Fast Five Quiz: Cardiovascular Disease Risk Management in Women

Yasmine S. Ali, MD


December 14, 2020

LDL-C–lowering drug therapy is recommended along with therapeutic lifestyle modification in women with CVD to achieve an LDL-C level < 100 mg/dL. Women with other atherosclerotic CVD or diabetes mellitus or 10-year absolute risk for CVD > 20% should also receive LDL-lowering medications.

Presently, no guidelines recommend postmenopausal estrogen therapy for CVD risk reduction in women, although it has been shown to have certain beneficial effects on the CV system, such as decreases in LDL-C, increases in high-density lipoprotein cholesterol, and dilation of blood vessels. However, a healthy lifestyle (ie, abstinence from smoking, eating a healthy diet, and engaging in regular physical activity) during the menopausal transition has been associated with reduced development of atherosclerosis.

Pharmacotherapy for hypertension is recommended when blood pressure is ≥ 140/90 mm Hg (or ≥ 130/80 mm Hg in the setting of chronic kidney disease and diabetes mellitus). Unless contraindicated, patients commonly receive thiazide diuretics as part of the treatment regimen; beta-blockers and/or angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers, in addition to other drugs as needed, are recommended for high-risk women with ACS or MI. Note that ACE inhibitors are contraindicated in pregnancy.

Indefinite use of long-acting beta-blocker therapy after MI or ACS is only recommended for women with left ventricular failure or for those with coronary or vascular disease (unless contraindications are present) after MI or ACS. For all other women, beta-blockers should be used for 1-3 years after MI or ACS (unless contraindicated).

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