Skip to main content

Advertisement

SpringerLink
Log in

Perspectives and current strategies for dyslipidemia in women

  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Cardiovascular disease remains the leading cause of death for women in the United States, with dyslipidemia a major contributing risk factor. A growing body of evidence supports aggressive diagnosis and treatment of dyslipidemia; however, women and physicians continue to underestimate cardiovascular risk in women. Specific evidence-based guidelines provide the clinician with strategies for safe, efficacious evaluation and treatments. Evolving risk factor assessment tools may also aid in identifying women at greater risk than predicted by traditional analysis. Ongoing concerns remain regarding the complex role of estrogen as it interacts with lipids and cardiovascular risk, with strong recommendations from the guidelines against estrogen therapy for cardiovascular risk prevention. Ongoing research is needed to understand mechanisms impacting cardiovascular risk related to dyslipidemia in women and optimize risk intervention across the life cycle.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Rosamond W, Flegal K, Friday G, et al.: Heart disease and stroke statistics—2007 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006. [Epub ahead of print.]

  2. Libby P: Vascular biology of atherosclerosis: overview and state of the art. Am J Cardiol 2003, 91:3A–6A.

    Article  PubMed  CAS  Google Scholar 

  3. Wilson PW, D’Agostino RB, Levy D, et al.: Prediction of coronary heart disease using risk factor categories. Circulation 1998, 97:1837–1847.

    PubMed  CAS  Google Scholar 

  4. White AD, Folsom AR, Chambless LE, et al.: Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years’ experience. J Clin Epidemiol 1996, 49:223–233.

    Article  PubMed  CAS  Google Scholar 

  5. Wilson PW, D’Agostino RB, Levy D, et al.: Prediction of coronary heart disease using risk factor categories. Circulation 1998, 97:1837–1847.

    PubMed  CAS  Google Scholar 

  6. Michos ED, Nasir K, Braunstein JB, et al.: Framingham risk equation underestimates subclinical atherosclerosis risk in asymptomatic women Atherosclerosis 2006, 184:201–206.

    Article  PubMed  CAS  Google Scholar 

  7. LaRosa JC, He J, Vupputuri S: Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999, 282:2340–2346.

    Article  PubMed  CAS  Google Scholar 

  8. Grundy SM, Cleeman JI, Bairey-Merz CN, et al.: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines H. Coordinating Committee of the National Cholesterol Education Program. J Am Coll Cardiol 2004, 44:720–732.

    Article  PubMed  Google Scholar 

  9. Tuzcu EM, Kapadia SR, Tutar E, et al.: High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults evidence from intravascular ultrasound. Circulation 2001, 103:2705–2710.

    PubMed  CAS  Google Scholar 

  10. Walsh JME, Pignone M: Drug treatment of hyperlipidemia in women. JAMA 2004, 291:2243–2252.

    Article  PubMed  CAS  Google Scholar 

  11. Sharrett AR, Ballantyne CM, Coady SA, et al.: Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions. Circulation 2001, 104:1108–1113.

    Article  PubMed  CAS  Google Scholar 

  12. Carmena R, Duriez P, Fruchart JC: Atherogenic lipoprotein particles in atherosclerosis. Circulation 2004, 109:III-2–7.

    Article  CAS  Google Scholar 

  13. Bays H, McKenney J, Davidson M: Torcetrapib/atorvastatin combination therapy. Expert Rev Cardiovasc Ther 2005, 3:789–820.

    Article  PubMed  CAS  Google Scholar 

  14. Stagg Elliott V: Trial halted on drug shown to increase HDL cholesterol. http://www.ama-assn.org/amednews/2007/01/15/hlsa0115.htm. Accessed January 30, 2007.

  15. Colhoun H, Betteridge D, Durrington P, et al.: Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004, 364:685–696.

    Article  PubMed  CAS  Google Scholar 

  16. 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.

  17. Mosca L, Appel LJ, Benjamin EJ, et al.: Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004, 109:672–693.

    Article  PubMed  Google Scholar 

  18. Friedewald WT, Levy RI, Fredrickson DS: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972, 18:499–502.

    PubMed  CAS  Google Scholar 

  19. Warnick GR, Knopp RH, Fitzpatrick V, Branson L: Estimating low-density lipoprotein cholesterol by the Friedewald equation is adequate for classifying patients on the basis of nationally recommended cutpoints. Clin Chem 1990, 36:15–19.

    PubMed  CAS  Google Scholar 

  20. Manolio TA, Pearson TA, Wenger NK, et al.: Cholesterol and heart disease in older persons and women. Review of an NHLBI workshop. Ann Epidemiol 1992, 2:161–176.

    Article  PubMed  CAS  Google Scholar 

  21. Campos H, McNamara JR, Wilson PW, et al.: Differences in low density lipoprotein subfractions and apolipoproteins in premenopausal and postmenopausal women. J Clin Endocrinol Metab 1988, 67:30–35.

    Article  PubMed  CAS  Google Scholar 

  22. Shaw LJ, Bairey Merz CN, Pepine CJ, et al.: Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol 2006, 47:S4–S20.

    Article  PubMed  Google Scholar 

  23. Shaw LJ, Lewis JF, Hlatky MA, et al.: Women’s Ischemic Syndrome Evaluation: current status and future research directions, report of the National Heart Lung Blood Institute (NHLBI) workshop, section 5: gender-related risk factors for ischemic heart disease, October 2–4, 2002. Circulation 2004, 109:56e–58e.

    Article  Google Scholar 

  24. Everett BM, Kurth T, Buring JE, Ridker PM: The relative strength of C-reactive protein and lipid levels as determinants of ischemic stroke compared with coronary heart disease in women. J Am Coll Cardiol 2006, 48:2235–2242.

    Article  PubMed  CAS  Google Scholar 

  25. Lloyd-Jones DM, Wilson PW, Larson MG, et al.: Framingham risk score and prediction of lifetime risk for coronary heart disease. Am J Cardiol 2004, 94:20–24.

    Article  PubMed  Google Scholar 

  26. Pasternak RC, Abrams J, Greenland P, et al.: 34th Bethesda conference: task force #1—identification of coronary heart disease risk: is there a detection gap? J Am Coll Cardiol 2003, 41:1863–1874.

    Article  PubMed  Google Scholar 

  27. Ballantyne CM, Hoogeveen RC, Bang H, et al.: Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident coronary heart disease in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2004, 109:837–842.

    Article  PubMed  CAS  Google Scholar 

  28. Hecht HS, Superko HR: Electron beam tomography and national cholesterol education program guidelines in asymptomatic women. J Am Coll Cardiol 2001, 37:1506–1511.

    Article  PubMed  CAS  Google Scholar 

  29. Raggi P, Shaw LJ, Berman DS, Callister TQ: Gender-based differences in the prognostic value of coronary calcium J Womens Health 2004, 13:273–288.

    Article  Google Scholar 

  30. Suk Danik J, Rifai N, Buring JE, Ridker PM: Lipoprotein(a), measured with an assay independent of apolipoprotein(a) isoform size, and risk of future cardiovascular events among initially healthy women JAMA 2006, 296:1363–1370.

    Article  PubMed  CAS  Google Scholar 

  31. Ridker PM, JUPITER Study Group: Rosuvastatin in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: rationale and design of the JUPITER Trial. Circulation 2003, 108:2292–2297.

    Article  PubMed  Google Scholar 

  32. Collins R, Armitage J, Parish S, et al.: MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003, 361:2005–2016.

    Article  PubMed  Google Scholar 

  33. Colhoun HM, Betteridge DJ, Durrington PN, et al.: Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004, 364:685–696.

    Article  PubMed  CAS  Google Scholar 

  34. LaRosa JC, Grundy SM, Waters DD, et al.: Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005, 352:1425–1435.

    Article  PubMed  CAS  Google Scholar 

  35. Mosca L, Mochari H, Christian A, et al.: National study of women’s awareness, preventive action, and barriers to cardiovascular health. Circulation 2006, 113:525–534.

    Article  PubMed  Google Scholar 

  36. Bittner V: Perspectives on dyslipidemia and coronary heart disease in women. J Am Coll Cardiol 2005, 46:1628–1635.

    Article  PubMed  Google Scholar 

  37. Arnett DK, Jacobs DR Jr, Luepker RV, et al.: Twenty-year trends in serum cholesterol, hypercholesterolemia, and cholesterol medication use: the Minnesota Heart Survey, 1980–1982 to 2000–2002. Circulation 2005, 112:3884–3891.

    Article  PubMed  Google Scholar 

  38. Mosca L, Bairey Merz N, Blumenthal RS, et al.: Opportunity for intervention to achieve American Heart Association guidelines for optimal lipid levels in high-risk women in a managed care setting. Circulation 2005, 111:488–493.

    Article  PubMed  Google Scholar 

  39. Mosca L, Linfante AH, Benjamin EJ, et al.: National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation 2005, 111:499–510.

    Article  PubMed  Google Scholar 

  40. Welty FK, Lewis SJ, Friday KE, et al.: Women achieve American Heart Association optimal lipid goals with statin therapy. Circulation 2005, 111:e62.

    Google Scholar 

  41. McKenney JM, Davidson MH, Jacobson TA, et al.: Final conclusions and recommendations of the National Lipid Association Statin Safety Assessment Task Force. Am J Cardiol 2006, 97(Suppl 1):S95–S97.

    Google Scholar 

  42. Knopp RH, Gitter H, Truitt T, et al.: Effects of ezetimibe, a new cholesterol absorption inhibitor, on plasma lipids in patients with primary hypercholesterolemia Eur Heart J 2003, 24:729–741.

    Article  PubMed  CAS  Google Scholar 

  43. Welty FK: Cardiovascular disease and dyslipidemia in women. Arch Intern Med 2001, 161:514–522.

    Article  PubMed  CAS  Google Scholar 

  44. Grady D, Rubin SM, Petitti DB, et al.: Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992, 117:1016–1037.

    PubMed  CAS  Google Scholar 

  45. Barrett Connor E, Grady D: Hormone replacement therapy, heart disease, and other considerations. Annu Rev Public Health 1998, 19:55–72.

    Article  PubMed  CAS  Google Scholar 

  46. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA 1995, 273:199–208.

  47. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA 1993, 269:3015–3023.

    Article  Google Scholar 

  48. Hulley S, Grady D, Bush T, et al.: Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998, 280:605–613.

    Article  PubMed  CAS  Google Scholar 

  49. Herrington DM, Reboussin DM, Brosnihan KB, et al.: Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000, 343:522–529.

    Article  PubMed  CAS  Google Scholar 

  50. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women’s Health Initiative randomized controlled trial. Writing Group for the Women’s Health Initiative Investigators. JAMA 2002, 288:321–333.

Download references

Author information

Authors and Affiliations

  1. Northwest Cardiovascular Institute, 2222 NW Lovejoy #606, Portland, OR, 97210, USA

    Sandra J. Lewis MD

Authors
  1. Sandra J. Lewis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sandra J. Lewis MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lewis, S.J. Perspectives and current strategies for dyslipidemia in women. Curr Cardio Risk Rep 1, 159–166 (2007). https://doi.org/10.1007/s12170-007-0026-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12170-007-0026-4

Keywords

Search

Navigation