Women and cardiovascular risk

Cardiovascular disease mortality rates have decreased in men during the past 20 years, but have steadily increased in women. In the United States, >500,000 women die of coronary artery disease (CAD) every year. Although many factors can influence an individual’s risk for CAD, some factors are unique to women, including reproductive status. Menopause is associated with significant elevations in serum cholesterol levels and a 3-fold increase in the risk of CAD. It has been suggested that these changes result from a reduction in the level of estrogen. However, recent data from prospective clinical trials have not found any evidence that hormone replacement therapy protects against cardiovascular disease. On the other hand, several studies have shown that, in women, lipid lowering with statin therapy can reduce coronary events. On the strength of these findings, the Beyond Endorsed Lipid Lowering with Electron-Beam Computed Tomography Scanning (BELLES) trial—a 1-year, multicenter, randomized, double-blind, parallel-group study—has been specifically designed to determine the benefits of aggressive statin therapy on the progression of atherosclerosis in postmenopausal women.