Women and cardiovascular disease—Prevention of heart disease

Abstract

The specific characteristics of cardiovascular (CV) disease in women are discussed, emphasizing that coronary heart disease (CHD) is the major health problem in women but, overall, women are still less likely to die of CHD than men. This is clarified by the fact that women under age 75 are more likely to die from a myocardial infarction when one occurs and that CHD, when it is present, is especially malignant in women under the age of 50. Separate from risk are the issues of prevention and treatment. The latest in prevention with aggressive treatment of cholesterol especially is emphasized and discussed. Regardless of gender, the guidelines for low-density lipoprotein (LDL) cholesterol lowering have become more and more intensive with benefit accruing to the patient with high CV risk of either sex at levels of LDL cholesterol below 70 mg/dl. Inflammatory risk factors as well as homocysteine and lipoprotein (a) have been shown to make a difference and their control has assumed increased importance. There are now multiple therapeutic options for attaining blood lipid goals and the major therapeutic options are discussed. Statins are still primary in controlling LDL cholesterol but numerous other medications contribute secondary additional benefits or are primary because of specific metabolic problems such as the metabolic syndrome and hypertriglyceridemia. When CHD is established or the risk for CHD is high, it is essential to treat aggressively all major risk factors: hypercholesterolemia, hypertension, cigarette smoking, diabetes mellitus, and metabolic syndrome. Such management delays development of clinical CHD and saves lives.