4-12 TREATMENT OF HYPERCHOLESTEROLEMIA IN WOMEN EQUALITY, EFFECTIVENESS, AND EXTRAPOLATION OF EVIDENCE
(This editorial comments and expands on the preceding.)
There is ample evidence that women with coronary heart disease (CHD) and hypercholesterolemia should be treated as aggressively as men. An elevated serum cholesterol level in women is as predictive of later CHD events as it is in men.
The prognosis of women with CHD is similar to (or worse than) that of men. Therefore, the old idea of women being at lower risk vanishes when CHD is documented. It is not surprising that trials of lipid-lowering agents show similar levels of effectiveness.
The recent "Cholesterol and Recurrent Events (CARE)" study (NEJM 1996; 335: 1001-09 — a secondary prevention trial) demonstrated benefit from pravastatin in patients with average cholesterol levels. Women had a 46% reduction in CHD events with separation of events beginning after only 6 months of treatment.
"Based on the admittedly minimal data at hand, women should be at the front of the queue to receive lipid-lowering therapy, rather than at its end."
JAMA April 23/30, 1997;277: 1320-21 Editorial from the Mary Imogene Bassett Research Institute, Cooperstown NY

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