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.
