Dyslipidemia Management for Secondary Prevention in Women with Cardiovascular Disease: What Can We Expect From Nonpharma
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SECONDARY INTERVENTION (JM FOODY, SECTION EDITOR)
Dyslipidemia Management for Secondary Prevention in Women with Cardiovascular Disease: What Can We Expect From Nonpharmacologic Strategies? Seamus Whelton & Grant V. Chow & M. Dominique Ashen & Roger S. Blumenthal
Published online: 21 July 2012 # Springer Science+Business Media, LLC 2012
Abstract Cardiovascular disease is the leading cause of death in women and the treatment of dyslipidemia is a cornerstone of secondary prevention. Pharmacologic therapy with statins can lower LDL-C by 30 %–50 % and reduce the risk of recurrent coronary heart disease in both men and women. While significant reductions in LDL-C can be achieved with statin therapy, diet and lifestyle modification remain an essential part of the treatment regimen for cardiovascular disease. Moreover, a large proportion of the US population is sedentary, overweight, and does not consume a heart-healthy diet. Nonpharmacologic treatment strategies also improve other cardiovascular risk factors and are generally easily accessible. In this review, we examine the effect of nonpharmacologic therapy on lipids as part of the secondary prevention strategy of cardiovascular disease in women. Keywords Women . Dyslipidemias . Cardiovascular diseases . Secondary prevention . Diet . Lifestyle
Introduction Cardiovascular disease (CVD) is the number one cause of death among women and those over 40 years old have a greater than 50 % lifetime risk of suffering a major adverse cardiovascular event [1]. Coronary heart disease (CHD) S. Whelton (*) Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-602, Baltimore, MD 21287, USA e-mail: [email protected] S. Whelton : G. V. Chow : M. D. Ashen : R. S. Blumenthal Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore MD, USA
typically presents about 10 years later in women, which is partially attributable to the adverse changes in lipid profile associated with menopause [2]. Despite later CHD onset, women younger than 75 years have up to twice the risk for early death after myocardial infarction compared with men of the same age [3]. Moreover, women with CHD or a riskequivalent are less likely than men to achieve their goal LDL-cholesterol (LDL-C) level [4]. Pharmacologic therapy for dyslipidemia is a cornerstone of CHD secondary prevention [5]. Statins can improve LDL-C levels by 30 % to 50 % and reduce the risk of CHD for both men and women [6, 7]. However, dietary and lifestyle modification are also integral components of a treatment regimen for CHD, and even small changes can result in a significantly improved risk factor profile [8]. This is especially important given that less than half of US adults meet the American Heart Association 2020 goal for physical activity, and >75 % consume a poor diet [1]. In this review, we examine the role of nonpharmacologic strategies for the treatment of dyslipidemia in women with a history of cardiovascular disease.
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