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Cholesterol, lipoproteins, and coronary heart disease in women
T L Bush1, L P Fried, E Barrett-Connor
1Department of Epidemiology, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD.
Insights
Cholesterol and lipoprotein levels in women are influenced by diet, lifestyle, and sex hormones. Elevated risk for coronary heart disease in women is primarily seen with total cholesterol above 260 mg/dL.
Area of Science:
- Cardiovascular Health
- Endocrinology
- Lipid Metabolism
Background:
- Coronary heart disease (CHD) is a leading cause of death in the U.S. for both men and women.
- Risk factors for CHD in women, particularly cholesterol and lipoprotein levels, are not well understood.
- Understanding these factors is crucial for effective prevention and treatment strategies in women.
Purpose of the Study:
- To review the determinants of cholesterol and lipoprotein concentrations in women.
- To assess the association between lipid levels (total cholesterol, HDL, LDL) and CHD occurrence in women.
- To evaluate evidence on whether modifying lipid concentrations affects CHD risk in women.
Main Methods:
- Literature review of studies on lipid determinants and CHD risk in women.
- Analysis of factors influencing lipid concentrations, including diet, lifestyle, and hormonal influences.
- Examination of epidemiological data linking lipid levels to CHD incidence and mortality in female populations.
Main Results:
- Lipid concentrations in women are influenced by genetics, diet, alcohol, smoking, physical activity, and notably, sex hormones (estrogen, progestin).
- Women generally have lower CHD rates than men at similar cholesterol levels.
- Significantly elevated CHD risk in women is observed only with total cholesterol exceeding 260 mg/dL, with a stronger association in older women.
Conclusions:
- Sex hormones play a significant role in modulating lipid profiles in women.
- CHD risk assessment in women requires consideration of specific cholesterol thresholds and age.
- Further research is needed to fully elucidate CHD risk factors and effective lipid management in women.
Abstract:
In the United States, coronary heart disease is the major cause of death and disability in women and in men. Despite this, little is known about the risk factors, including cholesterol and lipoprotein concentrations, for coronary disease in women. In this paper we review the determinants of cholesterol and lipoprotein concentrations in women, assess whether values for total cholesterol and lipoproteins (HDL and LDL) are associated with the occurrence of coronary heart disease in women, and evaluate the evidence that suggests that modifying the concentrations of lipids in women is associated with changing the risk of coronary disease. Besides genetic determinants, dietary cholesterol, dietary fat, total caloric intake, alcohol consumption, cigarette smoking, and physical activity are known to influence concentrations of lipids in women. Some of the strongest determinants of cholesterol and lipoprotein concentrations in women are sex hormones, including estrogen and progestin. Exogenous use of both of these hormones markedly influences HDL and LDL cholesterol; additional evidence suggests that endogenous sex hormones also influence lipid and lipoprotein concentrations. The few studies that have examined the association of total cholesterol with coronary heart disease occurrence and mortality in women have consistently shown that (a) women have much lower rates of coronary heart disease than men at the same values for cholesterol, and (b) clearly elevated risk for coronary heart disease in women is evident only at relatively high values of total cholesterol (i.e., greater than 260 mg/dL). There also appears to be an age effect, with total cholesterol concentrations being more predictive in older than in younger women.