Prevention and treatment of cardiovascular disease in women: the obstetric-gynecologist's point of view.

It has been confirmed that cardiovascular disease (CVD) is the leading cause of morbidity and mortality not only in men but also in women. The most recent American Heart Association (AHA) and European Atherosclerosis Society (EAS) recommendations specifically address women. This is in response to the majority of studies that primarily involved men. Ideal cardiovascular health has been defined for women, and new factors were added to the traditional risk factors. As stated by the American and European Menopause Societies (NAMS and EMAS), hormone replacement therapy (HRT) is no longer believed to be protective for CVD; on the contrary, women benefit just as much as men from statins to lower their risk of heart disease. At the onset of menopause, women exhibit an increase in cholesterol and an increased risk of CVD. Unfortunately, hyperlipidemia is largely undertreated in women, although the rate of hypercholesterolemia among women is similar to that of men. More aggressive intervention is recommended for persons with multiple risk factors and/or monogenic dyslipidemias. In women affected by familial hypercholesterolemia in the homozygous and compound forms, treatment such as lipoprotein apheresis is also suggested. There is evidence for the use of these techniques even in pregnancy. An update on the most recent guidelines issued by AHA, EAS, NAMS and EMAS for the prevention of CVD in women along with a brief overview on the use of lipoprotein apheresis in women during pregnancy is reported.