Prevention of cardiovascular risk in women. A new concern for the obstetrician/gynecologist

Cardiovascular disease is the leading cause of death in American women, accounting for nearly half a million deaths annually. While most of these women are postmenopausal, data from the Bogalusa Heart Study have shown that fatty streak formation begins early in life, perhaps even in childhood. Successful risk intervention is best initiated early in the process, before the clinical manifestations of disease become apparent. Several major risk factors for cardiovascular disease--elevated cholesterol, elevated blood pressure, and cigarette smoking--are amenable to intervention. The critical role of cholesterol in the pathogenesis of cardiovascular disease, and the impact of even small fluctuations of important subfractions on CV risk have been demonstrated in numerous epidemiologic and clinical studies. A sensitive predictor of cardiovascular risk appears to be the high-density lipoprotein (HDL) cholesterol fraction, which is considered cardioprotective if elevated and a significant independent risk factor if decreased. Reductions in HDL have been documented following the use of even low-dose oral contraceptives containing progestins of high androgenic activity. Elevated LDL cholesterol may be an independent risk factor for CV disease in women. Hence, changes in the LDL/HDL ratio may be more sensitive predictors of change in CV risk. Major risk factors for CV disease in women are outlined with specific reference to the effects of oral contraceptives on lipoproteins.