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Dyslipidemia Management for Secondary Prevention in Women with Cardiovascular Disease: What Can We Expect From Nonpharmacologic Strategies?

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Abstract

Cardiovascular disease is the leading cause of death in women and the treatment of dyslipidemia is a cornerstone of secondary prevention. Pharmacologic therapy with statins can lower LDL-C by 30 %–50 % and reduce the risk of recurrent coronary heart disease in both men and women. While significant reductions in LDL-C can be achieved with statin therapy, diet and lifestyle modification remain an essential part of the treatment regimen for cardiovascular disease. Moreover, a large proportion of the US population is sedentary, overweight, and does not consume a heart-healthy diet. Nonpharmacologic treatment strategies also improve other cardiovascular risk factors and are generally easily accessible. In this review, we examine the effect of nonpharmacologic therapy on lipids as part of the secondary prevention strategy of cardiovascular disease in women.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Roger VL, Go AS, Lloyd-Jones DM, et al. Executive summary: heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation. 2012;125:188–97.

    Article  PubMed  Google Scholar 

  2. Stevenson JC, Crook D, Godsland IF. Influence of age and menopause on serum lipids and lipoproteins in healthy women. Atherosclerosis. 1993;98:83–90.

    Article  PubMed  CAS  Google Scholar 

  3. Vaccarino V, Parsons L, Every NR, et al. Sex-based differences in early mortality after myocardial infarction. national registry of myocardial infarction 2 participants. N Engl J Med. 1999;341:217–25.

    Article  PubMed  CAS  Google Scholar 

  4. Ansell BJ, Fonarow GC, Maki KC, et al. Reduced treatment success in lipid management among women with coronary heart disease or risk equivalents: results of a national survey. Am Heart J. 2006;152:976–81.

    Article  PubMed  Google Scholar 

  5. Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–421.

    Google Scholar 

  6. Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–207.

    Article  PubMed  CAS  Google Scholar 

  7. Kostis WJ, Cheng JQ, Dobrzynski JM, et al. Meta-analysis of statin effects in women versus men. J Am Coll Cardiol. 2012;59:572–82.

    Article  PubMed  CAS  Google Scholar 

  8. Case CC, Jones PH, Nelson K, et al. Impact of weight loss on the metabolic syndrome. Diabetes Obes Metabol. 2002;4:407–14.

    Article  CAS  Google Scholar 

  9. Appel LJ, Sacks FM, Carey VJ, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the omniheart randomized trial. JAMA. 2005;294:2455–64.

    Article  PubMed  CAS  Google Scholar 

  10. Dansinger ML, Gleason JA, Griffith JL, et al. Comparison of the atkins, ornish, weight watchers, and zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293:43–53.

    Article  PubMed  CAS  Google Scholar 

  11. •• Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859–73. A significant improvement in lipids was observed with only a 3 kg weight loss at the 3-year follow-up.

    Article  PubMed  CAS  Google Scholar 

  12. •• Jenkins DJ, Wong JM, Kendall CW, et al. The effect of a plant-based low-carbohydrate (“eco-atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med. 2009;169:1046–54. After only four weeks there was a significant improvement in lipids with a non-animal fat diet.

    Article  PubMed  CAS  Google Scholar 

  13. Jenkins DJ, Jones PJ, Lamarche B, et al. Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial. JAMA. 2011;306:831–9.

    Article  PubMed  CAS  Google Scholar 

  14. de Lorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the lyon diet heart study. Circulation. 1999;99:779–85.

    Article  PubMed  Google Scholar 

  15. Vincent-Baudry S, Defoort C, Gerber M, et al. The medi-RIVAGE study: reduction of cardiovascular disease risk factors after a 3-mo intervention with a Mediterranean-type diet or a low-fat diet. Am J Clin Nutr. 2005;82:964–71.

    PubMed  CAS  Google Scholar 

  16. Singh RB, Dubnov G, Niaz MA, et al. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean diet heart study): a randomized single-blind trial. Lancet. 2002;360:1455–61.

    Article  PubMed  Google Scholar 

  17. •• Thomazella MC, Goes MF, Andrade CR, et al. Effects of high adherence to Mediterranean or low-fat diets in medicated secondary prevention patients. Am J Cardiol. 2011;108:1523–9. Participants had a mean LDL-C of <100 mg/dL and >80 % were on lipid lowering medications at baseline. Dietary treatment resulted in a significant improvement in total cholesterol and LDL-C.

    Article  PubMed  Google Scholar 

  18. Harris WS. N-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 1997;65:1645S–54S.

    PubMed  CAS  Google Scholar 

  19. Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet. 1989;2:757–61.

    Article  PubMed  CAS  Google Scholar 

  20. Costanzo S, Di Castelnuovo A, Donati MB, et al. Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2010;55:1339–47.

    Article  PubMed  Google Scholar 

  21. Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American heart association nutrition committee. Circulation. 2006;114:82–96.

    Article  PubMed  Google Scholar 

  22. Rimm EB, Williams P, Fosher K, et al. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ. 1999;319:1523–8.

    Article  PubMed  CAS  Google Scholar 

  23. Di Castelnuovo A, Costanzo S, Bagnardi V, et al. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006;166:2437–45.

    Article  PubMed  Google Scholar 

  24. Hartung GH, Foreyt JP, Mitchell RE, et al. Effect of alcohol intake on high-density lipoprotein cholesterol levels in runners and inactive men. JAMA. 1983;249:747–50.

    Article  PubMed  CAS  Google Scholar 

  25. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999;69:30–42.

    PubMed  CAS  Google Scholar 

  26. Ripsin CM, Keenan JM, Jacobs Jr DR, et al. Oat products and lipid lowering. a meta-analysis. JAMA. 1992;267:3317–25.

    Article  PubMed  CAS  Google Scholar 

  27. Hu FB, Stampfer MJ, Manson JE, et al. Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. BMJ. 1998;317:1341–5.

    Article  PubMed  CAS  Google Scholar 

  28. • Sabate J, Oda K, Ros E. Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Intern Med. 2010;170:821–7. Nut consumption can reduce total cholesterol and LDL-C.

    Article  PubMed  Google Scholar 

  29. Howe M, Leidal A, Montgomery D, Jackson E. Role of cigarette smoking and gender in acute coronary syndrome events. Am J Cardiol. 2011;108:1382–6.

    Article  PubMed  CAS  Google Scholar 

  30. Craig WY, Palomaki GE, Haddow JE. Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data. BMJ. 1989;298:784–8.

    Article  PubMed  CAS  Google Scholar 

  31. Cullen P, Schulte H, Assmann G. Smoking, lipoproteins and coronary heart disease risk. data from the Munster heart study (PROCAM). Eur Heart J. 1998;19:1632–41.

    Article  PubMed  CAS  Google Scholar 

  32. • Gepner AD, Piper ME, Johnson HM, et al. Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial. Am Heart J. 2011;161:145–51. Smoking cessation increased HDL-C by 6 %, with a greater improvement in women.

    Article  PubMed  CAS  Google Scholar 

  33. Kelley GA, Kelley KS, Tran ZV. Aerobic exercise and lipids and lipoproteins in women: a meta-analysis of randomized controlled trials. J Womens Health. 2004;13:1148–64.

    Article  Google Scholar 

  34. Barnard RJ, Inkeles SB. Effects of an intensive diet and exercise program on lipids in postmenopausal women. WHI. 1999;9:155–61.

    PubMed  CAS  Google Scholar 

  35. Fahlman MM, Boardley D, Lambert CP, Flynn MG. Effects of endurance training and resistance training on plasma lipoprotein profiles in elderly women. The journals of gerontology. Series A, Biological Sciences and Medical. Sciences. 2002;57:B54–60.

    Google Scholar 

  36. Williams MA, Fleg JL, Ades PA, et al. Secondary prevention of coronary heart disease in the elderly (with emphasis on patients > or = 75 years of age): an American heart association scientific statement from the council on clinical cardiology subcommittee on exercise, cardiac rehabilitation, and prevention. Circulation. 2002;105:1735–43.

    Article  PubMed  Google Scholar 

  37. Oldridge NB. Cardiac rehabilitation exercise programme. compliance and compliance-enhancing strategies. Sports Med. 1988;6:42–55.

    Article  PubMed  CAS  Google Scholar 

  38. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116:682–92.

    Article  PubMed  Google Scholar 

  39. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–41.

    Article  PubMed  CAS  Google Scholar 

  40. Melanson K, Gootman J, Myrdal A, et al. Weight loss and total lipid profile changes in overweight women consuming beef or chicken as the primary protein source. Nutrition. 2003;19:409–14.

    Article  PubMed  CAS  Google Scholar 

  41. Wood PD, Stefanick ML, Dreon DM, et al. Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med. 1988;319:1173–9.

    Article  PubMed  CAS  Google Scholar 

  42. Poobalan AS, Aucott LS, Smith WC, et al. Long-term weight loss effects on all cause mortality in overweight/obese populations. Obes Rev. 2007;8:503–13.

    Article  PubMed  CAS  Google Scholar 

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Whelton, S., Chow, G.V., Ashen, M.D. et al. Dyslipidemia Management for Secondary Prevention in Women with Cardiovascular Disease: What Can We Expect From Nonpharmacologic Strategies?. Curr Cardiovasc Risk Rep 6, 443–449 (2012). https://doi.org/10.1007/s12170-012-0254-0

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