Pharmacotherapy of dyslipidemia in postmenopausal women: Weighing the evidence

In the United States, coronary heart disease (CHD) is the leading cause of death in women. The incidence of CHD rises dramatically in women following menopause, which can be partially attributed to a more atherogenic lipoprot ein profile. For years, observational and epidemiological data have suggest ed that estrogen and progesterone therapy reduced CHD end points. However, the first prospective trial that evaluated hormone replacement therapy (HRT ) for secondary CHD prevention demonstrated no positive cardiovascular bene fit of HRT compared with placebo. In interventional studies, the 3-hydroxy- 3-methylglutaryl coenzyme A (HMG-CoA)reductase inhibitors significantly red uced CHD outcomes in postmenopausal women, and these agents have emerged as the drugs of choice for primary and secondary CHD prevention. The selectiv e estrogen receptor modulators (SERMs) may have a role in CHD prevention, b ut long-term clinical trials evaluating end points are needed. An evidence- based approach is necessary when deciding the appropriate pharmacotherapy o f dyslipidemia in postmenopausal women.