Perspectives on dyslipidemia and coronary heart disease in women: An update

Current Opinion in Cardiology

Volumn 21, Issue 6, 2006, Pages 602-607

  Bittner, Vera ^a,b  

^a University of Alabama at Birmingham   (United States)

^b Division of Cardiovascular Disease   (United States)

Author keywords

Coronary heart disease; Dyslipidemia; Women

Indexed keywords

ANTILIPEMIC AGENT; APOLIPOPROTEIN A1; APOLIPOPROTEIN B; ATORVASTATIN; FENOFIBRATE; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; LOW DENSITY LIPOPROTEIN; MEVINOLIN; SIMVASTATIN;

CARDIOVASCULAR RISK; CAUSE OF DEATH; CLEFT LIP; CLINICAL TRIAL; CORONARY ARTERY DISEASE; DISEASE CONTROL; DISEASE MARKER; DISEASE PREDISPOSITION; DUODENUM ATRESIA; DYSLIPIDEMIA; FEMALE; FETUS MALFORMATION; HUMAN; HYPOSPADIAS; NONHUMAN; PATHOPHYSIOLOGY; PATIENT COMPLIANCE; PRENATAL DRUG EXPOSURE; PRIORITY JOURNAL; REVIEW; SKIN MANIFESTATION; SPONTANEOUS ABORTION; TRISOMY;

ANTILIPEMIC AGENTS; APOLIPOPROTEINS; BIOLOGICAL MARKERS; CORONARY DISEASE; DYSLIPIDEMIAS; FEMALE; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HUMANS; HYDROXYMETHYLGLUTARYL-COA REDUCTASE INHIBITORS; PATIENT COMPLIANCE; RANDOMIZED CONTROLLED TRIALS;

EID: 33750349133     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.hco.0000245739.47712.0a     Document Type: Review

References (38)

1. World Health Organization. Preventing chronic diseases: a vital investment. World Health Organization Global Report 2005. Geneva: World Health Organization; 2005. This report shows that CHD does not only have a major impact in the developed world, but is emerging as the number one killer of women and men in many developing countries as well.
2. Bittner V. State of the art paper: perspectives on dyslipidemia and coronary heart disease in women. J Am Coll Cardiol 2005; 46:1628-1635. This is a comprehensive review of sex differences in lipoprotein physiology, the role of dyslipidemia in CHD development among women, and the role of lipid-lowering therapy in CHD prevention among women.
3. Okamura T, Hayakawa T, Kadowaki T, et al. The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population. Atherosclerosis 2006; 184:143-150.
4. Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case control study. Lancet 2004; 364:937-952.
5. Steyn K, Sliwa K, Hawken S, et al. Risk factors associated with myocardial infarction in Africa. The INTERHEART Africa Study. Circulation 2005; 112:3554-3561.
6. Mazza A, Tikhonoff V, Schiavon L, Casiglia E. Triglycerides + high-density-lipoprotein-cholesterol dyslipidaemia, a coronary risk factor in elderly women: the CArdiovascular STudy in the Elderly. Intern Med J 2005; 35:604-610.
7. Tikhonoff V, Casiglia E, Mazza A, et al. Low-density lipoprotein cholesterol and mortality in older people. J Am Geriatr Soc 2005; 53:2159-2164.
8. Terry DF, Pencina MJ, Vasan RS, et al. Cardiovascular risk factors predictive for survival and morbidity-free survival in the oldest-old Framingham Heart Study participants. J Am Geriatr Soc 2005; 53:1944-1950. This analysis of the Framingham Heart Study points out the importance of cardiovascular risk factors in middle age not only for longevity, but also for morbidity-free survival into old age. Data such as these may enhance 'buy-in' for risk factor reduction programs among patients who are more concerned with quality than quantity of life.
9. Jungner I, Sniderman AD, Furberg C, et al. Does low-density lipoprotein size add to atherogenic particle number in predicting the risk of fatal myocardial infarction? Am J Cardiol 2006; 97:943-946. The study suggested that LDL particle size does not provide incremental information over LDL particle number in predicting risk of fatal myocardial infarction.
10. Kathiresan S, Otvos JD, Sullivan LM, et al. Increased small low-density lipoprotein particle number. A prominent feature of the metabolic syndrome in the Framingham Heart Study. Circulation 2006; 113:20-29. This study confirmed the strong relationship between triglycerides, HDL-cholesterol level and number of small dense LDL particles among patients with metabolic syndrome, but found that the number of small dense LDL particles does not increase risk of cardiovascular events among these patients.
11. Shai I, Rimm EB, Hankinson SE, et al. Lipoprotein (a) and coronary heart disease among women: beyond a cholesterol carrier? European Heart Journal 2005; 26:1633-1639. This study reported increased cardiovascular risk among women with high lipoprotein (a). Whether treatment of lipoprotein (a) levels could ameliorate this risk is unknown.
12. Sesso HS, Buring JE, Chown MJ, et al. A prospective study of plasma lipid levels and hypertension in women. Arch Intern Med 2005; 165:2420-2427. An interesting analysis from the Women's Health Study suggests that dyslipidemia predicts future incidence of hypertension, even among women with normal blood pressures at baseline.
13. Oparil S, Zaman MA, Calhoun DA. Pathogenesis of hypertension. Ann Intern Med 2003; 139:761-776.
14. Kok HS, van Asselt KM, van der Schouw YT, et al. Heart disease risk determines menopausal age rather than the reverse. J Am Coll Cardiol 2006; 47:1976-1983. This provocative analysis of the Framingham dataset suggests that cardiovascular risk factors prior to menopause determine age at menopause.
15. Bittner V. Menopause and cardiovascular risk: cause or consequence? J Am Coll Cardiol 2006; 47:1984-1986.
16. Mora S, Lee I-M, Buring JE, Ridker PM. Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA 2006; 295:1412-1419. This important analysis of the Women's Health Study suggests that a physically active lifestyle cannot counteract the adverse cardiovascular consequences of obesity.
17. Howard BV, van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Intervention. JAMA 2006; 295:655-666. The report from the Women's Health Initiative diet trial indicates that the low fat diet designed to prevent colon and breast cancer was not effective in reducing cardiovascular event rates over 8 years of follow-up.
18. The FIELD Study Investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366:1849-1961. This was the only fibrate trial that included women, but did not meet its primary endpoint. No sex differences were observed.
19. 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. This statin trial suggested enhanced benefits with more aggressive statin therapy.
20. Pedersen TR, Faergeman O, Kastelein JJP, et al. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction. The IDEAL Study: A Randomized Controlled Trial. JAMA 2005; 294:2437-2445. This statin trial did not meet its primary endpoint, but largely confirmed the results of the Treating to New Targets Study.
21. Raggi P, Davidson M, Callister TQ, et al. Aggressive versus moderate lipid-lowering therapy in hypercholesterolemic postmenopausal women. Circulation 2005; 112:563-571. The authors describe a trial that compared two intensities of lipid-lowering therapy, achieved a substantial LDL-cholesterol difference between treatment groups, but could not show any difference in change in coronary calcification during follow-up. Electron beam tomography may not be a good surrogate endpoint in short-term lipid-lowering trials.
22. Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. Lancet 2005; 366:1267-1278. The authors conducted a meta-analysis of lipid-lowering trials which indicated that there are no sex differences in efficacy of lipid-lowering therapy.
23. Pollack PS, Shields KE, Burnett DM, et al. Pregnancy outcomes after maternal exposure to simvastatin and lovastatin. Birth Defects Research (Part A) 2005; 73:888-896. This is a unique compilation of data on teratogenic effects of statins.
24. Arnett DK, Jacobs DR, Luepker RV, et al. Twenty-year trends in serum cholesterol, hypercholesterolemia, and cholesterol medication use. Circulation 2005; 112:3884-3891. This report from the Minnesota Heart Survey shows lack of awareness of hyperlipidemia and inadequate control of dyslipidemia among treated participants.
25. Goff DC, Bertoni AG, Kramer H, et al. Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA). Gender, Ethnicity, and Coronary Artery Calcium. Circulation 2006; 113:647-656. This study showed substantial heterogeneity in prevalence, treatment, and control of dyslipidemia among different ethnic groups.
26. Persell SD, Maviglia SM, Bates DW, Ayanian JZ. Ambulatory hypercholesterolemia management in patients with atherosclerosis. J Gen Intern Med 2005; 20:123-130.
27. Wenger NK, Geiger MJ. Baseline characteristics of menopausal women with coronary heart disease in cardiovascular outcomes clinical trials of menopausal hormone therapy or raloxifene. Contemporary Clinical Trials 2005; 26:612-615.
28. Jacobs MJ, Kleisli T, Pio JR, et al. Prevalence and control of dyslipidemia among persons with diabetes in the United States. Diabetes Research and Clinical Practice 2005; 70:263-269. This report points out poor control of dyslipidemia among US patients with diabetes, a group at particularly high risk for CHD morbidity and mortality.
29. Sanderson BK, Bittner V. Women in cardiac rehabilitation: outcomes and identifying risk for drop-out. Am Heart J 2005; 150:1052-1058. Attendance at cardiac rehabilitation may improve the proportion of women who achieve Adult Treatment Panel III treatment goals.
30. Thomsen RW, Johnsen SP, Olesen AV, et al. Socioeconomic gradient in use of statins among Danish patients: population-based cross-sectional study. Br J Clin Pharmacol 2005; 60:534-542.
31. Rasmussen JN, Gislason GH, Abildstrom SZ, et al. Statin use after acute myocardial infarction: a nationwide study in Denmark. Br J Clin Pharmacol 2005; 60:150-158.
32. Mendis S, Abegunde D, Yusuf S, et al. WHO study on prevention of recurrences of myocardial infarction and stroke (WHO PREMISE). Bulletin of the World Health Organization 2005; 83:820-828. This 10-country survey documents a sex gap in lipid lowering therapy.
33. Daly C, Clemens F, Lopez Sendon JL, et al., on behalf of the Euro Heart Survey Investigators. Gender differences in the management and clinical outcome of stable angina. Circulation 2006; 113:490-498. The authors document underutilization of statins among European women with angina.
34. Ramsay SE, Whincup PH, Lawlor DA, et al. Secondary prevention of coronary heart disease in older patients after the national service framework: population based study. BMJ 2006; 332:144-145. This shows improvement in treatment rates among older women between 1998 and 2003.
35. Caspard H, Chan AK, Walker AM. Compliance with a statin treatment in a usual-care setting: retrospective database analysis over 3 years after treatment initiation in Health Maintenance Organization enrollees with dyslipidemia. Clin Ther 2005; 27:1639-1646.
36. Kulkarni SP, Alexander KP, Lytle B, et al. Long-term adherence with cardiovascular drug regimens. Am Heart J 2006; 151:185-191.
37. Mosca L, Ferris A, Fabunmi R, Robertson M. Tracking women's awareness of heart disease. An American Heart Association National Study. Circulation 2004; 109:573-579.
38. 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. A web-based survey of primary care providers, obstetrics/gynecology physicians and cardiologists documents that many providers underestimate CHD risk among women and thus tend to underutilize appropriate risk reduction strategies.