Pharmacotherapeutic decisions in menopausal women with cardiovascular risk

Epidemiological and therapeutic studies of cardiovascular disease have revealed definite gender differences with respect to risk factors, disease onset and intensity of treatment, in part related to complex hormonal-issues. Numerous studies have shown that in clinical practice, recognition and therapeutic reduction of cardiovascular risk in women is substantially less well done than that with men. In this paper, by reviewing data from therapeutic trials which enrolled women, including those using estrogen and standard lipid-modulating drugs, and by discussing lipoprotein trafficking abnormalities prevalent in women, we will outline more aggressive, step-wise therapeutic approaches likely necessary to achieve lipid and lipoprotein goals. Integral to a discussion of such aggressive treatment is a review of drug mechanisms of action as currently understood.