Prevention of heart disease in women: recommendations for management of risk factors

Dyslipidaemia in hypertensive obese type 2 diabetic patients in Jamaica

INTRODUCTION

Hypertension and obesity are common problems among diabetic patients accelerating progression of vascular diabetic complications.

MATERIALS AND METHODS

A two-stage stratified random sampling design was used, and individuals aged 15 years and over were interviewed. This cross-sectional study evaluated lipid abnormalities of 117 obese type 2 diabetic patients (28 males and 89 females), and 56 hypertensive obese type 2 diabetic patients (22 males and 34 females). Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL-C) and high-density lipoprotein cholesterol (HDL-C) concentrations were assayed using standard biochemical methods.

RESULTS

Hypertensive obese type 2 diabetic females had significantly higher mean serum concentrations of TC (p = 0.043), TG (p = 0.046), LDL-C (p= 0.040), TC/HDL-C ratio (p = 0.001) and LDL-C/HDL-C ratio (p = 0.003) compared with hypertensive obese non-diabetic females. Similar results were found in hypertensive obese type 2 diabetic males compared with hypertensive obese non-diabetic males. Hypertensive obese type 2 diabetic females had significantly higher serum TC, TG and TC/HDL-C ratio (p < 0.05) than hypertensive obese type 2 diabetic males. Hypertensive obese type 2 diabetic females had significantly higher mean serum concentrations of TG (p = 0.03) and TC (p = 0.01) than obese type 2 diabetic females. There was a significant association between blood glucose and LDL-C concentrations in type 2 diabetic subjects (r = 0.36; p< 0.05).

CONCLUSION

Obese hypertensive type 2 diabetic females are exposed more profoundly to risk factors including atherogenic dyslipidaemia compared with males.

Cardiac health in women with metabolic syndrome: clinical aspects and pathophysiology

Although the classical cardiovascular risk factors (e.g., smoking and hypertension) are becoming more effectively managed, a continuous increase of the so-called "cardiometabolic risk" is noted. Starting from this century, the nomenclature "metabolic syndrome" has become more popular to identify a cluster of disorders including obesity, dyslipidemia, hypertension, and insulin resistance. It is a primary risk factor for diabetes and cardiovascular disease in both genders. Interestingly, the metabolic diseases display a distinct gender disparity with an apparent "female advantage" in the premenopausal women compared with age-matched men. However, women usually lose such "sex protection" following menopause or affliction of metabolic syndrome especially insulin resistance. A controversy exists in the medical literature concerning whether metabolic syndrome is a real syndrome or simply a cluster of risk factors. Several scenarios are speculated to contribute to the gender dimorphism in the cardiovascular sequelae in patients with metabolic syndrome including sex hormones, intrinsic organ function, and the risk factor profile (e.g., hypertension, dyslipidemia, obesity, sedentary lifestyle, and atherogenic diet). With the alarming rise of obesity prevalence, heart problems in metabolic syndrome continue to rise with a distinct gender dimorphism. Although female hearts seem to better tolerate the stress insults compared with the male counterparts, the female sex hormones such as estrogen can interact with certain risk factors to precipitate myopathic changes in the hearts. This synthetic review of recent literature suggests a role of gender disparity in myopathic factors and risk attributable to each metabolic component in the different prevalence of metabolic syndrome.

Discontinuing hormone replacement therapy: attenuating the effect on CVD risk with lifestyle changes

BACKGROUND

Concern about the potential risks associated with hormone replacement therapy (HRT) has left post-menopausal women and healthcare providers searching for safe and effective means for cardiovascular disease (CVD) risk factor reduction.

METHODS

The Woman On the Move through Activity and Nutrition study is a 5-year clinical trial (2002-2006) designed to test whether a lifestyle intervention will reduce measures of subclinical CVD. Participants were randomized at baseline to a health education or lifestyle change group. The impact of lifestyle intervention on CVD risk factors was examined in 240 women who were initially on HRT at baseline and either continued (n = 110) or discontinued (n = 130) by 18 months.

RESULTS

The lifestyle-change group significantly decreased weight, body mass index, waist circumference (all p<0.0001), total cholesterol (p=0.02), and LDL cholesterol (LDL-C) (p= 0.01), improved fat intake (p<0.0001), and increased leisure physical activity (p=0.005) when compared with the health education group. HRT discontinuation resulted in increased total cholesterol (p=0.04) and LDL-C (p=0.009). CVD risk factor changes were further explored by the HRT group, stratified by randomized group assignment. Within the health education arm, HRT discontinuers averaged over a 22-mg/dL increase in total cholesterol and LDL-C, while HRT continuers averaged less than 4 mg/dL (p=0.004 and 0.002, respectively). No such differences were noted in the lifestyle-change group (p=0.78 and 0.90, respectively).

CONCLUSIONS

Lifestyle modification was effective for CVD risk factor reduction in post-menopausal women. HRT discontinuation resulted in increased total cholesterol and LDL-C, which were successfully attenuated by a lifestyle intervention incorporating weight loss, physical activity, and dietary modification.