Are observational data adequate to guide lipid altering therapy in women?

The epidemiologic data presented by Emond and Zareba in this issue provide interesting observations of the relationships among cholesterol concentrations, age, and risk of CHD events and death. The data they present did not incorporate some important variables in the CHD risk profile for women. The absence of good information on diabetes mellitus, menopause, and HRT and of adequate HDL-C data means that these data cannot be used to guide lipid-altering treatment. Other observational datasets and limited current intervention trial data suggest that women with documented CHD and women who, in the absence of CHD, have high risk for CHD should be treated according to currently recommended (i.e., NCEP) guidelines. Treatment of lipid levels in very low-risk patients is less clear. Data from clinical studies currently under way will define the potential benefits of lipid-altering therapy. Intervention trials with HRT will likely give us insight about the exact role of this modality in CHD risk reduction in women. Results of these trials should be available within the next decade.