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

-Team@CMHF

• The updated 2011 guidelines from the American Heart Association are the most user-friendly for lipid management because they can easily be applied to real-world clinical scenarios
• According to Dr Meagher the updated AHA guidelines for the 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
• It was also noted that women have different lipid profiles than men can create difficulties.
• Dr Meagher said one common gender difference is the prevalence of what’s bad in a lipid panel other than LDL, eg 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.
• 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.
• Meagher 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.

For further reading log on to: http://www.cardiologytoday.com/view.aspx?rid=88079