Changes in levels of LDLc (bad cholesterol) from pre- to post-menopausal examinations are not as good at predicting the amount of coronary calcification in post-menopausal women as measures of LDLc taken pre-menopausally at age 47, according to Lewis Kuller, M.D., Dr.P.H., in a report to the 39th annual Conference on Cardiovascular Disease Epidemiology and Prevention, March 26, in Orlando, Fla.
"Even though LDLc increases about 20 mg/dL between pre-menopause and the eighth year post-menopause, the LDLc levels at age 47 are the best determinant of risk. There is a very strong association of LDLc at age 47 and coronary calcifications discovered at age 59," said Dr. Kuller, "Thus it is very important that pre-menopausal women know their cholesterol levels."
Dr. Kuller continued, "It is possible to prevent the development of the underlying cause of heart disease in women by reducing risk factors prior to menopause. Even perfectly healthy pre-menopausal women should have their risk factor levels evaluated, and they should make an all-out effort to reduce their level of risk."
Dr. Kuller's group enrolled approximately 200 participants beginning in the mid-1980s. The investigators performed eight follow-up evaluations of risk factors, including coronary calcification measurements using electron beam computed tomography (EBCT). The eighth evaluation was performed 11 years later, postmenopausally. EBCT is an imaging procedure that measures coronary and aortic calcifications, known markers for increased risk for coronary events.
"Just as important, it is probably misleading to use LDLc levels taken after age 47 to determine what type of therapy a woman should receive to protect her against heart disease," remarked Dr. Kuller, principal investigator on the Healthy Women Study and chairman of the department of epidemiology at the University of Pittsburgh's Graduate School of Public Health. "We found that the change in LDLc levels from the first to eighth post-menopausal visit was unrelated to the extent of coronary or aortic calcification at the eighth post-menopausal visit, when women were 59," he added.
Dr. Kuller stressed the point that women with elevated risk factors can make a difference in the development of heart disease. "If a woman has elevated risk factors, there are very effective therapies including changing the diet, reducing saturated fat and cholesterol, lowering weight, increasing exercise and quitting smoking. There are also potent drugs to lower cholesterol levels; lower LDLc (<100 mg/dL); raise HDLc, or good cholesterol (60-65 mg/dL); and lower the systolic blood pressure (<120 mm Hg). Using a combination of these approaches, it should be possible to substantially reduce the risk and number of heart attacks and strokes among women in the community."