Preventing clinically evident coronary heart disease in the postmenopausal woman.
OBJECTIVE
This review summarizes data on the prevalent coronary heart disease risk factors of postmenopausal women and the pharmacologic and nonpharmacologic therapies available for preventing or treating them.


METHODS
Medline searches from 1966 on were used to identify manuscripts for coronary heart disease risk factor information, lipid levels as predictors of cardiovascular disease in women, non-pharmacologic therapies, side effects of statins, and lipid-lowering trials that included women and had myocardial infarction or coronary heart disease death as endpoints.


RESULTS
Dyslipidemias that occur with menopause are particularly atherogenic and tend to cluster with other metabolic and nonmetabolic risk factors. Estrogen therapy, with or without progestogen, can no longer be recommended for primary or secondary prevention of cardiovascular disease in postmenopausal women. Statins have been effective in reducing cardiovascular-related morbidity and mortality and should be first-line therapy for lipid-lowering.


CONCLUSIONS
A considerable number of women look to obstetricians-gynecologists for primary care. For postmenopausal women especially, primary care must include management of risk factors for coronary heart disease. Estrogen or estrogen plus progestin should be used only for symptomatic hot flashes and at the lowest dose possible. Statins should be first-line therapy in preventive strategies for lipid-lowering.
Welty
Francine K
FK
Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. fwelty@caregroup.harvard.edu
D000273:Adipose Tissue; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001384:Azetidines / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D017023:Coronary Angiography; D003327:Coronary Disease / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy; D000069438:Ezetimibe; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017698:Postmenopause / Q000502:physiology; D012307:Risk Factors; D012907:Smoking; D014057:Tomography, X-Ray Computed; D014280:Triglycerides / Q000097:blood; D016387:Women's Health
D000924:Anticholesteremic Agents; D001384:Azetidines; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014280:Triglycerides; D000069438:Ezetimibe