Prevention and Treatment of Cardiovascular Disease in Women: The Obstetric‐Gynecologist's Point of View

Abstract

It has been confirmed that cardiovascular disease (CVD) is the leading cause of morbidity and mortality not only in men but also in women. The most recent American Heart Association (AHA) and European Atherosclerosis Society (EAS) recommendations specifically address women. This is in response to the majority of studies that primarily involved men. Ideal cardiovascular health has been defined for women, and new factors were added to the traditional risk factors. As stated by the American and European Menopause Societies (NAMS and EMAS), hormone replacement therapy (HRT) is no longer believed to be protective for CVD; on the contrary, women benefit just as much as men from statins to lower their risk of heart disease. At the onset of menopause, women exhibit an increase in cholesterol and an increased risk of CVD. Unfortunately, hyperlipidemia is largely undertreated in women, although the rate of hypercholesterolemia among women is similar to that of men. More aggressive intervention is recommended for persons with multiple risk factors and/or monogenic dyslipidemias. In women affected by familial hypercholesterolemia in the homozygous and compound forms, treatment such as lipoprotein apheresis is also suggested. There is evidence for the use of these techniques even in pregnancy. An update on the most recent guidelines issued by AHA, EAS, NAMS and EMAS for the prevention of CVD in women along with a brief overview on the use of lipoprotein apheresis in women during pregnancy is reported.

Correlation Pattern of Serum Lipid Parameters and a Biological Anti-Oxidant Potential Between Premenopausal and Perimenopausal Healthy Women

“…Even though the LDL-C level was not so high in perimenopausal women of the present study, speculatively, LDL-C and/or LDL particle might be oxidatively modified under the perimenopausal state [12]. Importantly, the present study finding may also provide a proper timing for the management of LDL-C levels in women [14]. An increase of LDL-C can be caused by not only a simple biological aging but an alteration of sex hormones with menopausal transition [12], and the change in sex hormones is assumed to affect the correlation between LDL-C and BAP levels.…”

Impact of menopause and diabetes on atherogenic lipid profile: is it worth to analyse lipoprotein subfractions to assess cardiovascular risk in women?

“…As expected, having detectable CAC was associated with worse traditional lipid profile and increased atherogenic subfractions. Although an HRT-dependent shift on the proportions of lipoprotein subfractions could be expected in postmenopausal women, trials have not shown any benefit in cardiovascular morbidity or mortality [126–128]. Only in a subset of younger women who initiated on HRT immediately after menopause some beneficial effects were detected [129].…”

Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician–Gynecologists’ Knowledge, Attitudes, and Practice Patterns

“…Of all responding OB/ GYNs, slightly over half agreed that CVD care should be tailored differently for African American patients, and less than half agreed that care should be tailored for Hispanics. These opinions are in conflict with medical recommendations that physicians should tailor preventive strategies differently for high-risk groups [51] and use more aggressive interventions for women with multiple CVD risk factors [52].…”