Statins and menopause

During the reproductive period, women generally have lower low-density lipoprotein (LDL) cholesterol and higher high-density lipoprotein cholesterol than age- and diet-matched men. However, these possibly antiatherogenic characteristics of lipoproteins are changed to a potentially atherogenic profile after menopause. Menopause-related changes in lipoprotein profile can be corrected by the administration of hormone replacement therapy (HRT). However, the results of recent studies did not show definite benefits of HRT on coronary heart disease-related mortality rates. On the other hand, several large-scale, long-term clinical trials provide evidence for efficacy and safety of HMG-CoA reductase inhibitors (statins) in both men and women. The results of 19 short-term clinical trials using simvastatin, pravastatin, fluvastatin or lovastatin in postmenopausal women are summarised and discussed. All these investigations reported significant reductions in both total and LDL cholesterol levels. The question of whether statin therapy results in a significant decrease in cardiovascular-related mortality rates along with a better quality of life in postmenopausal women remains to be investigated in large-scale, randomised, double-blind, placebo-controlled clinical trials.