Lipids, atherosclerosis, and the postmenopausal woman. A clinical perspective

Gynecologists are often responsible for the primary care of postmenopausal women. In this role, they become responsible for the assessment and subsequent management issues surrounding the prevention of atherosclerotic disease. The effects of estrogen upon the physiology of lipoproteins can be simplified to include an increased flux of apo B-100 particles out of and then back into the liver, an inhibition of hepatic lipase activity, and an apparent decrease in the hepatic secretion of lipoprotein(a) particles. In clinical practice, the lipoprotein picture is best thought of as one of a group of risk factors that need to be assessed and modified as needed, based upon the overall estimation of risk. The only caveat to this approach is that one should consider patients with proven heart disease for more aggressive therapy (to achieve an LDL cholesterol of less than 100 mg/dL), as long as there is no overriding morbidity from other causes.