Hypercholesterolemia In Women Research Articles

Is self-rated health associated with cardiovascular risk factors and disease in a low-income setting? A cross-sectional study from the Amazon Basin of Brazil

ObjectivePrior studies have suggested that self-rated health may be a useful indicator of cardiovascular disease. Consequently, we aimed to assess the relationship between self-rated health, cardiovascular risk factors and subclinical...

Association of mammographic density and benign breast calcifications individually or combined with hypertension, diabetes, and hypercholesterolemia in women ≥40 years of age: a retrospective study

Recent evidence has linked certain mammographic characteristics, including breast calcifications (Bcs) and mammographic density (MD), with atherosclerotic cardiovascular disease risk factors in women, but data are limited and inconsistent. We...

Special Considerations for Lipid-Lowering Therapy in Women Reflecting Recent Randomized Trials.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in women across all racial and ethnic groups within the USA. Despite robust evidence from randomized controlled trials demonstrating that treatment of hypercholesterolemia in women reduces cardiovascular events, women who are eligible for lipid-lowering therapy are less likely than men to be prescribed guideline-recommended therapy or to have therapy prescribed at the appropriate intensity. Historically, women have been underrepresented in clinical trials. Recent randomized clinical trials have shown that women derive similar benefits as men when treated with lipid-lowering therapy, and recent studies demonstrate potential uses for lipid-lowering therapies that extend beyond their previously well-established indications. In this review, we will discuss lipid-lowering therapies in the context of recent clinical trials with a focus on special considerations in women.

Comparison of anthropometric and body composition indices in the identification of metabolic risk factors

Whether anthropometric or body composition indices are better indicators of metabolic risk remains unclear. The objectives of this study were to compare the association of metabolic risk factors with anthropometric and body composition indices and to identify the better indicators for risk factors in a large-scale Korean population. In this cross-sectional study, the associations of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) as anthropometric indices and trunk fat mass (TFM), percent trunk fat mass (%TFM), whole-body total fat mass (WBTFM), and percent whole-body total fat mass (%WBTFM) as body composition indices with metabolic risk factors were compared by complex-samples multiple logistic regression models based on complex-sample survey data. In men, WHtR, BMI, and TFM were similarly associated with hypertension. Diabetes, hyperlipidemia, and hypo-high-density lipoprotein (HDL) cholesterolemia tended to be more strongly associated with WHtR and WC than body composition indices. Hypertriglyceridemia and hypercholesterolemia were more strongly associated with WHtR and %TFM than other indices. In women, hypertension tended to be more strongly associated with WHtR than other indices. TFM, %TFM, and WHtR were similarly associated with hyperlipidemia. Diabetes and hypo-HDL cholesterolemia were more strongly associated with WHtR and WC than body composition indices. Hypertriglyceridemia and hypercholesterolemia were more strongly associated with WHtR and %TFM than other indices. Among six metabolic risk factors, the validity and utility of the anthropometric indices in identifying risk factors tended to be similar to or better than those of the body composition indices, except for hypertension and hypercholesterolemia in men and hyperlipidemia and hypercholesterolemia in women.

Prediction of cardiovascular health by non-exercise estimated cardiorespiratory fitness

ObjectiveTo estimate the incidence of major biological cardiovascular disease (CVD) risk factors in adults using non-exercise estimated cardiorespiratory fitness (eCRF).Methods200 039 healthy people (99 957 women), aged ≥18 years (38.5±12.1...

The Ability of Baseline Triglycerides and Total Cholesterol Concentrations to Predict Incidence of Type 2 Diabetes Mellitus in Chinese Men and Women: A Longitudinal Study in Qingdao, China

ObjectivesThe purpose of this study was to assess the association between triglycerides (TG), total cholesterol (TC) at baseline, and type 2 diabetes mellitus (T2DM) incidence in a general Chinese population. Further, it aimed to evaluate the ability of TG and TC to predict T2DM incidence. MethodsQingdao Diabetes Prevention Program participants recruited between 2006 and 2009 were followed up in 2012–2015. TG, TC, and T2DM status were measured. Cox proportional hazards models were used to estimate the association between TG, TC, and T2DM incidence. The receiver operating characteristic (ROC) curve was used to evaluate the ability of TG and TC to identify T2DM participants. ResultsThe incidence of T2DM significantly increased with TG in women and TC in both men and women (Ptrend < 0.05). Univariate Cox regression indicated that higher TG {borderline high TG [hazards ratio (HR): 2.05; 95% confidence interval (CI): 1.40, 3.00] and hypertriglyceridemia [HR: 2.64; 95% CI: 1.68, 4.15]} and TC [hypercholesterolemia (HR: 2.05; 95% CI: 1.43, 2.95)] were significantly associated with increased risk of T2DM incidence in women but not in men. Multivariate Cox regression showed that hypertriglyceridemia in women (HR: 1.78, 95% CI: 1.07, 2.97), borderline high TC in men (HR: 1.61, 95% CI: 1.04, 2.48), and hypercholesterolemia in women (HR: 1.68, 95% CI: 1.81, 2.61) had a higher significant risk of T2DM incidence. The optimal cutoff values of TG were > 1.15 and > 1.23 mmol/L in men and women, respectively. For TC, they were > 5.17 and > 5.77 mmol/L in men and women, respectively. The area under the ROCs of TG and TC were 0.54 (0.51–0.57) and 0.55 (0.52–0.58), respectively, in men, and 0.60 (0.58–0.62) and 0.59 (0.56–0.61), respectively, in women. ConclusionElevated TG and TC were risk factors for T2DM incidence. However, no predictive capacity was found for both factors to identify T2DM incidence in Chinese men and women. Hence, TG and TC levels in both Chinese men and women might be used for decreasing the incidence of T2DM but no clinical predictive capacity for T2DM.

P5491Gender differences in long-term outcomes and predictors of all-cause mortality after percutaneous coronary intervention

Abstract Background Gender disparities have been consistently reported in the nature, presentation, and treatment of coronary artery disease, leading to significant outcome differences. Previous reports have suggested that after adjusting for differing baseline and procedural characteristics female gender was an independent predictor of all-cause mortality after Percutaneous Coronary Intervention (PCI). We examined this issue using data from the Genesis Cardiovascular Outcomes Registry (GCOR). Methods We prospectively collected data on 10,989 PCI procedures from January 2009 to January 2018 from 12 Australian Hospitals, and compared the baseline patient and procedural characteristics and 1-year mortality by gender. Results Female patients were more likely than males to present with NSTEMI (23.0% vs. 21.1%, p=0.042), however less likely to have prior MI (19.5% vs. 24.2%, p&lt;0.001) or PCI (28.8% vs 33.6%, p&lt;0.001). Procedural success rates were similar between females and males (97.2%). On multivariate logistic regression, female gender had a higher rate of all cause mortality (OR 0.58, 95% CI 0.31 to 1.07; P=0.08) but similar rates of MACE (OR 0.84, 95% CI 0.55 to 1.07, P=0.42). Variables contributing to an increased risk of mortality in female patients, included a history of previous heart failure (OR 2.45, 95% CI 1.15 to 5.22; p=0.02), myocardial infarction (OR 2.06, 95% CI 1.09 to 3.90; p=0.026), and peripheral vascular disease (OR 2.69, 95% CI 1.32 to 5.47; p=0.006). Performing PCI to the LMCA significantly increased the risk of mortality in female patients (OR 3.84, 95% CI 1.14 to 12.9; p=0.029), and the use of BMS vs DES contributed to a worse outcome in women compared to men (OR 0.46, 95% CI 0.25 to 0.84; p=0.012). The presence of hypercholesterolaemia in women significantly increased the risk of mortality (OR 0.44, 95% CI 0.22 to 0.86; p=0.016). Multivariate logistic regression assessing 1-year outcome by gender for all-cause mortality, MACE, and unplanned admissions Outcome Male (vs female) Odds ratio 95% CI P-value Death (143) 0.58 0.31 to 1.07 0.08 MACE (334) 0.84 0.55 to 1.28 0.42 Unplanned readmission (888) 0.79 0.63 to 0.98 0.04 Conclusion Women have significant differences in baseline characteristics and increased all-cause mortality at 1 year compared to men, although overall MACE rates are similar. This study increases awareness of women at high risk, highlighting the need to improve the care of women undergoing PCI.

The Relationship Of Waist Circumference And Hypercholesterolemia Incidence In Patient With Hypertension in Tegal Gundil Public Health Center at Bogor City

Hypertension and hypercholesterolemia are the causes of coronary heart disease (CHD) so that the presence of hypercholesterolemia in patients with hypertension will increase the risk of CHD. Central obesity describes the accumulation of fat in the stomach which can lead to abnormalities in the amount of lipids in the blood, when it occurs in patients with hypertension can lead to progression of the occurrence of high blood cholesterol and the risk of causing atherosclerosis and heart disease. The purpose of this study was to determine the relationship of waist circumference and other factors with the incidence of hypercholesterolemia in patients with hypertension. This research is a quantitative study through secondary data with Cross Sectional design. According to the results of multivariate tests with multiple logistic regression, there was a relationship between waist circumference, gender and age after being controlled by physical activity variables. Gender as a risk factor most associated with the incidence of hypercholesterolemia with a risk 8.5 times higher in women than men, then carried out waist circumference stratification test by sex in hypertensive patients with cases of central obesity found a significant relationship that women with central obesity have a risk of experiencing hypercholesterolemia as much as 5.5 times compared to central obesity in men with a value of p &lt;0.05. There is a waist circumference relationship with the incidence of hypercholesterolemia in women who are central obesity more at risk of developing hypercholesterolemia than central obesity in men.&#x0D; Keywords: Hypercholesterolemia, waist circumference, hypertensive patients

MON-213 Evaluation of Type 2 Diabetes and Cardiovascular Disease Risk Factors in Reproductive-Age Women with Polycystic Ovary Syndrome (PCOS) Using the 2014 Androgen Excess and PCOS Society Criteria for the Polycystic Ovarian Morphology

Polycystic ovary syndrome (PCOS) is a complex and prevalent endocrine condition among reproductive-age women associated with adverse metabolic consequences. Metabolic syndrome (MetS) is a cluster of risk factors conferring an increased risk for type 2 diabetes (DM2) and cardiovascular disease (CVD). Research has been limited, in part, due to marked heterogeneity in criteria employed to determine MetS, retrospective data collection, and the use of older or less accurate criteria to diagnose PCOS and polycystic ovarian morphology (PCOM). We aimed to 1) examine the prevalence of MetS and evaluate DM2 and CVD risk factors in reproductive-age Canadian women with PCOS; and, 2) assess the relevance of MetS to clinical and biochemical features of PCOS using a prospective comprehensive approach and a rigorously-defined PCOS population. Baseline observations were evaluated in 237 women with PCOS (Androgen Excess and PCOS [AE-PCOS] Society 2006 criteria for PCOS and AE-PCOS Society 2014 recommendations to determine PCOM) and 42 healthy controls (18-36 years). Clinical and biochemical measures of MetS (International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute 2009), DM2 (Diabetes Canada Clinical Practice Guidelines 2018), and CVD risk factors (AE-PCOS Society statement 2010) were assessed. The prevalence of MetS was 29.5% in women with PCOS; that is, approximately 6-fold higher than age-matched controls (P<0.001). Women with PCOS presented with higher glucose abnormality, acanthosis nigricans, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, and lower sex-hormone binding globulin (SHBG) concentrations when compared with controls after accounting for differences in the body mass index (BMI; P<0.01). Women with both PCOS and MetS exhibited exacerbated insulin and glucose responses to a 75-gram glucose tolerance test, increased TC/HDL-C ratio, TC, and SHBG concentrations, as well as increased hirsutism and acanthosis nigricans when compared to women with PCOS without MetS after adjusting for BMI (P≤0.05). Canadian reproductive-age women with PCOS whose PCOM were characterized according to the AE-PCOS Society 2014 recommendations have a high prevalence of MetS and exhibit adverse cardiometabolic and DM2 risk profiles. MetS is associated with increased hyperandrogenism and hypercholesterolemia in women with PCOS attributed to inherent insulin resistance, hyperinsulinemia, and synergistic effects of concomitant obesity. Screening and regular monitoring for CVD and DM2 risk factors are reinforced for women with PCOS across the reproductive lifespan.

Hypercholesterolemia During Pregnancy is Caused by Increased Endogenous Cholesterol Synthesis: Let’s Use it for Screening of Familial Hypercholesterolemias Too!

Aims: To demonstrate the origin and the diagnostic significance of non-cholesterol sterols (NCSs) in healthy pregnant women with gestational hypercholesterolemia. Patients and Methods: Based on a total of 21,000 clinical biochemistry tests of healthy pregnant women with hypercholesterolemia observed during pregnancy, a group of 84 women with TC (total cholesterol) &gt;7.0 mmol/L was recruited to analyze their NCSs using Gas Chromatography–Mass Spectrometry. The NCSs under examination comprised lathosterol (Lat) and desmosterol (Des) as markers of endogenous cholesterol synthesis, and campesterol (Cam) and sitosterol (Sit) as markers for intestinal absorption. Results: In the total of 21,000 pregnant women, the median values were: TC 6.8 mol/l, LDL-C 4.6 mmol/L, and HDL-C 2.2 mmol/L. In the testing group of 84 women, the average values were: Lat 7.8+/-1.7 μmol/L, Des 4.7+/-0.9 μmol/L, Cam 9.8+/-2.6 μmol/L, and Sit 9.6 +/-3.8 μmol/L. Lat was found to correlate with TC (r = 0.53), LDL-C (r = 0.36), and non-HDL-C (r = 0.35). No such correlations were observed for Sit (r = 0.162) or Cam (r = 0.153). Conclusion: Our findings show that the high incidence of hypercholesterolemia during pregnancy is caused by increased endogenous cholesterol synthesis via lathosterol. The enormous rise of TC levels during pregnancy can be effectively used to detect familial hypercholesterolemia in women.

Heart Disease in Women: Unappreciated Challenges, GPER as a New Target.

Heart disease in women remains underappreciated, underdiagnosed and undertreated. Further, although we are starting to understand some of the social and behavioral determinants for this, the biological basis for the increased rate of rise in atherosclerosis risk in women after menopause remains very poorly understand. In this review we will outline the scope of the clinical issues related to heart disease in women, the emerging findings regarding the biological basis underlying the increased prevalence of atherosclerotic risk factors in postmenopausal women (vs. men) and the role of the G protein-coupled estrogen receptor (GPER) and its genetic regulation as a determinant of these sex-specific risks. GPER is a recently appreciated GPCR that mediates the rapid effects of estrogen and aldosterone. Recent studies have identified that GPER activation regulates both blood pressure. We have shown that regulation of GPER function via expression of a hypofunctional GPER genetic variant is an important determinant of blood pressure and risk of hypertension in women. Further, our most recent studies have identified that GPER activation is an important regulator of low density lipoprotein (LDL) receptor metabolism and that expression of the hypofunctional GPER genetic variant is an important contributor to the development of hypercholesterolemia in women. GPER appears to be an important determinant of the two major risk factors for coronary artery disease-blood pressure and LDL cholesterol. Further, the importance of this mechanism appears to be greater in women. Thus, the appreciation of the role of GPER function as a determinant of the progression of atherosclerotic disease may be important both in our understanding of cardiometabolic function but also in opening the way to greater appreciation of the sex-specific regulation of atherosclerotic risk factors.

A Comparison of Statin Therapies in Hypercholesterolemia in Women: A Subgroup Analysis of the STELLAR Study.

Objective: Cardiovascular disease is the leading cause of mortality in women in the United States. Aggressive treatment of modifiable risk factors (e.g., hypercholesterolemia) is essential in reducing disease burden. Despite guidelines recommending the use of statin treatment in hypercholesterolemic women, this patient group is often undertreated. This subgroup analysis of the Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) trial examines the effects of statin therapy in hypercholesterolemic women.Methods: As part of the STELLAR trial, 1,146 women with elevated low-density lipoprotein cholesterol (LDL-C ≥160 and <250 mg/dL) and triglycerides <400 mg/dL were randomized to rosuvastatin 10–40 mg, atorvastatin 10–80 mg, simvastatin 10–80 mg, or pravastatin 10–40 mg for 6 weeks.Results: LDL-C reduction with rosuvastatin 10 mg, atorvastatin 10 mg, simvastatin 20 mg, and pravastatin 40 mg was 49%, 39%, 37%, and 30%, respectively, after 6 weeks. High-intensity statins (rosuvastatin 20–40 mg and atorvastatin 40–80 mg) reduced LDL-C to the greatest extent: 53% with rosuvastatin 20 mg, 57% with rosuvastatin 40 mg, 47% with atorvastatin 40 mg, and 51% with atorvastatin 80 mg. Similar results were observed for non-high-density lipoprotein cholesterol (non-HDL-C). Increases in HDL-C were greater with rosuvastatin across doses than with other statins. All treatments were well tolerated, with similar safety profiles across dose ranges.Conclusions: Statin therapies in the STELLAR trial led to reductions in LDL-C, non-HDL-C, and triglycerides and increases in HDL-C among hypercholesterolemic women, with rosuvastatin providing the greatest reductions in LDL-C and non-HDL-C.

Sleep duration and hypercholesterolaemia: Results from the National Health Interview Survey 2008

Previous studies have shown an inconsistent association between sleep duration and hypercholesterolaemia. This study examined the association between sleep duration and hypercholesterolaemia in a nationally representative sample of US adults. A cross-sectional study of 16,652 participants in the 2008 National Health Interview Survey (aged ⩾18years, 52.5% women) was conducted. Sleep duration was categorized as ⩽5, 6, 7, 8, or ⩾9h. Hypercholesterolaemia (n=5578) was assessed by questionnaire. A significant gender difference was found in the association between sleep duration and hypercholesterolaemia (P interaction=0.003). Among women, sleep duration ⩽5h was positively associated with hypercholesterolaemia after adjusting for potential confounders and mediators including physical activity, psychological distress, body mass index, diabetes mellitus, and hypertension. Compared with a sleep duration of 7h (referent), the multivariate odds ratio (OR) of hypercholesterolaemia was 1.27 (95% confidence interval [CI] 1.04-1.54) for sleep duration ⩽5h. In contrast, among men, sleep duration ⩾8h was inversely associated with hypercholesterolaemia. Compared with a sleep duration of 7h (referent), the multivariate OR of hypercholesterolaemia was 0.80 (95% CI 0.69-0.94) and 0.78 (95% CI 0.60-1.00) for sleep durations of 8 and ⩾9h, respectively. In subgroup analyses, the positive association between sleep duration ⩽5h and hypercholesterolaemia in women, and the inverse association between sleep duration ⩾8h and hypercholesterolaemia in men, were more pronounced among those aged <60 years and race/ethnic groups other than non-Hispanic Whites. Sleep duration ⩽5h was positively associated with hypercholesterolaemia in women, whereas sleep duration ⩾8h was inversely associated with hypercholesterolaemia in men.

Prevalencia, detección, tratamiento y grado de control de los factores de riesgo cardiovascular en la población de Extremadura (España). Estudio HERMEX

Objective To estimate the prevalence, detection, treatment and degree of control of cardiovascular risk factors in Extremadura. Design Cross-sectional study. Setting Population study in Don Benito-Villanueva de la Serena health area (Badajoz). Participants A random sample of the people between 25 and 79 years, who lived in this area, was selected. Methods History of cardiovascular risk factors and its treatment were obtained by questionnaire. Blood pressure and blood sample were obtained for all participants. We calculated the prevalence of each variable standardized for age and gender for the population of Extremadura. Results Of the 3521 eligible, 2833 (80.5%) participants were included, mean age 51.2 years, male 46.5%. Adjusted prevalence of current smoking in men: 40.5% (37.8-43.2), hypertension 39.5% (37.3-41.7), hypercholesterolemia, 37.9% (35.4-40.4), obesity 36.5% (33.9-39.1), diabetes 13.7% (12.1-15.4). Adjusted prevalence of hypercholesterolemia in women: 35,0% (32.9-37.2), hypertension 33,0% (31.3-34.7), obesity 30.7% (28.6-32.8), current smoking 26,6% (24.5-28.7), diabetes 12,0% (10.5-13.5). The detection level of each factor was above 70%, and the degree of control among those treated of 51, 62.3 and 74.7% for hypertension, diabetes and hypercholesterolemia, respectively. Conclusions Extremadura's population is highly exposed to major cardiovascular risk factors, especially men. Smoking, obesity and diabetes stand in the national context as the most prevalent in our community.

Response by sex to statin plus ezetimibe or statin monotherapy: A pooled analysis of 22,231 hyperlipidemic patients

BackgroundDespite documented benefits of lipid-lowering treatment in women, a considerable number are undertreated, and fewer achieve treatment targets vs. men.MethodsData were combined from 27 double-blind, active or placebo-controlled studies that randomized adult hypercholesterolemic patients to statin or statin+ezetimibe. Consistency of treatment effect among men (n = 11,295) and women (n = 10,499) was assessed and percent of men and women was calculated to evaluate the between-treatment ability to achieve specified treatment levels between sexes.ResultsBaseline lipids and hs-CRP were generally higher in women vs. men. Between-treatment differences were significant for both sexes (all p < 0.001 except apolipoprotein A-I in men = 0.0389). Men treated with ezetimibe+statin experienced significantly greater changes in LDL-C (p = 0.0066), non-HDL-C, total cholesterol, triglycerides, HDL-C, apolipoprotein A-I (all p < 0.0001) and apolipoprotein B (p = 0.0055) compared with women treated with ezetimibe+statin. The odds of achieving LDL-C < 100 mg/dL, apolipoprotein B < 90 mg/dL and the dual target [LDL-C < 100 mg/dL & apoliprotein B < 90 mg/dL] was significantly greater for women vs. men and the odds of achieving hs-CRP < 1 and < 2 mg/L and dual specified levels of [LDL-C < 100 mg/dL and hs-CRP < 2 mg/L] were significantly greater for men vs. women. Women reported significantly more gall-bladder-related, gastrointestinal-related, and allergic reaction or rash-related adverse events (AEs) vs. men (no differences between treatments). Men reported significantly more CK elevations (no differences between treatments) and hepatitis-related AEs vs. women (significantly more with ezetimibe+simvastatin vs. statin).ConclusionsThese results suggest that small sex-related differences may exist in response to lipid-lowering treatment and achievement of specified lipid and hs-CRP levels, which may have implications when managing hypercholesterolemia in women.

Favourable association of leg fat with cardiovascular risk factors

To assess the association of trunk and leg fat mass (FM) and leg lean tissue mass (LTM) with conventional cardiovascular risk factors. Cross-sectional study. We studied 1249 men and 3007 women (age 20-79 years) who attended a research institute for a health checkup between October 1995 and February 2004. Body mass index, waist circumference (WC), hip circumference (HC), systolic and diastolic blood pressure, total cholesterol, HDL cholesterol, triglycerides, glucose and haemoglobin A(1C) were measured. Trunk FM, leg FM and leg LTM were obtained by dual-energy X-ray absorptiometry. We evaluated the associations between the indices for regional body composition and cardiovascular risk factors, which included hypertension, hypercholesterolaemia, hypo-HDL cholesterolaemia, hypertriglyceridaemia, dyslipidaemia and diabetes mellitus. Increase in WC and HC respectively showed increase and decrease in odds ratios of cardiovascular risk factors. Increase in trunk FM by 1 kg significantly increased the risk of the cardiovascular risk factors with the odds ratios ranging between 1.11 and 1.45. Increase in leg FM by 1 kg significantly decreased the risk with the odds ratios ranging between 0.52 and 0.90, except for the nonsignificant results for hypercholesterolaemia and hypo-HDL cholesterolaemia in men. Odds ratios of 1 kg increase in leg LTM were only significant for dyslipidaemia in men and hypercholesterolaemia in women (both 0.93). WC and HC showed opposite and independent associations with cardiovascular risk factors. The favourable association of HC was mainly attributable to that of leg FM.

Consistency in Efficacy and Safety of Ezetimibe Coadministered with Statins for Treatment of Hypercholesterolemia in Women and Men

Women are often not treated as aggressively as men to control levels of low-density lipoprotein cholesterol (LDL-C), despite evidence that women and men realize comparable cardiovascular benefit from lipid-lowering therapy. Statins are the most effective drugs currently available for treating hypercholesterolemia. Despite the impressive cholesterol-lowering capacity of statins, however, many patients on statin therapy fail to reach established target levels of LDL-C. The cholesterol absorption inhibitor, ezetimibe, blocks the intestinal absorption of dietary and biliary cholesterol, a mechanism of action complementary to that of statins, which inhibit hepatic cholesterol synthesis. Ezetimibe coadministered with statins produces significant incremental reductions in LDL-C compared with statin monotherapy. Four randomized, double-blind, placebo-controlled, balanced-parallel group trials compared the efficacy and safety of statin monotherapy (lovastatin or pravastatin 10, 20, or 40 mg; simvastatin or atorvastatin 10, 20, 40, or 80 mg) vs. ezetimibe 10 mg plus statin (as above). A gender subset analysis (women, n = 1065; men, n = 796) on data pooled across these four trials was carried out to determine whether ezetimibe plus statin for the treatment of hypercholesterolemia is equally efficacious in women and men. Compared with statin monotherapy, ezetimibe plus statin demonstrated greater efficacy in reducing blood levels of LDL-C, apolipoprotein B, and triglycerides and raising high-density lipoprotein cholesterol. The beneficial effects of ezetimibe were comparable in women and men. The safety profile of subjects receiving ezetimibe plus statin was similar to that of patients receiving statin monotherapy and similar between the two sexes. Ezetimibe plus statin was more effective than statin alone in improving the lipid profile of patients with hypercholesterolemia and was equally efficacious in women and men. Ezetimibe plus statin was well tolerated and had a favorable safety profile in both patient subgroups. Ezetimibe coadministered with statins, a dual inhibition treatment strategy that targets both cholesterol absorption and synthesis, is an effective therapeutic option for women with hypercholesterolemia.

An Association Between Varying Degrees of Hypothyroidism and Hypercholesterolemia in Women: The Thyroid-Cholesterol Connection.

Evidence of an association between subclinical hypothyroidism and cardiovascular disease is mounting. The impact of thyroid hormone on lipid levels is primarily mediated through triiodothyronine (T(3))-bound thyroid protein binding and activation of the promoter regions of the low-density lipoprotein receptor and 3-hydroxy-3-methylglutaryl coenzyme A-reductase genes, leading to a reduction in serum cholesterol levels. Thus, the decreased T(3) seen in hypothyroidism may result in increased serum cholesterol. Although a clear correlation exists between overt hypothyroidism and clinically significant hypercholesterolemia, there is a logarithmic relationship between thyroid-stimulating hormone and cholesterol, and the effects of subclinical hypothyroidism on cardiovascular disease are under debate. However, current data suggest that normalizing even modest thyroid-stimulating hormone elevations may result in improvement in the lipid profile. (c)2001 CHF, Inc.

Postmenopausal hypercholesterolemia in women sent to a lipid clinic

Postmenopausal hypercholesterolemia in women sent to a lipid clinic

Treatment of Hypercholesterolemia in Women

The well-established fact that male sex is a risk factor for coronary heart disease (CHD) has been interpreted by some clinicians that CHD risk is lower for all women, that risk factors for CHD morbidity and mortality are somehow less predictive in women than in men, and that interventions to reduce that risk of CHD are inherently less effective in women. In this issue ofThe JOurnal, Schrott et al 1 describe the extent to which lipid abnormalities are treated in women, identifying those factors that are associated with achieving (or not achieving) goals in low-density lipoprotein (LDL) cholesterol levels as set forth by the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) guidelines. In 2763 postmenopausal women with documented CHD recruited into a clinical trial of estrogen replacement therapy, 91% did not meet the NCEP ATP-II goals of an LDL cholesterol level of 2.6 mmol/L (100 mg/dL) or