Emory University School of Medicine, Atlanta, GA, USA;
Int J Womens Health. 2010 Aug 9;1:181-91. doi: 10.2147/ijwh.s5110.
High-density lipoprotein cholesterol (HDL-C) concentration is essential in the determination of coronary heart disease (CHD) risk in women. This is especially true in the postmenopausal state, where lipid profiles and CHD risk mimic that of age-matched men. Thus, interventions designed to reduce CHD risk by raising HDL-C levels may have particular significance during the transition to menopause. This review discusses HDL-C-raising therapies and the role of HDL in the primary prevention of CHD in women. Lifestyle-based interventions such as dietary change, aerobic exercise regimens, and smoking cessation are initial steps that are effective in raising HDL-C, and available data suggest women respond similarly to men with these interventions. When combined with pharmacotherapy, the effects of these lifestyle alterations are further amplified. Though studies demonstrating gender-specific differences in therapy are limited, niacin continues to be the most effective agent in raising HDL-C levels, especially when used in combination with fibrate or statin therapy. Emerging treatments such as HDL mimetic therapy show much promise in further raising HDL-C levels and improving cardiovascular outcomes.
高密度脂蛋白胆固醇（HDL-C）浓度是确定女性冠心病（CHD）风险的关键因素。在绝经后，女性的血脂谱和 CHD 风险与同龄男性相似，这一点尤为重要。因此，通过提高 HDL-C 水平来降低 CHD 风险的干预措施可能在向绝经过渡期间具有特殊意义。本文讨论了升高 HDL-C 的治疗方法以及 HDL 在女性 CHD 一级预防中的作用。基于生活方式的干预措施，如饮食改变、有氧运动方案和戒烟，是提高 HDL-C 的初始步骤，并且现有数据表明女性对这些干预措施的反应与男性相似。当与药物治疗结合使用时，这些生活方式改变的效果进一步放大。尽管证明治疗中存在性别特异性差异的研究有限，但烟酸仍然是升高 HDL-C 水平最有效的药物，尤其是与贝特类或他汀类药物联合使用时。新兴的治疗方法，如 HDL 模拟治疗，在进一步提高 HDL-C 水平和改善心血管结局方面显示出很大的希望。
