Reducing Cardiovascular Risk in Postmenopausal Women: Estrogen or Statins?

Abstract

Before menopause, low-density lipoprotein (LDL) cholesterol levels in blood are lower and high-density lipoprotein (HDL) cholesterol levels are higher compared with those in men of the same age. After menopause, LDL cholesterol levels rise and may exceed those of age-matched men, with a shift to smaller, more dense (and potentially more atherogenic) particle sizes, and HDL cholesterol levels decline [1 – 2]. Prospective population-based observational studies including women have reported a positive association between total cholesterol levels and coronary heart disease risk, and an inverse association between HDL cholesterol levels and risk. In the Framingham cohort, women whose ratio of total to HDL cholesterol was between 5.5 and 7.4 had twice the risk of coronary heart disease compared with women whose ratio of these cholesterol values was less than 3.5: women whose ratio was between 7.5 and 9.4 had 4 times the risk, and women whose ratio was greater than 9.5 had 5 times the risk of coronary heart disease events [3]. The combination of high LDL with low HDL cholesterol levels (resulting in high ratios of total to HDL cholesterol) is commonly found in the “metabolic syndrome” associated with central obesity, hypertension and adult-onset diabetes. High levels of triglycerides (also a feature of the metabolic syndrome) also appear to be a marker of cardiovascular risk in women, and to a greater degree than in men [4 – 6].