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Editor: You may have seen this study reported in newspapers such as The Wall Street Journal and The New York Times last month. We thought you might like to include it in your publication.

Women with heart disease need more aggressive treatment for high cholesterol

IOWA CITY, Iowa -- Many older women with coronary heart disease have high levels of low-density lipoprotein cholesterol, also known as "bad cholesterol," even when taking cholesterol-lowering medication.

"We don't know if the women on lipid-lowering medications we studied have increased low density lipid-cholesterol (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," said Dr. Helmut Schrott, lead author of the study published in the April 23 issue of the Journal of the American Medical Association (JAMA). Schrott is associate professor of preventive and internal medicine at the University of Iowa College of Medicine.

"I suspect it is the second scenario," he said.

These findings point to the need for doctors to make sure that their patients with coronary heart disease (CDH) and high LDL-C levels are taking lipid-lowering medications, and that the drugs are working to significantly lower the level of blood fats such as cholesterol and triglyceride.

Part of the problem is that many physicians believe women are less threatened than men by CHD and are less responsive to lipid-lowering medications, wrote Drs. Thomas Pearson, Rochester University School of Medicine and Merle Myerson,

Mary Imogene Basset Research Institute, in an accompanying JAMA editorial.

In fact, CHD is the major killer of women in the United States, and previous research shows that women respond at least as well as men to lipid-lowering drugs.

"Women with CHD should be treated as aggressively as men for elevated LDL cholesterol levels," wrote Pearson and Myerson.

Schrott and colleagues at 17 other institutions across the country found that even though 47 percent of the 2,763 women studied 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. Ninety-one percent had LDL-C levels above the more stringent goal of less than 100 milligrams per deciliter set in 1993.

LDL is essential for proper body function, but too much can increase the risk for cardiovascular disease. Earlier studies have shown that lowering LDL-C levels in people with CHD can reduce mortality and the recurrence of heart attack, Schrott said.

The women studied ranged from 44 to 79 years old (average age was 67); 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 had diabetes.

Participants were part of the Heart and Estrogen/Progestin Replacement (HERS) Study, started in 1993 to evaluate the effect of hormone replacement therapy on reducing recurrent heart disease in post-menopausal women with CHD. The research is funded by Wyeth-Ayerst Research Company.

If you would like a copy of the JAMA paper, or would like to schedule an interview with Dr. Schrott, please call me.