Dyslipidemia in Women: Etiology and Management

This chapter summarizes the current knowledge regarding the prevalence of dyslipidemia in women, different response to therapy, and strategies to prevent and treat dyslipidemia during pregnancy and in postmenopausal women. Cardiovascular disease (CVD), particularly coronary heart disease (CHD), is the leading cause of death among women aged 60 and older. Appreciation of the differences between men and women in CHD risk factors and presentations can assist in treatment decisions. Some factors are unique to women, including reproductive status and menopause that increase the risk of dyslipidemia and consequently CVD in women. Menopause is associated with an elevation in LDL-cholesterol level in addition to threefold increase in the risk of CVD. Total cholesterol, very-low-density lipoprotein (VLDL) cholesterol, and triglyceride increase markedly after menopause. Dyslipidemias in post-menopausal women are particularly atherogenic and tend to cluster with other metabolic and non-metabolic risk factors. Randomized trials of statins for primary and secondary prevention of coronary heart disease suggest that statins have been effective in reducing the morbidity and mortality of CHD and should be considered as a first-line therapy for lipid lowering. In addition, pregnancy, known as an insulin resistance state, is associated with elevation of both cholesterol and triglyceride. Statins are contraindicated during pregnancy but omega-3 fatty acids may be used for hypertriglyceridemia. Those with genetic lipid disorders should consider consulting a clinician with lipid expertise before starting the pregnancy. This is particularly important due to the narrowed therapeutic options of lipid management which are available for pregnant women.