchers at the University of Sheffield, UK in 2008 and calibrated using outcomes data from large international cohorts. It estimates your 10-year probability of breaking a bone — specifically, a hip fracture or another major osteoporotic fracture (like a spine, forearm, or shoulder break). 

Rather than telling you how “bad” your bones are, FRAX® tells you how likely it is you’ll end up with a fracture over the next decade based on:

✔ age, weight, and height
✔ history of fractures
✔ parental hip fracture
✔ smoking status
✔ glucocorticoid (steroid) use
✔ rheumatoid arthritis
✔ other risk factors such as alcohol use or certain medical conditions
…and it can include your hip bone density from DXA if available to improve accuracy. 

That’s what makes FRAX® so powerful: it’s not just bone strength. It’s contextual bone risk.

So why does FRAX® matter?

If knowing your FRAX® score feels like getting assigned a prognosis, that’s because it helps you see the forest instead of the trees. Instead of treating a number on a scan, you’re assessing your overall fracture probability. This has three practical implications:

1. It identifies women who might benefit from treatment even without osteoporosis-level T-scores. Most fragility fractures occur in women with osteopenia, not full-blown osteoporosis. FRAX® helps catch that. 

2. It guides treatment decisions. U.S. consensus guidelines often recommend considering medication if your 10-year risk of major osteoporotic fracture is ≥20% or your hip fracture risk is ≥3%. 

3. It gives you a conversation starter with your clinician, not a prescription slip. Whether you decide to address bone health with medication, lifestyle changes, or both, FRAX® lets you personalize your plan.

In other words, the FRAX® tool can be used to guide treatment decisions in people who meet the following three conditions:

1. Postmenopausal women or men age 50 and older

2. People with low bone density (osteopenia)

3. People who have not taken an osteoporosis medicine

What the numbers mean (in plain speak)

Let’s imagine two women of the same age and DEXA T-score. One has a history of wrist fracture and a parent who broke a hip; the other doesn’t. Their bone density alone might look the same, but their fracture risk — as captured by FRAX® — will be very different. That’s because FRAX® integrates clinical risk factors with bone density, giving a more complete picture. 

A higher FRAX® score doesn’t mean you will fracture a bone. It means your probability of doing so over the next decade is higher than that of someone with a lower score. And that probability is not fixed — it’s modifiable with targeted interventions.

Action over anxiety

If your FRAX® score is elevated, it doesn’t mean resignation. It means opportunity. Here’s why:

• You can strengthen bones with the right treatment plan.

• You can improve balance and reduce fall risk with exercise and physical therapy.

• You can optimize nutrition, vitamin D, and calcium intelligently.

• You can engage with medications when appropriate in a way that aligns with your values and risk profile.

FRAX® doesn’t tell you to be afraid. It tells you to act with information.

Personalizing risk, not generalizing fear

Your bones don’t live in a vacuum, and neither should your fracture prevention strategy. The FRAX® score gives you a personalized 10-year risk estimate that accounts for your clinical history and lifestyle, not just a snapshot of bone mineral density. In doing so, it helps you and your doctor make informed decisions about therapy and prevention. 

And for women over 50, whose fracture risk accelerates after menopause, it’s one of the most actionable tools we’ve got. Keep it in your toolkit. Not as a verdict, but as a guide toward stronger bones and fewer surprises down the road. 

The recent ‘snowpocalypse’ on much of the East Coast reminded me of what happens every winter: my energy dips, I move a little less, and I start craving cozy, comfort foods. In the past, I’d sometimes ‘cave’ and satisfy my cravings whenever they arose while telling myself I’d deal with it in the spring. But now I do things differently, supporting my metabolism through winter with structure and intermittent fasting while still prioritizing protein and strength training during my eating window. 

Done thoughtfully, intermittent fasting (IF) can improve insulin sensitivity and lower inflammation (which is exactly why the first week of The Wellness Experiment includes autophagy and curated recipes). Instead of waiting to “fix” things later, during the Winter I lean into small, consistent habits now so Spring feels like a continuation and not a correction.

While there is interesting data that makes the question of whether or not women do well with IF a bit murky, let me be clear: there is no right or wrong answer here. If IF works for you, do it. If it doesn’t, don’t do it. Personally, I cycle through periods when I practice time-restricted eating and other times when I don’t, and I like both approaches! 

My no-sacrifice-secret: Pique Fasting Teas* formulated by Dr. Jason Fung. The matcha and electrolyte sachets have earned their place in the front of my kitchen cupboard, but for cold winter evenings, the Cinnamon Herbal Fasting Tea is my go-to. I use this ritual not only to support my metabolism, but also as a signal to wind down, offering warmth and subtle sweetness without sugar while supporting healthy blood sugar levels and calming digestion at the end of the day. 

I trust the products from Pique because they are 

• USDA Organic 

• Triple toxin screened

• Sugar-free

• Dissolve instantly (read: no prep required!)

Ready for Your Winter Reset?

If you’re feeling the winter slump and want a reset that feels supportive rather than extreme, this might be the shift your body needs. And, I just got word that Pique’s Fasting Teas are now back in stock! 

As a subscriber of Today’s Ajenda, you can order your winter fasting teas for 20% off! Click the button below to shop & save!

An important note on intermittent fasting: IF is not about eating less just to eat less. It’s about leveraging your digestive circadian rhythms and becoming more mindful about eating, often the same amount of food, compressed into an 8-hour time window. A fast-mimicking diet that triggers autophagy is different and usually involves eating 900 calories a day for no more than 7 days consecutively.
But both come with some cautionary criteria: If you have a history of disordered eating, are on a GLP-1 medication, or take other medications that should be taken with food, or have medical concerns, please talk with your doctor first. IF is not for everyone, and it does not have to be forever.

Subscribe to my paid newsletter, Off Duty, where I step away from the doctor’s desk and television sets and share the info from my real life that nobody else has access to.

Ready to start a proven plan built for women in this season of life? Come join us inside The Wellness Experiment. It’s where strength training meets smart nutrition, real accountability, and a community of women 50, 60, 70+ who are doing this together. No extremes. No fads. Just proven strategies that help you feel strong, capable, and confident again. Plus weekly LIVE Q&A sessions with me and pro-trainer Korey Rowe.

Click the button below to start your transformation today!

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ABOUT DR. JEN

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OBGYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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^{This material is provided solely for informational purposes and is not providing or undertaking to provide any medical, nutritional, behavioral or other advice or recommendation in or by virtue of this material.  This newsletter is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this newsletter or materials linked from this newsletter is at the user’s own risk. The content of this newsletter is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.}