Strategies for the prevention of atherosclerotic progression in women

Atherosclerosis is an inflammatory and fibrotic process that begins early in life in females. The pathogenesis involves the oxidation of the low-density lipoprotein molecule aggravated by smoking, hypertension, lipid abnormalities, and hormonal changes. Risks for progression of atherosclerosis can now be tabulated for the female based on age, cholesterol, smoking, high-density lipoprotein, and systolic blood pressure. During the reproductive years, emphasis should be placed on lifestyle changes, but women at increased risk for diabetes should be aggressively treated with lipid-lowering agents. During the menopausal phase of life, an important consideration is the use of hormone replacement along with lifestyle changes, smoking cessation, blood pressure control, and lipid modification. In the female with established coronary heart disease, standard cardiac medications are indicated along with more aggressive approaches to risk factors and target goals for cholesterol, low-density lipoprotein, and triglycerides. The effect of hormone replacement in established coronary artery disease is uncertain. Therefore, strategies for slowing the progression of atherosclerosis should begin during the reproductive years, with particular emphasis in patients during menopause and in patients with coronary heart disease.