Clinical Decisionmaking

Treatment of high cholesterol in women should be based on all risk factors for heart disease, not just lipid levels

For women who don't have cardiovascular disease, use of drugs, most often statins, to treat high levels of blood lipids or fats such as cholesterol and triglycerides (hyperlipidemia) does not affect rates of death due to coronary heart disease (CHD) or total death rates. For women with known cardiovascular disease, lipid-lowering therapy is effective in reducing CHD-related death, nonfatal heart attack, and revascularization (coronary angioplasty or coronary artery bypass graft surgery), but it does not affect total mortality, according to a new study.

Based on the study findings, researchers suggest that when deciding about beginning lipid-lowering therapy in women, doctors should consider not only a woman's lipid levels, but also her other risk factors for CHD. These risk factors include age, blood pressure, tobacco use, and diabetes, as well as the woman's overall risk of suffering a CHD event such as a heart attack. The study was conducted by researchers at the University of California, San Francisco-Stanford Evidence-based Practice Center, which is supported by the Agency for Healthcare Research and Quality (contract 290-97-0013).

EPC researchers Judith M.E. Walsh, M.D., M.P.H., and Michael Pignone, M.D., M.P.H., assessed and synthesized the evidence regarding drug treatment of hyperlipidemia for the prevention of CHD events in women. They conducted a meta-analysis of 13 studies on the effects of lipid-lowering drug treatment on mortality.

Six trials assessed the effects of lipid-lowering medications on 11,435 women without cardiovascular disease. This approach did not reduce total mortality, CHD mortality, nonfatal heart attack, or revascularization. However, some analyses were limited by too few CHD events in the available trials. Eight trials assessed the effects of lipid-lowering medications on 8,272 women with cardiovascular disease. Lipid lowering did not reduce total mortality in these women, but it did reduce CHD mortality by 26 percent, nonfatal heart attack by 29 percent, revascularization by 30 percent, and total CHD events by 20 percent.

See "Drug treatment of hyperlipidemia in women," by Drs. Walsh and Pignone, in the May 12, 2004, Journal of the American Medical Association 291(18), pp. 2243-2252.

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