Lipid management challenging, but necessary, for prevention of CVD in women

Issue: November 2011

WASHINGTON, D.C. - Controlling lipid levels in women with cardiovascular disease can be difficult due to a number of challenges, such as unclear guidelines and adverse reactions to medications, a presenter said here at the 22nd Annual Meeting of the North American Menopause Society.

"There is no shortage of guidelines for lipid management. The updated 2011 guidelines from the American Heart Association are the most user-friendly because they can easily be applied to real-world clinical scenarios," Emma A. Meagher, MD, of the University of Pennsylvania Health System, said during a presentation. For example, she noted that the updated AHA guidelines forthe prevention of CVD in women refer to at-risk or high-risk patients, whereas others use terms such as very high, high, moderately high risk or moderately low risk, which leaves a lot of room for interpretation.

Meagher also said the fact that women have different lipid profiles than men can create difficulties.

"One common gender difference is the prevalence of what's bad in a lipid panel other than LDL," she said. For example, in certain situations, an elevated non-HDL cholesterol may become an appropriate secondary target for intervention.

"In this setting, whatever level you set for the target goal for LDL, the non-HDL target should be 30 points higher," Meagher said.

Lifestyle changes, such as increased physical activity, improved diet and decreased alcohol consumption, are most important in managing lipid levels, according to Meagher. Physicians have other options as well, including treatment with statins and niacin.

Unfortunately, several issues prevent women from using these medications. Although statins are a good choice, Meagher said public debate has "primed patients not to take statins." She advised physicians to be prepared to discuss the risk-benefit profile of the drug in detail. In terms of adverse effects, the most common reason for discontinuation of statin therapy is myalgia. Myopathy is also a concern more commonly seen in patients taking other medications and in elderly or frail patients. However, physicians can work with patients to create a strategy to overcome these hurdles. Educating patients thoroughly on potential adverse effects is beneficial, Meagher said. She highlighted niacin as an effective alternative to statins, but noted that many patients still struggle with tolerability issues.

Meagher also cited cholesterol absorption inhibitors, fibric acids and omega-3 fatty acids as therapeutic options, yet explained that statins and niacin remain the best choices.

"The key message is that we have options - we just have to employ them," Meagher said. "The most important is statin therapy. We need to get on board and recognize therapeutic opportunities to further reduce CV events." - by Melissa Foster

For more information:

Meagher EA. Clinical challenges in lipid management. Presented at: the 22nd Annual Meeting of the North American Menopause Society; Sept. 21-24, 2011; Washington, D.C.

Disclosure: Dr. Meagher reports no relevant financial disclosures.

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