Treatment of dyslipidemia in pre- and postmenopausal women with and without known atherosclerotic cardiovascular disease
Cardiovascular disease is the primary cause of death among women in the United States, in part due to a very high prevalence of dyslipidemia. Clinical trials have shown that low-density lipoprotein cholesterol-lowering therapy can decrease angiographic progression of coronary disease and decrease clinical events among women and men. Although hormone replacement therapy has beneficial effects on the lipoprotein profile, its role in cardiovascular disease prevention remains unclear. The recently released Third Report of the National Cholesterol Education Program Expert Panel provides detailed guidelines for the management of dyslipidemia in women, with a focus on low-density lipoprotein cholesterol and intensity guided by risk of cardiovascular events.
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 1.American Heart Association: 2001 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association; 2000.Google Scholar
- 2.Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Second report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. NIH Publication No. 93-3095, September 1993.Google Scholar
- 3.Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497. New US guidelines for the assessment and treatment of hyperlipidemia.Google Scholar
- 8.Waters D, Higginson L, Gladstone P, et al., for the CCAIT Study Group: Effects of monotherapy with an HMG-CoA reductase inhibitor on the progression of coronary atherosclerosis as assessed by serial quantitative arteriography: the Canadian Coronary Atherosclerosis Intervention Trial. Circulation 1994, 89:959–968.PubMedGoogle Scholar
- 9.Ballantyne CM, Herd JA, Schein JR, et al.: Treatment of patients with mild to moderate hypercholesterolemia: Lipoprotein and Coronary Atherosclerosis Study (LCAS). CVR&R 1998, 12–24.Google Scholar
- 10.Campeau L, Hunninghake DB, Knatterud GL, et al., and the Post CABG Trial Investigators: Aggressive cholesterol lowering delays saphenous vein graft atherosclerosis in women, the elderly, and patients with associated risk factors: NHLBI Post Coronary Artery Bypass Graft Clinical Trial. Circulation 1999, 99:3241–3247.PubMedGoogle Scholar
- 17.Fonarow GC, French WJ, Parsons LS, et al., for the National Registry of Myocardial Infarction 3 Participants: Use of lipid-lowering medications at discharge in patients with acute myocardial infarction: data from the National Registry of Myocardial Infarction 3. Circulation 2001, 103:38–44.PubMedGoogle Scholar
- 20.Schwartz GG, Olsson AG, Ezekowitz MD, et al., for the Miocardial Ischemia Reduction With Aggressive Cholesterol Lowering (MIRACL) Study Investigators: Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: The MIRACL study: a randomized controlled trial. JAMA 2001, 285:1711–1718.PubMedCrossRefGoogle Scholar
- 34.Anderson RE, Wadden TA, Bartlett SJ, et al.: Effects of lifestyle activity vs. structured aerobic exercise in obese women: a randomized trial. JAMA 1999, 281:335–340. Randomized trial of two physical activity interventions that shows that lifestyle activity, which may be easier to implement for women, especially older women, is associated with significant benefit.CrossRefGoogle Scholar
- 35.Olson MB, Kelsey SF, Bittner V, et al., for the Women’s Ischemia Syndrome Evaluation (WISE) Study Group: Weight cycling and high-density lipoprotein cholesterol in women: evidence of an adverse effect. A report from the NHLBI-sponsored WISE Study. J Am Coll Cardiol 2000, 36:1565–1571. Provocative data on the impact of weight cycling on HDL-C in women. The study is limited by its cross-sectional design and the retrospective ascertainment of weight cycling, but points to a potentially very important side effect of repeated unsuccessful attempts to control body weight over time.PubMedCrossRefGoogle Scholar
- 42.Shlipak MG, Simon JA, Vittinghoff E, et al.: Estrogen and progestin, lipoprotein(a), and the risk of recurrent coronary heart events after menopause. JAMA 2000, 283:1845–1852. Subgroup analysis of the HERS trial. Points out that Lp(a) is a significant predictor of events among postmenopausal women with coronary heart disease. Also suggests that women with high Lp(a) may benefit from hormone replacement therapy.PubMedCrossRefGoogle Scholar
- 46.Cox JL: Lipid-lowering drugs in pregnancy and lactation. In Cardiac Problems in Pregnancy, edn 3. Edited by Elkayam U, Gleicher N. New York: Wiley-Liss; 1998:445–449.Google Scholar