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Women with heart disease may need aggressive therapy for high cholesterol
IOWA CITY, Iowa -- Women with coronary heart disease (CHD) have high "bad
cholesterol" levels even when taking cholesterol-lowering medication.
That research is reported in the April 23 issue of the Journal of the American
Medical Association by Dr. Helmut Schrott, University of Iowa associate professor
of preventive and internal medicine, and colleagues at other institutions.
These findings point to the need for doctors to make sure that their CHD
patients are on lipid-lowering medications to decrease blood levels of low-density
lipoprotein cholesterol (LDL-C), or "bad" cholesterol if needed
and that the drugs are working to significantly lower the level of blood fats
such as cholesterol and triglyceride.
"We don't know if the women on lipid-lowering medications we studied
have increased LDL-C levels because they aren't taking their medication, or
because their doctors are not increasing the drug dose or adding another medication
when LDL-C levels are still too high," Schrott says.
Researchers at 18 clinical sites around the country, including the UI Hospitals
and Clinics, examined the amount of LDL-C in the blood of 2,763 post-menopausal
women when they entered the Heart and Estrogen/Progestin Replacement (HERS)
"Although almost half were on medication, a large majority of them did
not meet treatment goals," Schrott says.
The researchers found that even though 47 percent of the women enrolled in
the study were taking medication to lower blood fats , 63 percent of the entire
group had LDL-C levels that exceeded recommendations set by the National Cholesterol
Education Program Adult Treatment Panel in 1988, and 91 percent had LDL-C
levels above the more stringent goals set in 1993.
Coronary heart disease is the major killer of women in the United States.
It includes diseases caused by narrowing of the coronary arteries such as
heart attack, angina and sudden death. It also includes people who need coronary
bypass surgery and balloon angioplasty.
High levels of LDL-C are a major risk factor for CHD, Schrott says. Earlier
studies have shown that lowering LDL-C levels in people with CHD can reduce
mortality and the recurrence of heart attack.
The women studied ranged from 44 to 79 years old; 88.7 percent were white,
7.9 percent were African-American, and 2 percent were Hispanic. The remaining
women belonged to other ethnic and racial groups. The participants were generally
not physically active and overweight; 13.1 percent were current smokers; 49
percent were former smokers; 59.5 percent had hypertension and 23 percent
The HERS study began in 1993 to evaluate the effect of hormone replacement
therapy on reducing recurrent heart disease in post-menopausal women with
CHD. The study is expected to continue through 1998.