HDL-C in post-menopausal women: An important therapeutic target

Coronary heart disease is a major cause of mortality in women in Western industrialised countries, particularly after the age of 50 years, coinciding with the onset of the menopause and potentially adverse metabolic changes that occur during the transitional peri-menopausal and post-menopausal periods. Dyslipidaemia characterised by increases in plasma levels of low-density lipoprotein cholesterol (LDL-C), triglycerides and lipoprotein(a) and a decrease in high-density lipoprotein cholesterol (HDL-C) together with the emergence of other diagnostic features of the metabolic syndrome are key factors that increase cardiovascular risk. Treatment beyond LDL-C with a combination of different lipid-modifying therapies may therefore be of greater importance in women than men. Fibrates and nicotinic acid are two treatments that may be added to primary statin therapy. Fibrates are more effective in lowering elevated triglycerides, whereas nicotinic acid is more effective in raising HDL-C. Although there is clearly a need for clinical trials in women, the available data suggests that combination lipid-modifying therapy is a logical treatment strategy in this high-risk patient group.