Treat lipids more aggressively in women
LDL guidelines need better implementation
Women may not be getting the lipid-lowering drugs they need. New research has produced evidence that may turn around a traditional view. It shows that women should be treated as aggressively as men for elevated cholesterol levels.
"Women should be at the front of the queue to receive lipid-lowering therapy, rather than at its end," says an editorial in a recent issue of the Journal of the American Medical Association. The same issue contains the results of the Heart and Estrogen/Progestin Replacement Study (HERS), which revealed that a majority of women with coronary heart disease (CHD) may have high levels of low-density lipoprotein cholesterol (LDL) even if they’re taking lipid-lowering medication.1
Women may benefit more than men
Two additional studies cited in the editorial suggest women may benefit more than men from lipid-lowering therapy. "While not proving better efficacy of cholesterol-lowering treatment in women vs. men," states the editorial, "these data certainly suggest that women with CHD should be treated as aggressively as men for elevated LDL cholesterol levels."
One of the focuses of the HERS study was treatment of hypercholesterolemia as a risk factor for CHD in women. Researchers looked at nearly 3,000 postmenopausal women with CHD to see how many met the guidelines recommended by the National Cholesterol Education Program Adult Treatment Panel for LDL. Approximately 1,700 of them were either taking lipid-lowering therapy or met guidelines to receive the drug therapy, and 63% did not meet the 1988 treatment goal and 91% did not meet the 1993 goal.
What’s the bottom line?
The bottom line is evidence of underutilization of lipid-lowering drugs to reduce recurrence, disability, and death in women with CHD. "The majority of women enrolled in the trial," said researchers, "had LDL levels that significantly exceeded the treatment goals set by the 1988 and 1993 Adult Treatment Panel guidelines. Better implementation of these guidelines among women with coronary disease would be highly desirable."
Reference
1. Schrott HG, Bittner V, Vittinghoff E, et al. Adherence to national cholesterol educational program treatment goals in postmenopausal women with heart disease. JAMA 1997; 277:1,281-1,286.
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