Cardiovascular disease: Screening and management of the a-symptomatic high-risk post-menopausal woman

Menopause-related oestrogen deficiency increases the risk of cardiovascular disease (CVD). The presence of abdominal obesity, dyslipidemia, hypertension, fasting hyperglycaemia or impaired glucose tolerance further aggravates the CVD risk imposed by menopause. A detailed personal history should be recorded, covering PCOS, gestational diabetes mellitus, alcohol intake and smoking, as well as a family history of cardiovascular disease. Screening of the a-symptomatic post-menopausal woman should include fasting lipid profile, plasma glucose and liver, renal and thyroid function tests. Serum low-density lipoprotein cholesterol (LDL-c) > 130 mg/dL is associated with an increased risk of CVD. Levels of triglycerides (TG) ≥ 150 mg/dL and high-density lipoprotein cholesterol (HDL-c) ≤ 50 mg/dL coupled with an increase in small dense LDL and very low-density lipoprotein (VLDL) particles constitute the atherogenic dyslipidemia, which characterizes the metabolic syndrome. In women with previous VTE episodes, screening for thrombophilia is advisable, as well as an estimation of baseline homocysteine and C-reactive protein (CRP). Non-pharmacological intervention should be targeted towards smoking cessation, a low-salt, low-fat, high-fibre diet and increased physical activity.