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STATE-OF-THE-ART PAPER

Perspectives on Dyslipidemia and Coronary Heart Disease in Women

Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.

Manuscript received February 13, 2005; revised manuscript received April 26, 2005, accepted May 2, 2005.

^_* Reprint requests and correspondence: Dr. Vera Bittner, Division of Cardiovascular Disease, 701 19th Street South-LHRB 310, Birmingham, Alabama 35294-0007. (Email: vbittner{at}uab.edu).

Coronary heart disease (CHD) remains the leading cause of death among American women. Numerous differences exist between younger and older women and between women and men with respect to the pathology of CHD and its incidence and prevalence over the life cycle. Differences in lipoprotein levels and lipid fractions play an important role in CHD risk. Hormonal influences on lipoprotein levels in women are complex, change throughout the life span, and are influenced by the administration of oral contraceptives and hormone replacement therapy. Women with obesity, metabolic syndrome, or diabetes have lipid profiles that adversely affect CHD risk. To date, no randomized trials testing the impact of lifestyle changes on lipoprotein levels and subsequent CHD events in non-institutionalized women have been performed, and women have not been well represented in clinical end point trials of pharmacologic lipid-lowering therapy. Available evidence suggests that lipid-lowering therapy with statins does provide benefit in reducing the risk of coronary events in women; however, women remain undertreated, and more data are needed to determine optimal cardiovascular prevention and treatment in this population.

Abbreviations and Acronyms   ALLHAT = Antihypertensive and Lipid-Lowering Trial to Prevent Heart Attack   ATP III = Third Report of the Adult Treatment Panel   CHD = coronary heart disease   CVD = cardiovascular disease   HDL = high-density lipoprotein   HERS = Heart and Estrogen/progestin Replacement Study   LDL = low-density lipoprotein   Lp(a) = lipoprotein(a)   MI = myocardial infarction   RLP = remnant-like particle

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